Approches éthiques des prises de décision limites en chirurgie, dans le cadre de l'innovation

Abstract : Aims: Innovation in Surgery differs from Innovation in Medicine. We aimed to describe Ethics of Responsibility and its necessary tools in innovative process in surgery from surgeons’ standpoint. Material and Methods: Innovation in surgery is a common decision-making process except the lack of past history. Organ transplant is an ideal representation of innovation in surgery. Heart, Liver and Face transplants allow to explore all the fields in innovation in surgery. Based on this postulate, extrinsic (history, laws, society) and intrinsic factors (pure medical decision) of the decision-making process were analyzed. Considering extrinsic factors, a literature review has been performed. Considering intrinsic factors, several models of medical decision-making process were evaluated and one was chosen: the Forces Interaction Model. Using interviews with renowned transplant surgeons, extracted components of the decision were exploited. Results: History of the Surgery showed a clear dichotomy with Medicine. Laws regulating Innovation seemed to be secondary to the borderline (and innovative) practice. Seven interviews of professors and transplant surgeons were reported. Analysis showed the Forces Interaction Model as relevant in order to perform the study. Surgeons instinctively defined two different types of innovation: the innovation-breach and the innovation-development. Differently from oncological practice, innovation in surgery is a pure collective activity, based on the consensus, the scientific literature and sometime on non-rational beliefs. The successful innovative surgeon must present some traits, including resilience and integrity. Ethics of Responsibility requires assessing regulation and methodology in the field of innovation. Finally, innovation is seen differently depending on the generation of surgeons and is slowed down by French Laws. Discussion et Conclusions: The definitive facet of the Innovation in Surgery is ethically problematic, still, Innovation is essential. Thus, it needs to be improved and facilitated. On the one hand, the evaluation tool in Surgery, the Evidence-Based Surgery, must be viewed as an independent instrument considering differences with Medicine. On the other hand, an exemption from provisions of current law in innovation in Medicine seems necessary, aiming innovative steps prior standardization of a surgical procedure. Integration of Clinical Nurse Specialists should allow to strengthen Individual Ethics while Laws reinforce Public Health Ethics. The use of morbidity and mortality meeting in innovation, led by the University and opened to all disciplines, including Social and Human Sciences, dictates a retrospective auto-regulated evaluation of the innovation. This process, while maintaining high scientific standard, enables to introduce Social and Human Sciences in the innovative process.
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Submitted on : Thursday, July 9, 2015 - 9:52:06 AM
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  • HAL Id : tel-01174403, version 1



Alban Zarzavadjian Le Bian. Approches éthiques des prises de décision limites en chirurgie, dans le cadre de l'innovation. Ethique. Université Sorbonne Paris Cité, 2015. Français. ⟨NNT : 2015USPCB074⟩. ⟨tel-01174403⟩



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