Does clinical ethics deserve the bad reputation that some people have given it? They indeed see only the pejorative meaning of casuistry, which maintains firm principles while limiting their impact when they have to be implemented in concrete situations.
To face up to the risk of mental restriction or too great subtlety, they prefer “consensual” ethics, made of standards, references and good practices, acknowledged by professionals and institutions. However, doesn’t this technical standardising, based on know-how and clothed in reverence for great principles inscribed in the new tables of the bioethical law, the ‘matrix principles’, carry with it the seeds of the risk of a true case study understood as a flexible practice with no strong interaction with the moral force of the principles it claims to follow?
Paradox or irony, it is the job of the jurist or the judge to remind us that too many regulations kill ethics. Clinical ethics is ethics practised, if not at the foot of the patient’s bed, at least with the very person of the patient as its essential concern. It is perfectly obvious that in a health-care system which depends on the community, the global approach to the patient implies also taking account of elements that are extrinsic to the person. But the care relationship, such as the one existing in biomedical research, maintains a personal commitment by the carer who not only conserves, whatever his status, his freedom of medical decision, but also has to preserve his freedom of conscience, even if he has to “expose” himself by taking the risk of jeopardising his responsibility…