Emmanuel Hirsch is Professor of Medical Ethics and President of the Council for Research Ethics and Scientific Integrity at the University of Paris-Saclay. In this forum for UP', he proposes the organization in the coming days of a citizens' convention to allow urgent consultation on the choices that will be imposed on our country in the face of the Coronavirus crisis. Their acceptability could be legitimized by this publicly shared reflection, which would shed light on the difficult political arbitrations.
It is obvious that the management of a major health crisis, such as the Coronavirus epidemic, is political. The responsibility for taking complex decisions, in a context of uncertainty, with so many impacts on the life of the nation and the continuity of economic activities falls within the authority of the State.
Ten years ago, in our collective work Influenza pandemic: the order of mobilization (Editions du Cerf), we analysed the components of an inevitable global social crisis caused by the spread of a viral strain. At the international level, it would impose restrictive measures in terms of the organisation of public life, the restriction of individual liberties, and even vital choices in the event of a shortage in the capacity to receive and treat sick people. As the values of our democracy, including its solidarity with the most deprived countries, were involved in the necessary arbitration, we proposed public consultation, a teaching method of shared responsibility.
The political approach, in the context of a pandemic, must anticipate the conditions for mobilizing society: it must understand the hierarchy of choices in order to adhere to them, and it must acquire a capacity for action that promotes accountability. National cohesion is based on a relationship of trust, an ability to recognize and respect the position, rights and skills of each person in a struggle that must be fought together, with reference to shared values.
France's coronavirus control policy is marked by the requirement for transparency, the sharing of evolving knowledge, the justified announcement of progressive measures, support for health and medico-social professionals and attention to vulnerable people.
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In the first few weeks, the public authorities adopted a fair and reassuring position without minimising the risks that had been controlled until then. The calm phase, during which everything possible was done to postpone the end of the crisis, is coming to an end.Today we are faced with circumstances that are difficult to predict their consequences on public life.Already the first restrictive measures decided upon are causing concern and disorganization at all levels of social life. Even if the strategies of anticipation in our country and the specificities of the health systems differentiate us, the radical decisions adopted by the Italian government give visibility to an eventuality that our country must consider.
The phenomenon of "globalization" is transposed to the experience of a pandemic, reinforcing a feeling of fragility, dependence, not to say powerlessness, which is not reassuring. If state of emergency provisions were to be imposed and, in a limited context, a choice had to be made between the person being treated and the person being abandoned, what would happen to their acceptance, the risk of protest and public disorder? What response would the government then give when our country has been tested for over a year by social phenomena that could be rekindled by mistrust of the state?Will the crisis of legitimacy and authority in our democracies, the mistrust of public speech and expertise not hinder the cohesion of society?This is not the time to debate policy choices that can be assessed once the health crisis has been overcome. On a personal note, I have every confidence in the expertise and vigilance of the public authorities, who are tirelessly and competently invested in order to avoid the worst. Democratic life would nevertheless benefit from better involving society in the difficult decisions that will have to be made, over and above the national representative bodies.
A citizens' convention to be held in the coming days could enable the government to benefit from this necessary contribution to the legitimisation of demanding decisions, with the concern for the common good as an imperative.
Emmanuel HirschProfessor of Medical Ethics, University of Paris-Sud-Paris-Saclay