Approche sociologique de l’observance : entre injonction à l’autonomie et besoin de protection

Abstract

From a sociological point of view, what are the challenges involved in the question of therapeutic compliance? While the causes of non-compliance have now been well identified in the opposing relationship with the treatment, in the patient's lack of resources, and in unequal doctor-patient interactions, it also raises questions about the patient's ability to be autonomous. In a context of deinstitutionalization and decline of asymmetrical therapeutic relationships, patient autonomy is at once a demand, an organizational necessity and a moral injunction. The patient must be able to fit into a new division of medical treatment protocols that transform the illness into a collaborative space, and the patient into a co-producer of care with a specific place in the therapeutic chain. This move toward professionalization and the inversion of the “locus of control” also leads to forms of moral exhaustion in the case of long-term chronic illness.