Questions de santé mentale et de libertés au croisement des dilemmes soignants remontés aux espaces de réflexion éthique régionaux

Abstract

The action of the Regional Ethical Reflection Spaces does not only concern the field of contemporary bioethics but also affects many issues concerning mental health that we may have to face in clinical practice and teamwork. To keep trying to identify the conflicts of values in ethical issues is an absolute necessity, which implies that we support a “living together” relying on a “thinking together” for both the sake of each of us and for the sake of all of us. Our duty is then to resist collectively to prevent any possible deleterious excesses on both human and therapeutic points of view. Moreover, to focus on the principle of proportionality in complex medical decisions in the field of mental health requires at the same time a balance between the protection, the safety and the respect of the fundamental freedoms and a balance between the public interest and the individual needs. Such arbitration demands a strong focus on the ethical reflection so as to avoid decisions simply oriented towards the health dimension and recorded without any consideration for the health democracy. The referrals of the ethical support cells in Brittany and everywhere in France bring to light the challenges we met on the field. In particular those aroused during the COVID crisis concerning the institutional decisions, to take care of the mental health of patients at the end of their life or when facing treatment of resistant diseases. These situations raise some critical issues about the respect for the dignity and the humanity of the people we take care of. It thus seems necessary to respect an ethical code of human understanding, with poise and right balance, relying on a collegiate discussion. Besides, receiving end of life care will today requires the development of a palliative psychiatry in France, which becomes a priority. This could enable us to lead to fairer and equitable care, respectful of the individual freedoms, and a care better adapted to the specific needs of the patients in great psychological suffering. Especially in places where vulnerability is at stake, such as the retirement homes, to maintain a better articulation between the principles of beneficence and of nonmaleficence.