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Emmanuel Hirsch: What medical ethics in the face of the coronavirus epidemic?

2020-03-02T18:09:16.569Z


FIGAROVOX / TRIBUNE - The professor of medical ethics Emmanuel Hirsch wonders about the management of the coronavirus epidemic by the French authorities. And calls for not neglecting ethical issues in favor of health considerations alone.


Emmanuel Hirsch is professor of medical ethics at Paris-Saclay University.

France has been able to implement a relevant system from the initial phase of what is now the Covid-19 epidemic. The expertise drawn from the preparatory approaches for H1N1 between 2006 and 2009, then the in-depth study of NRBC risks (nuclear, radiological, bacteriological, chemical) as well as in the dramatic context of terrorism, allowed the acquisition of a culture of l anticipation and management of major health risks. The fact that the General Secretariat of Defense and National Security is responsible for validating and coordinating procedures in this area is evidence of strategic issues. On February 29, 2020, a Defense Council followed by a Council of Ministers was devoted to the epidemic situation in France. Nothing to do with the circumstances of the seasonal flu evoked lately to be surprised by the means dedicated to the prevention of a possible pandemic. The consequences of the Covid-19 are not limited to the human tragedies which we deplore and whose scope we do not know. They concern all countries and international relations in all areas. The epidemic phenomenon is global and total.

These two months of initiatives of all kinds devoted to avoiding or postponing the epidemic stage while activating proportionate health responses prove to be decisive. The public bodies concerned are today recognized for the correctness of decisions accompanied by fair, precise and continuous communication. The remarks were not limited to the transmission of factual data. They have managed to create a relationship of trust between society and those who must decide, in an environment concerned with humanity and kindness. Doctors and scientists intervening to give knowledge and understanding knew how to make prudent remarks, attentive to share the uncertainties in a complex and evolving context followed relentlessly through information networks.

The urgency is to be united in commitment and to convey an explicit message to society in this regard.

The meeting on February 27 between the Prime Minister and the country's political leaders is also an important achievement. A consensus was imposed on the one hand to recognize that the action of the government did not cause the least reserve, on the other hand to affirm that the best interest of the nation was to preserve cohesion and solidarity. In the current political context, this resolution takes on a particular meaning: the urgency is to be united in commitment and to convey an explicit message to society in this regard.

It was important to consider the announced stage of an epidemic situation by leaning on the experience resulting from the controlled management of its preparatory phase. We indeed benefit from the excellence of health professionals invested from the first days, despite the structural difficulties of their exercise which they denounce the precariousness for months. The organizational system has demonstrated its efficiency, adaptability and responsiveness. However, so far the direct impact of Covid-19 in France has been limited to the mention of preventive quarantines concluded with a soothing outcome. The first two deaths heightened concerns and heightened a feeling of imminent threat that could worsen in the first weeks. The epidemic is revealed in aspects that are not only related to the ability of biomedicine to find treatments and to intensive care services to avoid fatal complications. How to understand an epidemic in its societal dimension and negotiate the transition between harmonious management of a moderate crisis and more restrictive management, especially from the point of view of respect for individual freedoms? According to what criteria would we choose if the hospital reception and home follow-up capacities prove insufficient?

The current phase seems to me to be based on the robustness of the measures arbitrated with discernment over the past few weeks.

What political intelligence should be deployed so that the decision to take essential measures in a major crisis situation does not arouse distrust or dissent? Have we acquired the means of concertation contributing to the awareness of the imperatives relating to the higher interests of the nation in our confrontation with an epidemic. What if it were appropriate to declare a state of emergency?

On March 4, the Senate will devote a session to "health measures taken in the face of the risks of an epidemic of Coronavirus in France". Can we limit the debate to health issues, even if they determine the practical modalities of the political approach to the epidemic?

The current phase seems to me to be based on the robustness of the measures arbitrated with discernment over the past few weeks. How can we now implement within our society a capacity for mobilization, and therefore appropriation of responsibilities which concern us individually and in our relationship with others? How to admit, and under what conditions, that going through this crisis (or others that will inevitably intervene) is only possible in concert and in an environment that respects everyone? What mediations should be involved in a dynamic that values ​​and meets the challenges?

A pandemic concerns the whole people. In these circumstances, our democratic life must therefore attest to its values.

The political intelligence that I mentioned earlier will determine the lines of action essential for social mobilization but also for the acceptability of arbitrations that could prove delicate. It must back up, as has been done so far, with ethical principles such as the requirement of loyalty, respect, justice, reciprocity and benevolence. In practice, the rigor of the decision-making processes, the proportionality of the measures and the fair distribution of constraints must be able to be validated and checked. However, and this can be seen in the application of measures restricting individual freedoms or likely to infringe on the private sphere and confidentiality, if only for epidemiological reasons, which body will ensure the legitimacy of decisions imposed by the circumstances? In its etymology, a pandemic concerns "the whole people". In these circumstances, our democratic life must therefore attest to its values.

Source: lefigaro

All news articles on 2020-03-02

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