Réflexion éthique et institutionnalisation de l'éthique

The French health care system has undergone dramatic changes since 2002, with the aim of better coordination of patient management and higher quality of care. In this context, health professionals have been encouraged to design, implement and evaluate ethical practices. Ethical issues have become a major concern and a prerequisite to obtain certification by the national health authorities (Haute Autorité de santé [HAS]) or approval by the national medicosocial board (Agence nationale d'évaluation sociale et médicosociale [ANESM]). Actually, ethics has become compulsory and subject to quality control. The question that arises is whether this is consistent with the principles of ethical reflexion. Quality control imposes an obligation to rationalize patient management in order to improve the efficiency of care. The risk is that ethics may become a mere adjustment parameter and not an essential element in the elaboration and implementation of ethic-certified recommendations. We propose to examine this issue from two different, and rather anti-institutional, perspectives: high-standard thinking and ethics of care.