[Physician-patient relations: right or self determination. Path across the Atlantic regarding medical responsibility]

In France, patients have a fundamental right to health care, specifically declared in the Public Health Code. Licensed physicians are endowed by law with the mission of providing such care. The patient-physician relationship thus operates in an atmosphere of mutual trust. This situation, derived from roman law, is much different from that in countries where Habeas Corpus is the founding principle. In the United States for example, in virtue of the right to autonomy or self-determination, a patient has to decide to receive health care. In both situations, patient consent is mandatory, but in France consent is a condition, and not the fundamental principle of health care. A recent court decision (Cour de Cassation, February 25, 1997) has however had considerable impact on the health care climate in France. According to this decision, the physician is charged with the responsibility of informing the patient of all possible risks inherent in a proposed treatment. In addition, the physician must be able to prove the patient has received such information. The danger is that health care in France depart from the notion of a medical mission, moving onto the unstable grounds of an open marketplace. If the physician becomes a salesperson meeting the desires of a client-patient, what will happen to the climate of mutual patient-physician trust so strong in France? There is an urgent need to preserve the fundamental right to medical care in France, a mission performed by legally designated physicians and other health carers, for the benefit of consenting patients.