Le principe de précaution en médecine : vingt ans après

Abstract

ObjectivesThe precautionary principle (PP) is a risk management method in situations of scientific uncertainty. Its lack of precise definition in official texts led to numerous interpretations in the past. The PP was initially limited to the environment. The extension to human health raised fears of an increase of proceedings and an interference with innovative research. MethodTwenty-four people involved in the precautionary principle have been interviewed and a literature review has been carried out. ResultsA renewed analysis of the PP has emphasized several points: the PP is a complex process that includes a spirit of caution, rigorous reasoning, and evaluation of hypotheses and, lastly, precautionary measures. The major part of confusion raises when the PP is in danger of drifting into inappropriate precautionary measures; individual care medicine is well controlled by the “Code de déontologie médicale” (Code of Medical Ethics); biomedical research has scientific constraints and its own rules. In these two medical fields, PP is not applicable unless a major innovation raises an ethical problem; on the other hand, public health may be submitted to the PP. ConclusionConsequently, mastery of the PP implies to promote training actions devoted to medical doctors, administrative and political decision makers, educational establishments and the media.