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Processus décisionnel de fin de vie en réanimation néonatale : arbitrer entre le certain et l'incertain

Abstract : The end-of-life (EOL) decision-making process remains a particular event that confronts health care teams with their doubts and uncertainties. Indeed, for such a decision to made, there must be some doubt and uncertainty, otherwise, instead of being a conscious “decision”, it becomes a simple application of prior knowledge. EOL decisions are not simply a case of the decision-maker overcoming his or her indecisiveness. In this work, I examine the role of the doctor as an arbitrator in the conflict between the certain and the uncertain in EOL situations in the neonatal period. I have based my work on the analysis of the trajectories of six clinical observations drawn from my own experience, which illustrate, better than a long speech, the notion of the certain and the uncertain, and give these abstract concepts a concrete and practical meaning.To explore the notion of the uncertain during the decision-making process in EOL situations, is to accept to go against the dominant medical culture that values certainty, because uncertainty is negatively perceived amongst caregivers. However, doubt can have a beneficial effect on the decision-making process itself, and on the consequences of the decision taken, since it encourages discussion between caregivers and allows time for decision-making. Thus, he or she who doubts is not ignorant, but cautious in the Aristotelian sense, when trying to deliberate a choice by subjecting it to the criticism of others as part of a procedure of collegial reflection.In this work, I also show that doubt and uncertainty compel the decision-maker to confront his or her personal convictions, which constitutes ethical ethics, with his or her responsibility, which is teleological ethics. It is only in the tension between these two ethics that the caregiver can decide with peace of mind.
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Submitted on : Thursday, December 19, 2019 - 4:57:05 PM
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Mostafa Mokhtari. Processus décisionnel de fin de vie en réanimation néonatale : arbitrer entre le certain et l'incertain. Ethique. Université Paris Saclay (COmUE), 2019. Français. ⟨NNT : 2019SACLS431⟩. ⟨tel-02420086⟩

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