Contenu du sommaire

Medical anthropology in western societies. Recent developments and new problems As she considers what is called to-day « medical anthropology at home » (an epistemologically complex expression), the author examines the recent developments of this discipline these last years. The comparison of the researches led in western societies and of those led in so-called « exotic » societies, aims at showing, on the one hand, what the first have inherited from the second, and on the other hand, what they have, in turn, brought to medical anthropology as a whole by contributing to assert its disciplinary specificity and by helping to the development of the reflection concerning issues in general social anthropology.

Medical decision-making between expertise and assessment of the daim: the case of termination of pregnancy Despite the ten-week legal limit on pregnancy termination, the 1975 French law makes medical termination at any point on the pregnancy possible, as long as the fœtus can be shown to be at risk of a very serious or incurable health risk. In this case, the decision requires the approval of at least two doctors. Given the ethical difficulties surrounding any clinical diagnosis, the Gynaecology and Obstetrics unit of a university training hospital (CHU) set up an ethical watchdog committee (comite de vigilance) comprising medical and non-medical members. The aim of the committee is to define the criteria used to approve or reject applications for pregnancy termination, since this is evidently an area where social norms play a role which is as important as medical expertise. Decisions are reached with reference to the psychological characteristics and family background of the patients. With regard to its goals (the definition of objective criteria in the justification of medical decisions) and to its practice (the fine line between medical and ethical criteria), the committee studied here offers an interesting example of the potentially conflicting nature of the rationalities which are at the core of medical practice in the field of human reproduction.

The medical profession facing the quality of care: comparison between four quality handbooks The health care System requires that the physicians demonstrate the quality of their work. One may think that the autonomy of the medical profession is threatened. However, the accreditation process seeems to let the professionnals choose the best way to testify to the quality of care. Moreover, new professionnal associations leaded by physicians with an experience in quality management are dedicated to introduce the methods of quality management in the health care System. These methods are used with an eye to differenciate one health care organization from another, or to defend the place of a medical discipline in a competitive context.