Enjeux éthiques à l’utilisation éventuelle de prédicteurs des préférences du patient pour soutenir la prise de décision substituée
DOI :
https://doi.org/10.7202/1126615arMots-clés :
prise de décision, soins de fin de vie, inaptitude décisionnelle, consentement substitué, principisme, autonomie relationnelle, bienfaisance/non-malfaisance, justiceLangue(s) :
FrenchRésumé
En 2010, Annette Rid et David Wendler proposaient que soient développés des prédicteurs des préférences du patient (PPP) pour guider les décisions de soins pour une personne inapte dont les volontés sont inconnues. Un PPP serait construit à partir des corrélations observées entre les préférences de soins et les caractéristiques sociodémographiques de répondants à un sondage. Il serait ensuite utilisé pour prédire les volontés inconnues du patient sur la base de ses propres caractéristiques. Un PPP pourrait améliorer la capacité à fournir aux patients inaptes des soins qui correspondent à leurs préférences, en plus d’atténuer la détresse que ressentent de nombreux décideurs substituts en raison de l’incertitude quant aux volontés du patient. Malgré ces attraits, de nombreuses objections au PPP ont été formulées au cours des 15 dernières années. Nous souhaitions mieux comprendre le débat éthique entourant ces outils d’aide à la décision, afin de déterminer s’il est opportun d’en entreprendre le développement. S’appuyant sur un modèle conceptuel de la prise de décision en contexte de démence, nous avons analysé 65 publications traitant d’enjeux éthiques associés au PPP. Les enjeux relevés ont été catégorisés selon le principe éthique auquel ils se rattachent. Nous concluons en faveur du développement de PPP, en autant qu’ils servent à soutenir, et non à remplacer, les décisions humaines. Nous soulignons ensuite le besoin d’évaluer leur acceptabilité sociale et leur performance réelle sur le terrain. Enfin, nous proposons des mesures susceptibles de réduire les risques associés à leur utilisation et de renforcer la confiance des utilisateurs.
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