Paris (AFP)
"When a victim is in danger, my duty is not only to treat it!" Pleads the surgeon Jacques Saboye, summarizing the dilemma of many health professionals, between respect for the secret and feeling of "no assistance to person in danger "in the face of domestic violence.
A few days before the conclusions of the Grenelle on domestic violence, the lifting of medical secrecy is presented by several actors as an indispensable measure to better come to the aid of victims, but some doctors and associations point to a "false good idea".
"The victim herself went to the emergency room ten times", "a medical certificate (...) noted the existence of scars, wounds and psychological shock" ... In his report on the marriages, made public Sunday, the General Inspectorate of Justice observes that "doctors and hospital services are best placed to note the existence of domestic violence".
Its authors plead for an amendment to the law on medical secrecy, "to allow any health professional to report the facts, even in case of refusal of the victim".
"It calls on the ethics of the doctor," said Justice Minister Nicole Belloubet, interviewed by the JDD, saying "favorable" to this opportunity to break the secret.
A wish shared by Dr. Saboye, president of an organization of plastic surgeons, SOFCPRE.
In the current situation, doctors represent "an intermediary link that is locked" in the chain of responsibility that leads to the escalation of domestic violence, he told AFP.
If he says he understands the reluctance of "family doctors", the specialist in reconstructive surgery believes that, faced with the seriousness of the wounds of women who sometimes push the door of his office (facial fractures, burns ...), he should "have the freedom to call the prosecutor" to report the facts.
- "I will keep the secrets" -
Currently, in the absence of a judicial inquiry or the patient's agreement, medical confidentiality is required in a "general and absolute" manner, except for minors and vulnerable persons.
The idea of a necessary evolution of this principle "in case of serious risk of renewal" of violence is also included in the conclusions of the working groups of the Grenelle, unveiled at the end of October.
But the wording used by Marlène Schiappa, of a "shared medical secret, for example between emergency doctors, lawyers and the police," leaves Dr. Saboye skeptical because it would limit the measure to women who go to the emergency room.
"This would not trigger action by the justice.This would not change anything in practice if there is no agreement from the person to file a complaint," said also Frédéric Douchez, a lawyer specializing in health law.
In addition to the criminal obligation, medical confidentiality is also an ethical imperative, the non-respect of which may lead to delisting by disciplinary orders.
"Admitted (e) in the intimacy of the people, I will keep the secrets which will be entrusted to me", enjoins the oath of Hippocrates that the doctors lend.
"Unveiling the confidences, in medicine, we do not like," said Marie-Pierre Glaviano-Ceccaldi, vice-president of the National Order of Physicians, who participated in the working groups of the Grenelle, to explain the reluctance in the profession.
"If the doctor does everything possible to have the consent of his patient and he can not, there may be opportunities to help and accompany them more easily," she hopes.
In a forum published Monday in L'Obs, 65 doctors who call to better "identify and prevent domestic and sexual violence" oppose a lifting of medical secrecy, not to "break the bond of trust" with their patients.
Other professionals also note the risk of "counterproductive" reports, which could put victims at risk.
"We often take refuge behind the secret, but report a victim, it is not a delation," says the psychiatrist Liliane Daligand.
The expert before the courts, also president of a women's aid association in the Lyon conurbation, calls for greater attention to the possibilities already offered by the law. It considers that the definition in the Penal Code of a "vulnerable person" ("unable to protect oneself by reason of age or physical or mental incapacity") can apply to many victims.
© 2019 AFP