2023-05-25 13:17:49
“Ethical tools help to take distance”
Amandine Tannioufreelance night nurse
“I have no recollection of courses on ethics during my training as a nurse. However, it is a job where we are crossed by many questions: “What is my rightful place?”, “How to support without influencing, especially the most fragile?” I wondered from my first steps as a student. To pierce someone’s skin is already a form of breaking and entering! But the physical dimension is not the most “hustling”. What bothers me the most are these young people leaving the ASE (Children’s social assistance) who, at 18-20, are doing very badly, but refuse to let me give the alert. Or even these elderly people who leave their homes for nursing homes, for the sole reason that it suits their children…
I arrived at the CEC somewhat by chance. At first, I just went to see, to get an idea. Ethics arouses mistrust, and rightly so, because sometimes it extinguishes debate, seeks to impose a way of doing or thinking. The quality of a clinical ethics consultation is very dependent on the person leading it, and on the contributors.
Participating in it makes me feel so good! The staffs enrich my reflection because there is always someone who will say something that I have not seen, not considered. Everyone has their own prism, the different points of view sometimes make me evolve. We talk about our representations and our emotions, but the ethical tools help to take some distance. Despite everything, certain situations put me in difficulty. When it comes to children, I struggle to take a step back. In these cases, I warn that I don’t feel like expressing myself, and I watch the others reflect and move forward. It is a form of learning. »
“Impotence has its place in medicine”
Pierre-Gilles Robialformer surgeon
“As a former surgeon, I had to come a long way to accept the non-performing, non-operational side of working with the CEC. We deliver several opinions, sometimes different, to the teams that approach us. No one is right or wrong. While medicine presents itself as all-powerful – which society demands, moreover – the CEC is a place where we try to manage impotence as little as possible. Faced with an ethical dilemma, there is no good solution. We recognize the legitimate questioning of caregivers, we try to reflect with them. If they feel helpless, it’s not because they are useless, but because this helplessness has its place in medicine.
A trigger in my journey took place in my digestive surgery department. We placed an artificial anus on a patient with Alzheimer’s disease, because he had an intestinal obstruction. But following this intervention, his wife decided not to keep him at home. This gentleman found himself brutally rejected from the family framework. His life has changed. Had we wondered what he wanted?
Later, a university degree in palliative care opened me up to a world I had never known. I understood how much I had remained locked in my block, obsessed with technique. I then enrolled in a university degree in clinical ethics at the Cochin Hospital in Paris, with Véronique Fournier, who imported this North American method to France. That’s where I met Miguel.
Is morality above ethics? Or ethics, above morality? For me, the principle of respect for life dominates. But clinical ethics declines this principle in particular cases. And in some situations, saving life at all costs can be inhuman. Ethics leads to a re-examination of morality.
I am a practicing Catholic but at the CEC, no one asserts their beliefs. This is not the rule of the game. We argue with tools, the principles of Beauchamp and Childress. However, I do not forget my convictions, but I put them in tension. This is a question that belongs to me. After a staff, I have an hour’s drive to go home. Often, I ruminate, because some cases take the guts!
I can’t ignore my faith. I happened to consider leaving the CEC, because I did not feel in agreement with the insights that were given. But the mistake might be precisely to leave. Better to accept being disturbed, sometimes strongly, than to remain in a bubble. I believe I have something to do there, as a Christian.
I pray every day for people I meet through the clinical ethics consultation. Some for years. We come across moving stories. After that, it’s impossible to go home whistling. These stories, we take them with us. »
“Exchange creates genius!” »
Pierre Guignardphilosophy teacher
“I entered the clinical ethics consultation in 2015, through my philosophy professor. I was a student, and this experience called me, almost. Not out of voyeurism, but to better understand the ethical tensions that may exist.
There is a strong link between philosophy and medicine, which is tied in questions around death and life. Asking questions about good health and illness, the normal or the pathological, is not unique to the doctor. There is no monopoly on these subjects.
I like to chat with the team during staff meetings. Exchange creates genius! There is warmth, movement in the reflection. It’s not cold, procedural. I also see it as a form of commitment, because we are close to the teams and the patients, faced with unique stories that call up universal existential questions. »
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