Arnaud LARROUTURE

Autonomy orthoses (Abstract)
By analogy, like a state, an individual capable of self-governance would be autonomous. Having reached the end of his life, when his dependence and illness limit his freedom and
choices, is it still relevant to speak of the patient's autonomy in this sense? By bringing into play the political, legal, moral, philosophical and psychological fields, we will analyze the grammar and stakes of this autonomy.
Over the past thirty years, patients have won new rights such as the right to
information, the right to refuse treatment, the obligation to consent to care. New legal provisions such as advance directives and the designation of a trusted support person have emerged. How can they be transposed to the end-of-life phase? This new conception of the medical relationship, inspired by the liberal conception of the art of governing, raises the question of medical governance, its nature and its limits.
Making the development of autonomy a capital and priority issue in the
care contract means transferring certain responsibilities and decisions to the patient. It also means reconfiguring the medical contract in palliative care.
By analogy with an orthosis, we believe that caring for a patient at the end of life means
acting as an autonomy orthosis, i.e. filling in, compensating for the loss of his autonomy, by being adjusted to him to the point of being forgotten.
But, in the name of the principle of autonomy, should we go as far as medical assistance in
suicide? A real ethical question, both political and moral: how far should doctors still govern patients at the end of life?

Arnaud Larrouture. Autonomy orthoses. Philosophie. Université Gustave Eiffel, 2022. French. ⟨NNT: 2022UEFL2066⟩. ⟨tel-04127367⟩