Fails is the surgeon failed and not treatment

The strict application of good clinical practices of the so-called law "Huriet" relative to the protection of persons participating in medical research is not adapted to the surgery. This is due mainly to the fact that the surgery can be likened to a simple drug treatment.

First of all, the methodology of clinical trials set for drug treatment is not transposable as what surgery because the surgical gesture is irreversible, and it is impossible to implement the method of the "double blind" (neither the patient nor the physician knows if he receives the tested drug or its comparator).

On the other hand, the high variability of surgical treatment, adapted to each patient is very rarely taken into account. Such as medicine, surgery is characterized by a "knowledge" medical classic, but added a specific "know-how". However, this expertise requires own validation, which is not in the current formalization of medical research ethics.

The first face transplant in Amiens well highlights this fact. It poses a question: the face transplant is feasible (surgical skills) The answer is Yes. In this sense, the first surgical responds very well to the question.

And then she raises a second question: should we propose this treatment to the degraded patients (i.e., medical) The answer would require the establishment of a clinical trial. How to structure such a clinical test Against what compare the face transplant How to propose a blind The "first" Amiens does therefore not say whether or not it should be offer treatment to others, but it establishes the technical feasibility. On the other hand, it shows that it is impossible to implement a protocol for clinical research seeking to demonstrate the effectiveness of this file. Would the answer to this formal impossibility not in an ethical reflection on the psychological consequences of degraded patients face transplant The answer is to look for in a substantive reflection on the person. It is not within the purview of the only doctors but should benefit from the scientific, philosophical, psychological, religious contributions... And beyond the framework of the medical consultation.

The technical dimension of the surgical gesture is dependent on the surgeon. Surgical treatment is not a simple act administered to the patient might be a tablet, surgical treatment and the surgeon do that one. Fails, is the surgeon failed and not treatment. In medicine, an antibiotic does not work on infection, if the antibiotic is ineffective.

This personalization of surgical therapeutic changes completely the surgeon-patient report. Does not: "I go see a doctor", as opposed to "I go to see my surgeon" The appropriation of this relationship is true in both directions: the patient has his surgeon, the surgeon has his patient. This unique relationship clearly exceeds the simple statement benefit/risk of the surgery. It is linked to the extreme violence of the surgical gesture and transgression that relates to the penetration in the body. This violence and this transgression explain the stress and anxiety of the patient. They also explain the stress and the intense concentration in operating blocks. Silence and concentration in intervention are often compared to silence and contemplation of a religious office. It is this confusion leads incorrectly to the deification of the operating room by people who ignore the operation. If singular surgeon-patient report is not properly taken into account in a classic clinical research protocol. This surgery of the many features often misunderstood and often denied. Also, it appears necessary to propose the development of a specific surgery ethical procedure, including both medical knowledge and surgical expertise.