Du concept de démocratie sanitaire à I'analyse du rapport Compagnon et à Ia loi santé 2015

Abstract

After the second World War, during which medicine was manipulated to serve an ideology, a deep movement arised to protect human beings. In 1964, Helsinki declaration was adapted to protect persons involved in medical research. In 1988, the Séruscalt-Huriet law introduced the obligation of informed consent. In 1994 the bioethics law introduced the notion of care consent. The March 2002 law created the notion of health care system "user". The general philosophy of the law was to give a larger autonomy to the patient. The various heath crises, contaminated blood crisis, mad cow disease, human growth hormone, hospital borne infections, were triggers for the development of patients' associations. The health system appeared fallible. Compagnon report aim is to increase the role of patients' associations in the health system at every level. The "health democracy" term has been coined to place the "political democracy" and "social democracy" concepts face to face. Internet information has transformed the patient into a knowledgeable person. Has it made him an expert? The doctor/patient duality is by essence asymmetric. Public health decisions are constrained by the economical context. The democracy paradox lies in the impossibility to be at the same time a representative anda decision maker. Personal interest collides with common interest. An alliance between representatives of patient's, heath system actors, politics and financers should be knotted to build up a new heath care system.