TOPIC 2
Clinic evolutions and the new care paradigms

New care practices take into account long-term illnesses and patients in their wholeness, by considering their values, choices and living social conditions. The notion of care is not understood here as “nursing care” but as an action medical paradigm, as technic, ethical, social and political. The care of the patient is neither understood as opposed, nor as only complementary to the illness cure, but the first one is considered as the a pillar to the second one : the technical and scientific fight against illness is made necessary by the objective of care, worry and treatment of patients, purpose and meaning of Medicine.

The Topics Covered :

The medical shared decision in somatic medicine and mental health

 - The complexity of medical decisions involving different types of experts and many Therapeutic options, requires taking into account expectations, needs and values of the patient.
-> Values-Based Medicine -> Practice of the medical shared-decision. Gives an active role to the “patient”, therefore recognised in his/her singularity, his/her skills, and as an actor of decision.
Enhance the Therapeutic alliance, the mutual trust, and therefore the compliance with the treatment resulting in improves Therapeutic results. Pachoud, I. Salmona, M. Mortier (CRPMS, Paris Diderot), P-H. Castel, A. Ehrenberg (Cermes 3 Paris Descartes) En lien avec plusieurs services de médecine de Paris Diderot
Related Researches : Cofunding of the 10th Internation Conference on Clinical Ethics – 24th & 26th of april 2014 Topic : « The patient’s voice ».  « The formalisation of consent and the evaluation of medical capacities » & « The restrictive dimensions of care practices : transformations of usages and legal frame  »   ( L. Velpry, N. Henckes,  CERMES 3 Paris Descartes ) « From Psychatric power to shared-decision :  Pluralisation of health actors in psychatry », Isabelle Salmona « Assisted Reproductive Technology » (M. Gaille, SPHERE Paris Diderot)

Values Based Medicine :

Every medical decision is based on 2 principles : facts (Knowledge) and values (Values are usually implicits, but are expressed during conflicts ). Values have an increasing complexity what has direct effect on medical decisions (patients and relatives values, values of experts contributing to medical decision. Increase of therapeutic options having to be prioritised in front of these values. The Values-Based Medicine offers a range of resources to manager complexe values and sometimes antagonistic or with tension in medical decisions (similar to the Evidence-Based Medicine is a response to the increasing complexity of facts/knowledge in Medicine). Complementary to the EBM approach, more exactly it is an underestimated dimension of the EBM, which is based on three pillars: (1) proof data, (2) clinical experience, (3) Values (Sackett & al., 2000).

The recovery, from mental health to Somatic Medicine :

The notion of recovery from psychological problems constitute a new care paradigm, for which the remission of symptoms, based on objective criteria, is less important than the re-integration of the patient in the life of the society. It is a movement initiated by users’ associations (advocacy), but also a philosophical and ethical approach with an influence on Health public policies. The programme studies convergences and divergences of recovery and institutional psychotherapy philosophical sources. The programme will also study the possibility of transferring the recovery towards Somatic Medicine, for example the Oncology. (resp. Pachoud, CRPMS Paris Diderot/P.–H. Castel, A. Ehrenberg, CERMES3 Paris Descartes) ;

The paradigm of support cares:

Medical and Pcyhosocial actions aimed at improving people’s life, in the physical, psychic and social dimensions, in parallel to the specific cares of the disease. They have emerged from Cancerology. They gather various practices from Pain Medicine to palliative care, from Psychological support to Psychiatric treatment, from Therapy or Dietetics to relaxation and fitness activity, from supporting relatives to social work. They represent the evolution of medical needs and social expectations. Centre G. Canguilhem Paris Diderot/ CIRPHLES (CNRS - ENS)/Institut Curie/Plateforme Ethique Univ. de Lausanne/Institut de Sociologie Univ. Libre de Bruxelles

The « care » as social relationship : 

Illness is not defined anymore only by the relationship between patient/, but in a frame including multiple different actors, relations, networks that are not exclusively medical. Feminist ethics of the « care » as well as social sciences have revealed the relational and collaborative side of the care work, but in an environment where multiple actors, relations, networks not exclusively medical are involved. The extension of the « care » frame is visible in the clinic and the health system where we can find multiple actors and needs for mediations, that in the society, families, relations, societies and networks which also play a key role. (Researches conducted by the UFR CERILAC-LARCA Paris Diderot/PRISMES Paris 3) ;

Population, clinic, care in global health

 In the globalisation of logics, practices, and health actors, The Person, is both : application point of global policies, and at the origins of their local appropriations and transformations. The Seminary « global health: anticipations, infrastructures, knowledge » studies the globalised frame of health and its organisation: new actors, targets and tools: collaborations between public and private sectors, foundations, local communities. Focus on the modern infrastructures and dynamics of the knowledge production, of the diagnostical and insurance intervention, and Therapeutic innovation, as well as on their locations in Africa, Asia or South America. Focus on the local forms taken by global health in daily practices of Epidemiological previsions, of research, of care, of political decisions, and on the future developments they anticipate.
Beaudevin J. –P. Gaudillière, L. Pordié  (Cermes3), F. Keck (CNRS-LAS), G. Lachenal, C. Lefève  (SPHERE, UPD-IUF),, V. –K. Nguyen (Collège d’Etudes Mondiales), E. Sanabria (ENS)