Several recent cases have placed medical decision-making at the heart of societal debates. Whether it’s Vincent Lambert’s long end-of-life journey or this seven-month-old baby plunged into an irreversible coma, each tragedy reminds us that doctors remain the fragile guardians of our lives.
Very often, they have the formidable mission of arbitrating between the interests of the patient, the wishes of the family, and respect for ethics. As medical progress gradually erases these lines of conduct, practitioners must make a conscious decision between particular “interests” and fundamental values.
The story told today by Marine Lamoureux in the newspaper La Croix is the perfect illustration of this. “For the first time in France, reports the journalist, a woman carrying the BRCA1 gene, predisposing to breast cancer, was authorized to benefit from a preimplantation diagnosis (PGD). »
This technique, used exceptionally in a few centers, allows parents who risk transmitting a particularly serious and incurable genetic disease to their child, to have recourse to in vitro fertilization. The embryo, which does not carry the anomaly, is then selected.
There is no list of diseases giving access to PGD. In the case of cancers, underlines the daily, several conditions must be met: “The high tumor risk, the early age at which the disease occurs, incurability or treatment at the cost of disabling sequelae. »
The BRCA1 gene does not exactly meet these benchmarks. The occurrence of breast cancer is not certain, and the disease is not incurable. Removal of the breasts and ovaries being one of the alternatives.
So, several medical or ethical voices were heard to denounce “the rupture” or “the drift” caused by this specific case. But doctors must also deal with the history and the request of the couples. “The young woman did not know her mother – who died when she was very young – nor her aunt nor her grandmother, who all died very young of breast cancer”, explains to the newspaper the Pr Pascal Pujol, from Montpellier. This family trauma, the psychological aspect, therefore weighed in the decision of the medical team.
While some doctors claim this margin of appreciation and this right to exception, others highlight the danger of the “perfect fetus” and that of the “ideal performance”.
“Each small step may seem innocuous, but we end up finding ourselves where we never thought we were going,” warns Professor Jean-François Mattéi, professor of pediatrics and medical genetics, and former Minister of Health.
