By Barbara Stiegler (*)
For the past 15 years, I have been teaching ethics and public health to caregivers who come to the university for training. Together, we try to understand why “free and informed consent” has become the cornerstone of biomedical ethics.
Why it compensates for the potentially dangerous asymmetry between patients (or healthy subjects of an experiment) and medical power. Why it can only be free if it is collected without blackmail, threats or psychological pressure of any kind – an indispensable condition for it not to be “extorted”. Why access to care can never be conditioned to the acceptance of the proposed treatment and why a patient who refuses to give his consent cannot be excluded from the care system under this pretext. Why, more generally, and contrary to Emmanuel Macron’s latest allegations, which violate all the principles of our social contract, the rights of the citizen cannot, under any circumstances, be conditioned by the invocation of previous duties. Why, finally, the collection of consent forbids any recourse to the argument of authority of the type: “Obey, because it is I, or rather the health authorities, who know what is good for you!”
Freedom in the sense of the Enlightenment, but also of the so-called “Kouchner” law of 4 March 2002 on patients’ rights and health democracy (itself inherited from another epidemic, that of the AIDS virus), is based on the capacity to reason for oneself that should be attributed to all citizens of legal age (or in the process of being so), whatever their beliefs or level of education. All the subjects called to consent must be considered by principle, and whether we like it or not, as rational subjects, able to deliberate together and in a contradictory way about the truth and the common thing (respublica), without any guardian of humanity being able to enact the common good in their place (1).
Defense of a collective care system
It is precisely this freedom which, in the processions against the health pass, was invoked by thousands of caregivers, vaccinated or not, who said they refused to violate these fundamental principles. And it is this heritage of Enlightenment thought that I myself defended by marching alongside them in the streets. Contrary to what has been insinuated by certain defamatory comments, this freedom is the exact opposite of that of the libertarians and supporters of Donald Trump, for whom any consideration of the common good threatens the sovereign individual in the unlimitedness of his desires. Reducing the huge processions of this summer to hateful, irrational and indifferent crowds to the common good has been one of the most dishonest media-political operations of this health crisis.
But it is also a certain idea of public health that determined me to mobilize with parliamentarians and actors and researchers in the field (2). Attached to the defense of a collective health care system, we know that the health authorities must sometimes impose preventive measures by making them mandatory. However, in the case of a health product, this is only acceptable if the benefit-risk is indisputable and if there is no other means of protection.
In this case, vaccination is being imposed on everyone on the basis of a fourfold gamble: that of a mass vaccination supposed to
1) to create collective immunity and eradicate the variants;
2) to protect the lives of others by preventing contamination;
3) as well as that of all vaccinated individuals, as if they were equally vulnerable to the virus and identically protected by the vaccine;
4) while having no serious adverse effects on their health. We can understand why a community of exhausted citizens governed by the fear of reconfinement would want to believe in this rhetoric of promise, even if we ourselves were very skeptical from the start.
Trusting the clinical acumen of health professionals
But at a time when the scientific community itself believes less and less
1) in the possibility of eradicating the virus and in the conquest of a collective immunity by these vaccines;
2) in the “civic” argument of the protection of the life of others;
3) the fantasy of the omnipotence of so-called “booster” doses supposed to “boost” young people in good health (while the public at risk are left to their own devices in the face of Doctolib, with vaccination of the over-60s among the lowest in Western Europe) (3), and even though health care providers are obliged to note the reality of certain post-vaccination incidents (4), the information that is supposed to enlighten consent is no longer “fair” (as specified in article 35 of the medical code of ethics). The universal imposition of a sanitary and then vaccinal pass violates the fundamental principles of our ethics, our public health and our law, while hindering the lives of entire communities of patients, summoned to choose between the fear of serious side effects and their own freedom.
A health management of this crisis is however possible. It implies giving back the power of prescription to the health professionals themselves and trusting their clinical sense, which requires a direct relationship between caregivers and patients, in the respect of ethics and public health. Since the vaccine is not a panacea, this health management also implies the deployment of an arsenal of complementary and varied measures: a vaccination directed towards the public at risk of severe forms combined with treatments, the early management of symptoms, the massive distribution of FFP2 masks for people or events at risk and the equipping of all public buildings with efficient ventilation systems. Why then do the new liberals who have taken power in our country persist in this inefficient and authoritarian management? Because the new liberalism they defend has hit the wall. The ecological and sanitary crisis is forcing it to reinvent itself as a matter of urgency, giving a stinging denial to the promises of neoliberalism of a “happy globalization”.
Banishment from society
The sanitary and henceforth vaccinal pass allows this ideology, until then hegemonic and just beginning to enter into crisis, to discreetly fall back on its feet, by combining:
1) the continuation of the destruction of the public services of health, education and research through austerity and the managerial management of its personnel;
2) the “technological solutionism” with its mantra of innovation, which serves both the financialized capitalism of Big Pharma and that of the universal digital shift, by creating the huge markets of e-health, e-learning and e-commerce;
3) the questioning of our social contract, with the banishment of millions of individuals from society (today the non-vaccinated, and soon all other citizens who are not observant or judged undeserving).
By proudly declaring that he “has a great desire to piss off” to the point of bending all those he cannot “put in jail himself,” Emmanuel Macron is defending a conception of politics such as can be found in the work of the German jurist Carl Schmitt: that based on the friends-enemies partition, with on one side the warlord and his pack (“us”) and on the other side the enemies within (“them”) whom it is a matter of “reducing,” that is, of subduing or annihilating. Invoking health and the protection of the public hospital to impose this appalling vision of politics has been one of the most perverse operations of this five-year term.
Let us hope that this will have the virtue of waking up all the citizens of this country, whether they are vaccinated or not, worried or confident in front of this innovation, but who remain attached to a republican and democratic conception of our political community.
(1) See Kant, Answer to the Question: What is the Enlightenment? (1784)
(2) See the article “Extension of the health pass to children and adolescents: researchers and health professionals sound the alarm”, on Mediapart, and the petition “Sortons du pass et de l’impasse sanitaire”, Libération, 6 August 2021, online on change.org.
(3) See the latest data from the European Center for Disease Prevention and Control (https://qap.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#age-group-tab). On the French delay in vaccination among at-risk individuals, see Florence Débarre et al. “The French domestic ‘sanitary pass’ did not solve Covid-19 vaccination inequities in France.”
(4) On the risks of litigation related to these incidents, see “Covid: les effets secondaires du vaccin vont coûter de cher à l’Australie”, in Les Echos.
(*) The author
Barbara Stiegler was born in 1971, she is a French philosopher, professor of political philosophy and head of the Master’s degree “Care, ethics and health” at the University Bordeaux Montaigne. She is also a member of the Institut Universitaire de France. Stiegler is the author of several books: Nietzsche et la biologie (Presses universitaires de France, 2001), Nietzsche et la critique de la chair (Presses universitaires de France, 2005), “Il faut s’adapter”: Sur un nouvel impératif politique (Gallimard, 2019), De la démocratie en pandémie: santé, recherche, éducation (Gallimard, 2021). She has just published Nietzsche et la vie: une nouvelle histoire de la philosophie (Gallimard, 2021).
Translation from French, Marie Prost