What medical ethics for epidemic times? Jean-François Mattei's answers

Jean-François Mattei is a former Minister of Health. President of the National Academy of Medicine, he notably published Questions of conscience (Les Liens qui Libérez, 2017) and Health, the great upheaval (Les Liens qui Libérez, 2020).

FIGAROVOX.- In your book Questions of conscience you define the difference between "moral" and "ethical". Is this crisis an opportunity to redefine our ethical criteria?

Jean-François MATTÉI.- We often confuse morality, which is universal, and ethics, which depends on particular cultures and circumstances. Morality is eternal and irrefutable. But faced with exceptional situations, because Man is endowed with conscience, he can "in conscience" decide to transgress the prohibition. As for ethics, it is a questioning in order to find the most suitable response to a new situation.

We can see this with this crisis where countries react very differently: Anglo-Saxon utilitarian ethics look at the impact on the greatest number of individuals (economic disaster) while Latin, essentialist ethics, which comes to us from the Greek and then Christian heritage, cares above all about the person. The current pandemic creates situations rarely encountered before. The transgression of a moral prohibition may be necessary. Ethical questioning will lead to different choices depending on the company. For example, unlike others, ours is rather rebellious in tracking people from telephone or digital data.

Precisely, this question is likely to arise at the end of containment. How far should we go in surveillance using new technologies in the name of the health imperative?

I believe that France is not South Korea and that it would be illusory to believe that we are going to implement the same scenario for ending the crisis. I think that France is not culturally ready for general surveillance by geolocation. The CNIL has already spoken out on this issue many times, including during the state of emergency to deal with the terrorist threat. We remain a country of freedom: look how the containment was difficult to make people accept! There were 359,000 fines for non-compliance with the rules!

What inspires you from the debate around chloroquine, whose effectiveness Professor Raoult defends?

I know Professor Raoult with whom I had the opportunity to work in Marseille, then when I was Minister of Health when he gave me a premonitory report on the threat of a viral pandemic. Because he is intelligent, hardworking, competent and sometimes visionary, he does not accept the constraints that hinder his action. So he does not hesitate to break free from the common rules.

I regret this debate around hydroxychloroquine which should not have been. It caused crowd movements, the shortage of the drug to the detriment of patients who needed it for a chronic illness, serious complications due to self-medication without respecting premature doses and hopes. He put himself on the fringes of the scientific community and gathered around him those who hate the intelligentsia and the system. I find this unfortunate because the medical elite is an elite that we need.

Is it necessary in emergency times to suspend the usual medical protocols?

This is already the case: instead of taking weeks, the approval of medical experiments is done in 24 hours. But we cannot lift all control in the name of urgency. I do not think, except in isolated and very specific cases, that it is good to bypass the protocols of clinical experiments. They alone can meet the sustainable requirements for entire populations.

More generally, this crisis raises the question of the relationship between the political and the scientific. What is the difference in nature between a political decision and a scientific decision?

I don't think we should stick to the relationship between the politician and the scientist. We must not forget the citizen who is more informed than before, who sometimes has his own convictions. It must be closely associated so that it is a stakeholder and sees itself as a committed actor. Politicians cannot take drastic decisions if the population is not ready to accept them. Transparency must be the rule. The role of the scientist is to say what he knows, but also what he does not know. He brings his experience and his interpretation of the facts. He is there to enlighten the politician, give him advice and answer his questions. But he is not there to decide. The role of the political, given the scientific data and the circumstances of the moment, is to make choices. It is he who must make the most appropriate decisions given the seriousness of the issues, combining determination and pedagogy to convince, train and if possible bring together.

It is easy to judge in retrospect that we have not made enough radical decisions. Not postponing the municipal elections may have been crazy, but at the time the opposition was against it. I was Minister of Health during the heat wave of 2002: many precautions had been taken, the administration alerted, but it was extremely difficult to make people aware that the climate could be a health issue. At the time, everyone was taken aback.

The question of a possible "sorting" of patients arose in Alsace and Italy. Is this new or is it a problem already studied by medical ethics?

The basis of humanist philosophy imposes the idea that the life of the human being cannot be evaluated because it has an unconditional value. However, the doctor is sometimes confronted with the necessary hierarchy of patients. This was the case when it was necessary to designate the patients who would be the first to benefit from the artificial kidney, it is still the case when it is necessary to choose among the candidates for an organ transplant. Not so long ago, the choice of HIV / AIDS patients was essential, who would receive the first treatments, which were still too rare. With the French Red Cross, I experienced these tragic situations at the scene of earthquakes or tsunamis when it was impossible to take care of all the injured. Military doctors are well aware of such situations on the scene of combat.

There is never an ethical choice without moral tension. Selection, based on medical criteria and depending on the means available, tears the veil of proclaimed virtue. Only the doctor, in his soul and conscience, can decide the undecidable when necessity rules.

Does the coronavirus crisis not replace medicine in the face of its essential missions: treating, curing the disease, far from the transhumanist chimeras that may have agitated it? Doesn't this invite modesty?

As often, it is in trials that the truth of Man appears. It is in this dramatic epidemic that caregivers find all the reasons why they chose this profession. They are ready to forget their fatigue and to dig deep down to save lives. They are there to heal and heal. They show us what team spirit, solidarity and, more simply, what humanity is. The truth. The rantings of the augmented man, of a transhumanism which does not admit the fragility of man, no longer meet any echo when one touches the essential and the deep meaning of the life of others. These caregivers make us modest, but help us to grow taller.