Au-delà de l’autonomie du patient : l’ « esprit de soin » dans les trajectoires de cancer avancé

In a context of the transformation of medical institutions, the question of recognizing patients’ subjectivity in care is critical. Starting from an ethnographic survey in services for advanced stage cancer patients, the article aims to show the issues that this consideration raises by focusing, on the one hand, on the moral conceptions of the patient as a subject that professionals use in the relational work and, secondly, on care interactions where the activities of patients and caregivers' expectations diverge. The focus on these situations and the mobilization of case studies capture the diversity of the criteria used by caregivers to describe the « needs » of patients, beyond the development of the disease or the development of treatments. Pinpointing the existence of a moral and social hierarchization of the human in the « spirit of care », but also the abilities of negotiation or resistance deployed by patients against it, this research is an illustration of the tensions and limits of the development of health democracy