{"id":103110,"date":"2017-06-23T14:29:15","date_gmt":"2017-06-23T13:29:15","guid":{"rendered":"http:\/\/kapitalis.com\/tunisie\/?p=103110"},"modified":"2017-06-23T14:29:15","modified_gmt":"2017-06-23T13:29:15","slug":"relation-medecin-malade-le-consentement-eclaire-aux-soins","status":"publish","type":"post","link":"https:\/\/kapitalis.com\/tunisie\/2017\/06\/23\/relation-medecin-malade-le-consentement-eclaire-aux-soins\/","title":{"rendered":"Relation m\u00e9decin-malade : Le consentement \u00e9clair\u00e9 aux soins"},"content":{"rendered":"

\"\"<\/p>\n

Dans la relation m\u00e9decin-malade, on est en train de passer d\u2019un mod\u00e8le paternaliste o\u00f9 le praticien d\u00e9cide de tout \u00e0 un mod\u00e8le autonomiste o\u00f9 la participation du malade est exig\u00e9e.<\/strong> <\/em><\/p>\n

Par Dr Karim\u00a0Abdessalem<\/strong><\/p>\n

<\/p>\n

Depuis quelques temps on observe un changement dans la relation m\u00e9decin-malade : ce dernier ne veut plus se fier aveuglement au savant; il veut recevoir des informations claires sur son \u00e9tat de sant\u00e9 pour participer \u00e0 la d\u00e9cision m\u00e9dicale. On passe d\u2019un mod\u00e8le paternaliste o\u00f9 le praticien d\u00e9cide \u00e0 la place du patient \u00e0 un mod\u00e8le autonomiste qui fait de l\u2019information au malade et de son consentement des exigences.<\/p>\n

Paternalisme du m\u00e9decin et autonomie du patient<\/strong><\/p>\n

Dans la relation classique, la d\u00e9cision m\u00e9dicale ne peut reposer que sur le seul jugement du m\u00e9decin. Sans avoir besoin d\u2019informer ou de se concerter, il sait ce qu\u2019il faut faire pour prot\u00e9ger la sant\u00e9 de son patient et r\u00e9aliser son bien-\u00eatre. Le praticien consid\u00e8re que le malade est incapable de prendre des d\u00e9cisions au sujet de son \u00e9tat de sant\u00e9 et que des informations graves peuvent lui \u00eatre dissimul\u00e9es lorsqu\u2019elles risquent de heurter sa sensibilit\u00e9 ou de freiner sa gu\u00e9rison.<\/p>\n

Dans ce rapport paternaliste, le patient est d\u00e9pendant d\u2019un m\u00e9decin en qui il accorde sa confiance et vis-\u00e0-vis duquel l\u2019expression de sa volont\u00e9 propre n\u2019est pratiquement d\u2019aucun poids.<\/p>\n

A contrario, dans la relation moderne, le m\u00e9decin n\u2019est plus seul \u00e0 d\u00e9cider de ce qui est le mieux pour le malade. Il doit lui donner des explications claires sur son \u00e9tat de sant\u00e9 pour lui permettre de bien comprendre sa maladie et de participer aux d\u00e9cisions relatives aux investigations et aux traitements.<\/p>\n

Sans \u00eatre soumis \u00e0 l\u2019autorit\u00e9 du praticien, le patient autonome choisit ce qui lui semble la meilleure ligne de conduite. Chaque personne a le droit de prendre les d\u00e9cisions qui la concernent, et d\u2019abord celle d\u2019accepter ou de refuser le traitement qui lui est propos\u00e9.<\/p>\n

C\u2019est le principe du consentement, valeur essentielle de respect sans laquelle aucun acte m\u00e9dical ne peut \u00eatre pratiqu\u00e9 et cela quelque soit sa nature : examen radiologique, pr\u00e9l\u00e8vement biologique, traitement m\u00e9dical ou intervention chirurgicale.<\/p>\n

Adapter la loi et le code de d\u00e9ontologie m\u00e9dicale<\/strong><\/p>\n

Contrairement aux pays avanc\u00e9s, o\u00f9 l\u2019information, le consentement aux soins et son corollaire le droit de refuser des soins sont garantis, en Tunisie, ces dispositions ne figurent ni dans la loi ni dans le code de d\u00e9ontologie m\u00e9dicale.<\/p>\n

Le code d\u00e9ontologique, ensemble de normes morales r\u00e9gissant la pratique m\u00e9dicale, actuellement en vigueur, n\u2019a fait l\u2019objet d\u2019aucune modification depuis son abrogation en 1993. Il devrait \u00eatre r\u00e9vis\u00e9 pour s\u2019adapter au respect des principes lib\u00e9raux qui s\u2019appliquent \u00e0 la m\u00e9decine comme au reste de la soci\u00e9t\u00e9.<\/p>\n

La diffusion de la r\u00e8gle du consentement \u00e9clair\u00e9e se heurte \u00e0 deux \u00e9cueils principaux.<\/p>\n

D\u2019abord, celui de la difficult\u00e9 de compr\u00e9hension de l\u2019information : pour qu\u2019un consentement aux soins soit valide, le sujet doit bien comprendre le diagnostic de la maladie, la nature de l\u2019intervention propos\u00e9e, ses b\u00e9n\u00e9fices et risques, les autres choix possibles de traitements et les cons\u00e9quences d\u2019un refus ou d\u2019une non-intervention. Ce qui est loin d\u2019\u00eatre simple parce que le patient peut manquer du minimum de comp\u00e9tence m\u00e9dicale n\u00e9cessaire \u00e0 la compr\u00e9hension des informations et parce qu\u2019il n\u2019est pas \u00e9vident de la part du soignant de rendre compr\u00e9hensible des donn\u00e9es cliniques complexes.<\/p>\n

Ensuite, en r\u00e9v\u00e9lant toute les donn\u00e9es, celui d\u2019augmenter les souffrances psychiques du malade dans les cas o\u00f9 il est confront\u00e9 \u00e0 une pathologie grave notamment canc\u00e9reuse.<\/p>\n

D\u2019apr\u00e8s notre exp\u00e9rience, quand le pronostic est sombre, la plus part des m\u00e9decins choisissent de dissimuler la v\u00e9rit\u00e9, ou du moins \u00e0 ne la divulguer que tr\u00e8s progressivement, particuli\u00e8rement lorsque le malade semble incapable de la comprendre et de la supporter.<\/p>\n

Bon gr\u00e9 mal gr\u00e9, le principe du consentement aux soins s\u2019impose dans la relation m\u00e9dicale. La l\u00e9gislation et la formation des soignants doivent s\u2019adapter \u00e0 ce changement.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dans la relation m\u00e9decin-malade, on est en train de passer d\u2019un mod\u00e8le paternaliste o\u00f9 le praticien d\u00e9cide de tout \u00e0 un mod\u00e8le autonomiste o\u00f9 la participation du malade est exig\u00e9e. Par Dr Karim\u00a0Abdessalem<\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[992,1000,2433],"tags":[810],"class_list":["post-103110","post","type-post","status-publish","format-standard","hentry","category-a-la-une","category-tribune","category-tunisie","tag-sante"],"yoast_head":"\nRelation m\u00e9decin-malade : Le consentement \u00e9clair\u00e9 aux soins - Kapitalis<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kapitalis.com\/tunisie\/2017\/06\/23\/relation-medecin-malade-le-consentement-eclaire-aux-soins\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Relation m\u00e9decin-malade : Le consentement \u00e9clair\u00e9 aux soins - Kapitalis\" \/>\n<meta property=\"og:description\" content=\"Dans la relation m\u00e9decin-malade, on est en train de passer d\u2019un mod\u00e8le paternaliste o\u00f9 le praticien d\u00e9cide de tout \u00e0 un mod\u00e8le autonomiste o\u00f9 la participation du malade est exig\u00e9e. 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