Contenu du sommaire

Managing medical uncertainty : collegiality and lateral control in oncology In oncology, a more collective model of medicine is finding increasing legitimacy at the expense of the traditional figure of the professional whose decisions are autonomous and mainly grounded on his own experience. Physicians tend to consider more and more that this collective model is helpful, since they have to face medical and institutional uncertainties. Furthermore, mechanisms of social control between peers contribute to the diffusion of this model.

Medical judgment and medical decision-making in a high-uncertainty situation : when clinical practices meet genetics The introduction of genetics into medical fields has often been presented, by professionals, as giving clinical work an objective basis from which to reinforce itself. In the social sciences, this movement has largely been interpreted as a kind of genetic reductionism that is gradually overtaking medicine. This article proposes a different reading of the situation based on a comparison between two forms of clinical practice — in cancer genetics in the first case, and in genetic psychiatry in the second. It outlines the emergence and development of a new kind of clinical practice characterized by the strong presence of numerous uncertainties that practitioners face with regards to the knowledges and the techniques they are mobilizing, to the objects and the circumstances they are exploring, and the purposes to which the findings should be put. The article demonstrates how the qualification of uncertainties which are in part generated in the course of clinical activities, becomes a central object for professionals working with these genetic practices. As a result, the framing, the content, the actors and the modalities of medical work are all transformed. In both case studies, doing clinical work consists in stretching pathological categories towards biomedical entities that are uncertain and unstable. Yet the association between the risk of disease and the presence of certain genes and mutations is, in a number of conditions, quite poorly mastered. To elaborate medical judgments and clinical decisions therefore, it is necessary to do work to provisionally stabilize biomedical entities and the syndromes which might possibly be associated to them. As it will be shown, this work is not carried out by the individual clinician but by collectives that bring together biologists, clinicians and researchers who mobilize multiple modalities of judgment and forms of expertise.

Uncertainty in French general practice : where does it come from and how to deal with it ? Based on a qualitative sociological study carried out with a number of French GPs over several years, this paper analyses the way uncertainty is dealt with in general practice. Causes and forms of medical uncertainty are firstly considered through classical categories of Fox and through the historical, sociological and economical context of general practice in France. The way GPs deal with uncertainty and the way they handle it more or less in their practice is then put under scrutiny. This leads to a mapping of GPs positioning, which makes us understand the heterogeneity of their practices and their ways of thinking, between established knowledge and the complaints of lay people being taken into account.

Health professionals and the decision of termination of pregnancy for fetal abnormality : between clinical indications and ethical embarrassments Termination of pregnancy for fetal abnormality (TOP) forms an exemplary situation of the ethical tensions traversing health professionals decisions and practices. Although embedded within a legal framework, it raises ethical concerns supported by various levels of uncertainties brought up by the professionals, when TOP takes shape in concrete decisions and practices. It is what this paper explores by pointing up three categories of uncertainty which relate to the decision-making process, to the legitimacy of the act — field of embarrassment for the professionals when medical and social norms are conflictual —, and to its effective realization for the actors who deal with and have to assume it.