The Ethical Panel as a Participatory Mechanism and Negotiated Order

This article seeks to tackle the traditional opposition between an approach centered on decisions made by the majority and another centered on consensually made decisions by observing the discussions of an ethical panel of the Espace ethique in Paris. In a context where medical authority is increasingly challenged in a growing process of democratization, these entities adhere to a democratic and inclusive function by involving the passive actors of the hospital (nurses and patients). The article asks to what extent and how these new forums illustrate a consensual approach that is able to include every actor in the system. Using the concept of A. Strauss’s “negotiated order,” this article shows how ethical tensions transform the traditional balance of power between active physicians and passive patients. This process leads to a new kind of medical accountability that involves taking care of the patient through knowledge. Moreover, the deliberations undertaken in these ethical groups mix accommodation and hierarchy.