There is a culture of accomplishment in surgery

Innovation is listed in the medicine, whether it is a new drug, a new medical device or a new surgical technique. However, whereas the introduction of a new drug follows a highly codified route, the adoption of new surgical techniques is too seldom in research protocols. Yet they are the cornerstone of the current medicine, based on the evidence. To be adopted, an innovation must prove that it allows better caring for the sick, by comparing the situation of those who have been treated with this innovation to those receiving standard treatment. Should we accept that the surgery be exception, and for what It is for these topics was discussed in the ethics and surgery, Symposium for the week last by French and francophone medical ethics society.

Risk of exception

The surgeons are ardent supporters of a plan of exception. "Historically, surgical methods are not derived from research but protocols"schools"where they have been imposed by a master of empirically", observed Alain Danino, doctor in aesthetic plastic surgery at the Centre hospitalier universitaire (CHU) of Dijon. "In addition, he continues, the innovations in surgery almost always supposed transgressions.". There is a culture of accomplishment in surgery. If it is to implement a protocol for any innovation, the surgeon becomes a simple running and risk of not being able to innovate.

Professor Bernard Devauchelle, surgeon in CHU of Amiens, which conducted a year ago the first partial face transplant, goes even further. "There is no surgery without surgeons and surgeon is an artist", he doesn't hesitate to declare, comparing the interpreter music "following a partition but at times interpreted freely." Before you say that "there no art without experimentation. A term which, applied to human, yet concern claims flashbacks and is no stranger to the malaise, mixed morbid fascination, that resulted in a substantial part of public opinion this famous face transplant probably. "The first surgical are generally provocative but they are sources of progress", defending Bernard Devauchelle, always also conclusively, before leaving her presentation with a photo of the smiling woman after him have shown D'ICI, as if this was enough to prove his good physical and mental health. Compare his condition to other patients also disfigured and treated differently would have been much more persuasive.

"The first surgical should not be excluded from the scope of the Act on the protection of persons suitable for biomedical research, also considered Claude Huriet, President of the Institut Curie, which gave its name to this Act." Medicine is a social practice, for his part recognized Christian Hervé, Director of the laboratory of medical ethics of Paris-V. As a result, it must evolve with society. "However, while patient associations mobilized to enforce their rights, the idea of a medicine which has no accountability seem anachronistic. As patients expect the doctor and the surgeon more than simple compliance with the laws.

Listen to the patient

At the time of the growing technification of the medicine, they are asking more of humanity.

Jean-Pierre Lacroix, representing the National Federation of the insufficient kidney, was a poignant spokesperson for this expectation. "In addition to a rigorous assessment of the risk-benefit ratio, patients expect including the surgeon that he considers the person as a whole, it knows to listen and empathize. In General, the sick deplore not more see the surgeon. "Because even if there is a team effort, never the psychologist will replace the surgeon", insists Jean-Pierre Lacroix. A fortiori, when it comes to surgical innovation.

"The surgical Act remains something exceptional in which there is violence and often of the transgression, while the patient is in a State of vulnerability, for its part said Emmanuel Hirsch, Professor of medical ethics at the Faculty of Medicine of the université Paris-Sud XI." Unfortunately, the surgeons are not majority very open to ethical questions, he says. Because "entering" in the body, because they are sacred and secret of the operating space, they enjoy a great prestige. "And to conclude without concession:"prestige gives them easily a sense of omnipotence and the feeling that they have to answer to anyone."