Difficile réconciliation en France entre logique de rentabilité du secteur médico-social et démarche éthique souhaitée par les patients

Abstract

The French laws between 1982 and 2016 have created a compelling environment in the medical and social areas, which are actually expected to behave in an ethical and responsible way. Two hardly reconcilable ideas have come to face each other: a profit-oriented one and a patient satisfaction-oriented one. Thus, it has emphasized the divergence between caregivers and administrators’ goals. Moreover, many users are questioning the public expenses legitimacy. Besides, technological innovations (informatics, databases, interconnecting files, datamining...) have permitted to measure and acknowledge patients’ expectations more precisely (Medical information departments in hospitals, satisfaction surveys...). We should observe an ascending process (from patients’ needs and expectations to management), yet it is often the opposite (from management demands on patients), which works against organizational ethics. A reform announced in July 2018, which focuses on territorial healthcare organizations, seems promising, yet ambitious regarding the means that will be dedicated to it. However, it remains to be seen if mobilization of territorial resources will be balanced, safe, and ethical. Lots of real cases that patients have come through show a lack of consistency, leading to a troubling situation for both patients and their families: the situation seems critical, but organizational solutions can be provided, in the absence of more expensive and immediate solutions.