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La démocratie sanitaire à l'épreuve des pratiques médicales : sociologie d'un modèle participatif en médecine

Abstract : In many policies, among which the law passed on March 2nd 2002, a new figure of the sick person is promoted. This figure of a self-sufficient decision-making individual proves difficult to call up in a space where relationships, although based on an equality of status, do not necessarily find their expression through situations in which symmetrical cooperation exists. For there is not equality, in terms of each individual having the same degree de power in a doctor vs patient relationship. It is in this particular framework that we have examined the evolutions of medicine, in the much contrasted fields of hospital care on the one hand and ambulatory care (general practitioners and specialists who work on their own) on the other hand. In the first part of this thesis, we've aimed at rebuilding the problems, resources and forms of commitment that made the figure of the patient evolve as well as his-her relationship to medical doctors. We've analysed how both the emancipation process of the Sick and the decompartmentalization of medical practise incorporate into a same participatory pattern. In the second part, we've examined the way in which a participatory pattern, based on the rights of the Sick, can be taken into account, become legitimate and effective. We have brought into light the hibridization of quality and law that favour the implementation of these rights. The third part has brought us to carry out an individual-centered approach, about the extent to which the patient can benefit from participation in the framework of hospital care. We've searched about the vulnerability of the status of the “subject of rights” through ordinary medical practise. It has enabled us to bring into light a form of self-sufficiency as a reaction to the hospital institution, although in a partial and unevenly shared way. The last part is dedicated to liberal medicine. In this part we've examined the qualification of the status of people when looking at medical practise, trying to find out whether this qualification can renew practise as compared to the paternalistic pattern. We have been able to see that the participatory pattern deeply interferes into the forms of traditional medical regulations. It does not substitute to the paternalistic model but does coexist along with it. As a conclusion to this thesis, the promotion of users into the health system does not appear as a homogeneous move toward “sanitary democracy”. It results of a dissemination of practises based both on a renewed conception of the status of the sick people and on a participatory model of the patient-doctor relationship. Looking at facts, as we've presented them, shows that the health institution did not change at the same pace than speeches. One must point out the fragility of observable changes. The disparity in practises remains significant. However the participatory pattern as well as the re qualification of the status of users, though partial in fact, allow a more symmetrical cooperation.
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Submitted on : Thursday, July 2, 2009 - 8:00:00 AM
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Christelle Routelous. La démocratie sanitaire à l'épreuve des pratiques médicales : sociologie d'un modèle participatif en médecine. Sciences de l'Homme et Société. École Nationale Supérieure des Mines de Paris, 2008. Français. ⟨NNT : 2008ENMP1610⟩. ⟨pastel-00005246⟩



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