Discursivité et co-autorité en éthique clinique : regard critique sur le rôle et les fonctions de la délibération éthique en comité

Abstract

Clinical ethics, as instituted in committees, aims to solve ethical problems by means of interdisciplinary deliberation. Elucidation and deliberation are used as pragmatic means whose finality is decision-making. This being so, it may be wondered if clinical ethics has not been pruned of its more global critical potential. Narrative approaches open some ways of thinking of this critical function, but they seem to us to be nevertheless still insufficient for the task. We propose to explore the heuristic and practical fertility of the concepts of discursiveness – more inclusive than narrativity –, and co-authority – that we will have to situate and relate to notions of power, expertise and normativity –, in order to give fresh thought to the role and functions of a clinical ethics committee in a health care institution, and consequently the possible contribution of clinical ethics both as deliberation process and critical reflection of practices. To achieve this result, we propose the following approach. First of all, we will identify the limits of current narrative proposals. Secondly, we will present the concept of discursiveness based on work that follows on from the ethics of discussion. Thirdly, we will expose our definition of the concept of co-authority in a discursive space which includes both the actors of the clinical situation and the actors of the deliberation. Fourthly and finally, we will draw the consequences for a critical theory of the role and functions of a clinical ethics committee.