Vulnerability

Corine Pelluchon immediately places his reader in a demanding posture: the quote highlighted by his work, borrowed from Max Horkheimer, evokes the suffering experienced at every moment on earth, without the conscience of which “ Any decision is blind », All certainty or illusory happiness. She also inscribes her book in a filiation to Emmanuel Levinas and Claude Lévi-Strauss, a duo who, in the course of the work, is completed by Paul Ricœur. The requirement is also on the side of the author, which offers an ambitious reflection program. Because of “ New medical practices “(P. 4), the contemporary context is conducive to questioning the roles and the purposes of medicine and the expectations that everyone nourishes towards them and the stake is not less than that of” lay the foundations of another humanism (P. 292).

Vulnerability: a political question

In this context, the philosopher must make a work of reflection “ ethics ” but also “ policy “In the sense of” A question on the common good (P. 4). Corine Palluchon particularly insists on this dimension because according to her, “ we undergo “Currently a” silence “Or a” empty that barely disturbs a conference cacophony where the pompous title of ethics badly conceals all that its status has symptomatic “And where” language, which makes us political beings, has lost its power (P. 6). According to her, we cannot be content to work on categories “ ethical », Such as dignity, autonomy or consent. The political reflection that Corine Palluchon is deploying is presented as a third way, which must make it possible to get out of a double dead end: on the one hand, procedural ethics and minimalist ethics and on the other, an ethics which presupposes faith. More specifically, it is not necessary to give up a work of explaining values ​​and principles specific to our “ political community (P. 15). This requires an ontological work that will support a vision of man and his freedom. Levinas’ philosophy intervenes here in a decisive way: it induces an apprehension of subjectivity as “ vulnerability ” (Or broken autonomy), thanks to which men can redefine their reciprocal relationship and their relationship to other species: “ Everything happens as if the experience of vulnerability revealed to man the sense of responsibility (P. 22).

In accordance with the program she presented, Corine Palluchon is committed to a “ reconfiguration »Of the notion of autonomy, first of all emphasizing how much the lived reality of the patient is in the idea of ​​a moral self-determination of man: the patient suffers, he may take drugs that produce effects on his capacity for understanding and memorizing the information issued by the doctor, if necessary, he is likely to be afraid or to be in denial. The doctor’s task, from this point of view, is much more complicated than that which simply consists in informing the patient and obtaining his free and enlightened consent, according to the devoted formula.

Against procedural ethics

Beyond the doctor-patient relationship, questioning about the status conferred in medical ethics to autonomy must be questioned “ policy ». The example of euthanasia provides an illustration to highlight how much medical practices are “ Society choice ». From this example, Corine Pelluchon is more involved in a general political reflection and disavows procedural ethics. This, resulting in particular from one of the founding works of bioethics, The Foundations of Bioethics De Tristam H. Engelhardt (Oxford University Press, 1996), is radical. The reasonable agreement envisaged by John Rawls in his theory of justice is no longer even on the agenda according to Th Engelhardt. The only thing that can be an agreement in a democratic and morally fragmented world is the conflict negotiation procedure. Any design of the property is put in parentheses.

Against this perspective, Corine Palluchon seeks to highlight the harmful effects of ethics and procedural policies in health matters, based on a critical analysis of the American situation, and by confronting the philosophy of public health developed by Rawlsien Norman Daniels and the positions of Amartya Sen and Martha Nussbaum. She defends the need to explain and critically reflect on common values ​​that underlie any choice of society and that, with regard to a fundamental questioning relating to the “ human condition (P. 130).

Policy ontology: Levinas

The second part of the book intends to deploy this questioning which affects ontology and politics. It is structured around a discussion of Heideggerian thought. The reference to Martin Heidegger is precious to understand the “ Affective tones “, THE “ mood “Patients at the end of life or seriously disabled (p. 168), but it is according to Corine Palluchon insufficient because the anxiety does not exhaust” The whole truth of our relationship to the world (P. 168). It is to Levinas that the privilege of revealing it returns, when it invites everyone to deposit their sovereignty, to give up self-assertion to register in the relationship with others. Medical care must be redesigned in the light of this invitation: “ It is in this exhibition to the other that we must seek the secret of the accompaniment. She can teach us to take care of people at the end of their lives and all those who are in dependence or with whom verbal communication is almost impossible, such as demented or patients with Alzheimer’s disease (P. 170-171).

Anxious to return to the political dimension of her reflection, Corine Palluchon offers in the wake of this ethical position a conception of common life based on this figure of autonomy (or cogito) broken. This concern also gives meaning to critical analyzes, encountered during reading, on the use of genes with meliorative aim and on the instrumental relationship of men to animals: the “ strong evaluation Based on the ethics of vulnerability calls into question the meliorative aim and suggests another way of considering animals.

Autonomy full of the moral subject: a principle without scope ?

Corine Palluchon’s work is part of a dynamic richly illustrated for several decades both in France and abroad: demanding philosophical work and better and better informed of medical practices, thanks to frequentation of the medical community and places of care ; A reflection which intends to highlight the choices of society involved by these practices, the values ​​and the conception of the human condition which underlie them. Within this dynamic, Corine Palluchon is part of an already well -established current of thought, which made Levinas the figurehead of a questioning: that of a medicine thought in terms of the principle of autonomy and a conception of the rational, all powerful and master of his life. Broken autonomy offers a feeding version of this vulnerability ethics.

One can undoubtedly confirm the relevance of such a perspective, especially in its critical dimension: it precisely comes to moderate a vision of the patient where we have sometimes confused the affirmation by law of a principle (the autonomy of the moral subject) with facts of fact on the omnipotence of the individual (and his legitimacy to claim medicine “ mercierist »). But, in reverse, it is important not to forget why this principle could be asserted with so much force in the late 1960s and in the early 1970s: the advent of bioethics (or its renewal if you want to bring its birth to the Nuremberg trial or to another moment that is still previous) is linked to a protest against the abusive use of groups of populations in medical experiments. From this point of view, the affirmation of law of the principle of autonomy of the moral subject has a completely different scope.

In the bioethical concert, it is not so easy to demonstrate the inanity of a position, either because it has had its reason for being at some point and it may be relevant again, or because it is the witness of a question that it is ethically and politically difficult to decide. These questions are legion due to the complexity of the problems aroused by medical practices, both from the point of view of the doctor-patient relationship and the choices of society. In the ranks of philosophy and other disciplines of the human and social sciences, such questions have long been aroused a living and often enlightening discussion. Broken autonomy presents in this regard a small strangeness, which consists in denouncing as a introductory remarks the “ silence “Politics or” cacophony Contemporary debate, while discussing some theories in detail and recurrently.