Décision médicale et travail du soin

The book questions the standards and tools that now frame medical decision-making: shared decision-making, evidence-based medicine, evidence-based patient choice, as well as the conceptions of autonomy that they convey.

Based on fieldwork carried out in an internal medicine hospital department, Agathe Camus examines these “new standards” in the context of acute care situations involving chronically ill, frail or multimorbid patients. She proposes an analysis of several concrete situations of complex care, to update the work of medical decision-making, which is deployed not so much according to a “logic of choice”, which makes the autonomy of patients a starting point, but rather in a “logic of care”, which integrates it into a broader aim.

The author demonstrates that in the context of chronicity, the therapeutic or “crisis management” logic must coexist with the perspective of medicine seen as support for living with the disease. She calls for medical decisions to be reconsidered as a real work of care that aims above all to preserve a certain “leeway in life” for people who will not recover, and whose lives are permanently marked by illness, disability or frailty.

Combining conceptual work and an empirical approach, the author draws on a body of work combining philosophy and social sciences to deliver her observations and proposals in a clear and fluid style. This work, the result of a thesis that won the Institut la Personne en médecine thesis prize, will be of interest to students, teachers and researchers in the humanities and social sciences, as well as to health professionals and health students.