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La question du juste soin dans la prise en charge bucco-dentaire des patients présentant des limitations durables de leurs capacités de décision : des tensions éthiques aux perspectives d’évolution

Abstract : In France, under the impulse of the Law of 4 March 2002 on patients' rights and the quality of the health system, deep changes have been undertaken in the care relationship for a more active participation of patients. This imposes a repositioning of each individual involved in the relationship. The law specifies that the involvement of patients in decision-making should be sought even when they present limitations of their decision-making abilities. The affirmation of these rights is consistent with the recognition of patients' decision-making abilities and the development of a shared decision. Nevertheless, when the limits of these abilities are reached, it leads to practical difficulties in the consent of patients and/or legal guardians and caregivers. It is now recognized that the oral health needs of patients with enduring limitations of their decision-making abilities are not satisfied, and are increased compared to those of the general population. These health inequities result from many barriers in access to care and prevention, but also during care, and yet the principle of equal access to care for all citizens is recognized as a national legal principle. This situation constitutes a loss of opportunity for these people - especially as, beyond its local impacts, impaired oral health may have impacts on their overall health and particularly on their quality of life and social integration. These limitations, which accumulate day after day, may lead to symptomatic therapies being favoured without concerted thinking on a global functional rehabilitation. Yet it is recognized that the fight against health inequalities requires the development of comprehensive overall health care. This means that, relying on the participation of the different stakeholders including patients in decision-making, the barriers separating areas concerning health, social and educational care have to be abolished for a continuum by priority. The aim of this work is to explore, by qualitative and participatory research, the reasons for the limitations of the therapeutic response from each member of the care relationship - patients, caregivers and dentists. Once these reasons have been better understood, the different representations are considered face to face and the ethical tensions that emerge are discussed. Then, ways in which the management of oral health can be improved and, beyond this evolution, ways in which society could change are proposed with the ultimate hope of reducing health inequalities.
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https://tel.archives-ouvertes.fr/tel-01940571
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  • HAL Id : tel-01940571, version 1

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Alessandra Blaizot. La question du juste soin dans la prise en charge bucco-dentaire des patients présentant des limitations durables de leurs capacités de décision : des tensions éthiques aux perspectives d’évolution. Ethique. Université Sorbonne Paris Cité, 2016. Français. ⟨NNT : 2016USPCB142⟩. ⟨tel-01940571⟩

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