Beyond Beneficence: Moral Asymmetry and the Minimization of Suffering in End-of-Life Care
DOI :
https://doi.org/10.7202/1124210arMots-clés :
soins de fin de vie, compassion, conséquentialisme, asymétrie morale, soins palliatifsLangue(s) :
AnglaisRésumé
Cet article examine de manière critique les fondements éthiques de la minimisation de la souffrance en fin de vie. La réduction de la souffrance constitue une préoccupation majeure dans le discours éthique relatif aux soins de fin de vie. Certains penseurs accordent une importance particulière au fait de réduire autant que possible la souffrance non désirée et inutile en fin de vie. Pourtant, beaucoup d’autres considèrent que la minimisation de la souffrance constitue une justification insuffisante, voire risquée, pour la prise de décision en fin de vie. Le désir de minimiser la souffrance est souvent considéré comme équivalent ou entièrement réductible à l’utilitarisme ou, en bioéthique, au principe de bienfaisance. J’argumente ici qu’il est erroné de fonder le désir de minimiser la souffrance en fin de vie sur l’utilitarisme ou la bienfaisance, puisqu’ils reposent sur une symétrie morale, alors que l’engagement à minimiser la souffrance est moralement asymétrique. Comme alternative, je propose et développe la doctrine du moindre mal évitable (DMME), fondée sur l’utilitarisme négatif, également appelé conséquentialisme moralement asymétrique. J’évalue la DMME au regard d’une série de traitements de fin de vie et montre qu’elle s’accorde bien avec les engagements éthiques de ceux qui souhaitent minimiser la souffrance en fin de vie. Je conclus que la DMME offre aux personnes, aux institutions et aux médecins une base théorique formelle, systématisée et défendable pour soutenir le désir de minimiser la souffrance en fin de vie.
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© Adam Braus 2026
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