During a conference in the International Ethics Colloquium which took place in Paray-le Monial from 11th to 13th November, Pierre-Yves Gomez, specialist in political economy, looked at the existing links between economy and vulnerability in our society.
Here we report some notable aspects. This document, which deserves to be entirely read, is available at www.genethique.org.
The links between economy and vulnerability are determined by a certain view of the economy and a way to understand what medicine is. The one and the other develop in a relationship of reciprocal influence. The dominant liberal thinking led to a certain conception of medicine. Liberalism is characterized by three assumptions: men are rational; they are autonomous; and finally the common good is not the condition of the life in society. In the liberal perspective, the good is conceived as a consequence of individual choices.
From "patient" to "client"
The first consequence of this liberal view is a disillusionment of medicine. In the past the physician was "guarantor of the good a priori" and took care of the weakest, is now in front patients more and more informed, wanting an efficient answer to their demand.
Patients? The word is old fashion. From now it would be better to talked about “clients". The physician is no more seen as a knowledge holder and her/his "client" comes with a precise expectation.
The personal care area becomes the place of technical elaboration of a service. Far from being spared by the liberal economy, the medicine went through a commercial logic where the offer depends on the demand.
To reply to the anxiety of a short and fatal life, the politician promises to the liberal individual a long and healthy life. Then the medicine has to satisfy this promise of good health made to all. According to this logic, the relation between the medicine and the politician is reversed. The politician has created the conditions for practicing medicine, required it to translate concretely the performance expectations. Slowly, the medicine became a tool for the politician and the personal care was not in the center of the worries, the main challenge being now that of healing. Now the medicine is answerable in terms of economic profitability.
The medicine, victim or author?
Yet, the healing promise is unrealistic, at technical and economical level. Hence the need to exclude those who will be the most expensive, or those we do not know how to care. Vulnerable people are no longer weak people to protect, but carriers of a default which must be cured or eliminated. The vulnerable person, being aware of the inability of the medicine to cure him, even accepts his elimination.
But within these evolutions, the medicine is not neutral: it has itself contributed to the development of the liberal economy. Pierre-Yves Gomez determines a key date: the decriminalization of abortion in 1974. At this time, when politicians asked the physicians to practice acts contrary to Hippocratic Oath, they did not know to say "no". The politicians turned to them to answer the rejection of the child by his/her parents when he/she is still in gestation. This was the decriminalization of VTP. Putting on this role, health professionals became "le fireman of the politician" and it is now hijacked.
If politicians had a problem to resolve, is it the role of the medicine to reply to it? In fact, abortion has nothing to do with a medical act. To help his audience to well understand the demonstration, Pierre-Yves Gomez took his reasoning to the chocking assumption of the creation of an "organization of public executors" by the politician, to resolve the social problematic, which does not belong to the medicine area.
Which future for the medicine?
To finish, Pierre-Yves Gomez spoke vigorously to health professionals, repeating their responsibility in the situation, yet passed, but also current: it is when saying "yes" to act against his own principles the medicine has lead the society in this spiral. Today, the question is simply misplaced. The politician will ask the medicine if it accepts to play a new role of "executor" end of life people. Will health professionals know to oppose collectively?
It is yet possible to reverse the balance. According to Pierre-Yves Gomez, "We touched the limits of the all-liberal. Something is happening". More than ever, the compromise of each to defend the idea he has of the medicine is important. "Your vote is important. It speaks for all […]. With you, the vulnerable people speak or keep quiet".