Le droit français et la recherche biomédicale : l'épreuve de la pratique

Exception notable au principe de l'inviolabilité de la personne, la recherche biomédicale chez l'Homme est depuis la loi du 20 décembre 1988 une réalité scientifique, médicale, voire économique pleinement reconnue par le droit français. Le choix législatif, confirmé par les modalités de sa mise en oeuvre, aura été pour mieux assurer la protection des personnes, d'englober toutes les recherches biomédicales dans la loi, les soumettant à un régime d'organisation fait de règles communes et spécifiques. La loi distingue en effet deux grands types de recherche : celles qui procurent un bénéfice individuel direct et celles sans bénéfice individuel direct. Dans la première situation, la conjonction de l'intérêt individuel et de l'intérêt collectif permet, tout en précisant rigoureusement les modalités de cette recherche, d'en admettre une pratique étendue, aux confins voire en continuité de l'activité strictement médicale. Dans la seconde des situations, au contraire, son domaine sera plus strictement limité et les obligations de ceux qui la mettent en oeuvre seront plus grandes. Il en est notamment ainsi de la mission des comités de protection des personnes, dont l'avis est obligatoire avant toute recherche, et du pouvoir des autorités sanitaires tant sur le plan de la prévention que sur celui des contrôles et des sanctions éventuelles. L'enjeu est dès lors grand pour le droit: ayant « sacrifié » le caractère absolu du principe d'inviolabilité de la personne, il doit dès lors démontrer son efficacité « au quotidien ».One notable exception to the principle involving the inviolate nature of the person occurs in biomedical research performed on humans as set forth under the Statute of December 20, 1988, raised thereby to a scientific, medical and albeit economic reality fully recognized under French law. This legislative choice, as confirmed under the conditions of its implementation, was intended to better ensure the protection of people and extend to all biomedical research within a legal cadre, thereby subjecting it to common and specific rules in an organized framework. Indeed, the law recognizes two major categories of research : one providing direct individual benefits and the other not providing them. In the first case, the coming together of individual and collective interests gives rise to the allowing of extended practive even to the limits of or in the pursuit of a stricly medical activity — while formally laying down the conditions of such research. In the second case involving situations, on the contrary, this field becomes more narrowed while the obligations of those implementing it widen. This is, in fact, the case of committees entrusted with the mission of protecting people, whose opinions are required prior to any research, and the power of health authorities both regarding prevention and supervision, or possible sanctions. The challenge is indeed a sizable one for law, since having « sacrificed » the absolute character of the inviolability of the person, it must now demonstrate its efficiency on a daily basis

Bioethics, law and European integration

Bioethics is always described as implying a multidisciplinary and pluralistic approach of the issues encompassed. No doubt that the law and lawyers have deeply contributed to its origin and present development. However, conversely to the United States, it seems that bioethics has opened some new perspectives to the law in Europe. First, it forced the law to move out of its own frontiers and to apply its reasoning to life sciences issues with the consequence that some consider that the legal norms are used to legitimate unlawful practices while others believe legal norms have imposed binding conditions to the free development of science and technology. Second, Europe is the only region of the world where biomedical techniques are subjected to legal and sometimes binding harmonisation. In some way, we may conclude that the role played by the law in the elaboration of European bioethics is just an example of the important role of the law in the European integration

Bioetički aspekti robotike u kirurgiji

Julian Huxley, founder and the first Director-General of UNESCO, is at the heart of contemporary debates on the nature and objectives of the concept of transhumanism, which he first used in the early 1950s. Therefore, the analysis of his idea of transhumanism - a tool to improve the quality of life and the condition of man - should lead us to question his heritage in terms of philosophy that inspires UNESCO’s action as it seeks to build a comprehensive approach to artificial intelligence that takes into account, among other things, the values and principles of universal ethics and aims to derive the best from the use of this technology.This title where the British biologist, the elder brother of the famous science fiction writer, Aldous Huxley, author of the Brave New World1, coexists with the United Nations Organization in charge of Education of Science and Culture is obvious for those who know the history of this international organization or who like radio games: Julian Huxley was appointed as the first Director-General of UNESCO in 1946. But, beyond this evidence, there is a deeper link that highlights the history of the renewal of the idea of transhumanism (I) and questions about the role that UNESCO has, among the other international organizations (II)Julian Huxley, osnivač i prvi generalni direktor UNESCO-a, u središtu je suvremenih rasprava o prirodi i ciljevima koncepta transhumanizma, koji je prvi put upotrijebio početkom pedesetih godina prošlog stoljeća. Analiza njegove ideje o transhumanizmu - alatu za poboljšanje kvalitete života i stanja čovjeka - trebala bi nas, stoga, dovesti do toga da njegovu baštinu propitkujemo u smislu filozofije koja nadahnjuje UNESCO-vo djelovanje jer želi izgraditi cjelovit pristup umjetnoj inteligenciji koji uzima u obzir, između ostalog, vrijednosti i principe univerzalne etike i teži upotrijebiti najbolje od te tehnologije. Naslov ovog rada, u kojem britanski biolog, stariji brat slavnog pisca znanstvene fantastike Aldousa Huxleyja, autora romana “Hrabri novi svijet”, koegzistira s organizacijom Ujedinjenih naroda za obrazovanje znanost i kulturu, razumljiv je za one koji znaju povijest ove međunarodne organizacije ili one koji vole radijske igre: Julian Huxley imenovan je prvim generalnim direktorom UNESCO-a 1946. godine. No, osim ovih činjenica postoji i dublja poveznica koja ističe povijest obnove ideje transhumanizma (I) i propituje ulogu UNESCO-a među ostalim međunarodnim organizacijama (II)

Médecine et droit : Le devoir de conscience

Les pouvoirs de la médecine autant que les espoirs qui sont mis en elle confèrent au médecin une place particulière dans l’organisation sociale. Détenteur par son savoir d’une action sur les corps, son pouvoir interfère avec celui des maîtres de la Cité qui lui imposent des limites mais aussi l’obligation d’exercer son « ministère » au profit d’une quête individuelle et collective du bien-être.Le médecin, magicien ou thérapeute, fait peur dès lors qu’il n’attribue ses pouvoirs qu’à ses connaissances. Il faut donc le rattacher à la Cité des hommes et, tout en reconnaissant la particularité de son activité, lui signifier qu’il n’est pas au-dessus de la loi, qu’il est lié à chacun de ses patients parce que ceux-ci lui font confiance. Mais ce contrat entre deux individus est aussi et, de plus en plus, un « contrat social » qui insère l’activité médicale dans le jeu complexe des relations sociales, quitte à ce qu’il subisse parfois les « dérives » trop économistes de celles-ci. D’où l’intérêt d’une autre limite sociale, celle qui lui rappelle que ses interventions, parce qu’elles portent sur le corps, supposent le respect de la personne d’autrui dans son autonomie, dans son identité. Une médecine trop orgueilleuse, trop hautaine, voire simplement trop paternaliste, ne peut plus conserver pour elle seule la maîtrise des nouvelles technologies biomédicales. Il lui faut la partager avec les patients, devenus des acteurs de santé, titulaires de droits subjectifs.Le nouveau « drame » de la médecine n’est-ce pas alors, moins que les limites imposées à quelques promoteurs d’une médecine « prométhéenne », les obligations faites à l’ensemble des médecins de prêter leur concours à servir des fins sociales collectives ou individuelles qui ne laissent souvent plus rien percevoir de cette « confiance qui rejoint une conscience » ?Serviteur de l’action sanitaire de la collectivité, le médecin pourra encore se sentir utile dès lors que sa liberté de relation à l’égard de ceux qu’il assiste sera préservée. Cela ne rend pas forcément impossible sa participation à certaines formes de « contrôle social » mais exige la définition de modalités qui respectent substantiellement la fonction médicale. Cette recherche d’un équilibre, ambiguë voire impossible diront certains, apparaît de façon encore plus aiguë dans le cadre des pratiques biomédicales. Le monopole conservé, voire renforcé, du médecin pour protéger l’individu au début ou en fin de vie, lui fait aussi porter, d’une certaine manière, le poids de tous désirs individuels, des intérêts contradictoires, de la tentation de franchir les limites du possible, de l’interdit. Il faut alors admettre que sa conscience puisse lui permettre, lorsqu’il ne peut pas ou ne veut modifier la volonté de ceux qui le requièrent, de décliner son concours. Mais, même en agissant ainsi, et c’est pour cela que la clause de conscience se distingue de la liberté de contracter, le médecin qui refuse d’administrer tel acte, ne devra pas cesser de compatir avec celui qui lui fait face.Gageons qu’ainsi comprise, la pratique médicale contribuera à rendre le droit qui s’y applique conforme au rôle que d’Aguesseau voulut pour la justice : « juger humainement des choses humaines ».The powers of medecine, as well as the faith put into it, endows the doctor a particular place within our social organisation. Possessor of its knowledge on the actions on the bodies, its power interferes with that of the society elits which imposes limits as well as obligations to profit the search of individual and collective well being.The doctor, magician or therapist, incites fear from the moment he attributes his powers only on the basis of his knowledge. We therefore have to consider him on the same level as the rest of society and while recognizing the special role of his profession, make sure that he is aware that he is not above the law, that he is linked to each of his patients due to the trust that they place in him. But this contract between two individuals is as well, and increasingly a social contract which places the medical practice in the complex game of social relations, even if at times it is seen on a more economic level. And that is why it is important to insert another social limit that would remind the doctor that his interventions affect the human body, and therefore the respect of a person and her identity and integrity. A medical science that is too proud or paternalistic, cannot keep to itself the mastery of new biomedical technology. It must be shared with his patients who now have a new role in healthcare, as holders of subjective rights.Should not the new "drama" of medical science, rather than imposing limits on some promoters of "promethenne" médecine, be that of reinforcing the obligations doctors have in general to serve their purpose towards social, collective and individual means that so often don't inspire the trust that should be linked to conscience?Slave of a collective healthcare system, the doctor should still feel useful if his freedom to serve those that he helps is preserved. This does not necessarily mean that his participation in establishing certain social norms is impossible, however, it requires a definition of those issues that are relevant to the medical fonction. This search towards equilibrium, however ambiguous, and some even say impossible, appears to be even more acute in the sphere of biomedical practices. The monopoly conserved—and even reinforced—of the physician to protect the individuals at the beginning or at the end of their life, is added to a doctor's burden, to a certain extent, of the weight of all the individual's desires, of contradictory interests, and desire to do all that is possible in a world with real limitation. We therefore have to admit that his conscience can allow him to decline care to the patients that require it when he cannot or does not want to change their wishes. But even by acting this way, and that is why the clause of conscience distinguishes itself from contractual liberty, the doctor who refuses the administration of care must continue to have compassion towards his patients. So we can now wager, based on what we have just stated, that the medical practice will be a contributing factor in making law conform to the role that Aguesseau wanted for justice: "Juger humainement des choses humaines"

Tests génétiques et preuve pénale

Byk Christian. Tests génétiques et preuve pénale. In: Revue internationale de droit comparé. Vol. 50 N°2, Avril-juin 1998. Etude de droit contemporain. pp. 683-709