[ETHNOMEDICAL ETHICS WITH REGARD TO PATIENT PLURIVOCALITY: BETWEEN AUTONOMY AND HETERONOMY]

In a contemporary multicultural context that stimulates new dynamics within the plural health systems, the universality of the patient autonomy principle is questioned. Wishing to contribute to the discussion on the topic, this article presents a reflection drawn from a case study in an integrative health care (IHC) clinic. This type of organization, polarizing a variety of care traditions, is an exceptional social laboratory for the analysis of the convergence of values and ethical principles, marked by various cultural foundations.

The combination of different data collection methods (semi-structured interviews, participant observation during interprofessional meetings, recorded clinical meetings) permitted the detailed analysis of patients' therapeutic itineraries in a Quebec IHC clinic that grouped practitioners of biomedical, alternative and traditional approaches. The interpretive conceptual framework illustrates the occasionally contradictory intersection of different cultural foundations influencing patient and practitioner explanatory models (EM) and semantic networks (SN).

Data analysis highlights a dissonance between a liberal and Cartesian conception of the individual, responsible for the management of his or her health, and some Taoist premises of traditional Chinese medicine (TCM), prioritizing the benefit of the person to his or her self-determination. The monitoring of therapeutic patient itineraries emphasized a phenomenon of EM plurivocality, proposing that individuals can use different voices and embody different characters, autonomous or heteronomous, depending on the context in which they describe their illness. The exploration of the heterogeneity of patients' SNs illustrates that it is possible for the same person to both need to be taken by the hand and desire autonomy.

Stressing the influence of certain cultural foundations on differential prioritization of patient autonomy principle, this article offers a reflection on the development of narrative ethnomedical ethics respecting the idiosyncrasies and plurivocality of the person.