The role of 'accompagnement' in the end-of-life debate in France: from solidarity to autonomy

International audienceThis paper traces the way autonomy has become a recognised value in health care in France. In a country which based for many years its social fundamentals on the very idea of solidarity, autonomy has long been considered a foreign ‗Anglo-American principle'. Taking the example of the end-of-life debate, the paper shows however how the use of the French term ‗accompagnement' allowed to redefine autonomy and to associate it with the leading moral principle of solidarity. Exploring the arguments used over the past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that had happened in public and legal discourses on end-of-life care. The analysis demonstrates how the scope of autonomy had to be limited by other social values such the protection of the dying person, in order to become an accepted social value in its own. The example of the French end-of-life debate shows that depending on how the concept of autonomy is adapted and applied in a specific context, it can be compatible with the idea of solidarity. Such compatibility has been challenged previously in the international bioethics debate. By demonstrating the possibility of combining autonomy and solidarity, this paper makes an important contribution to the international bioethics debate and to the dialogue between countries that are often perceived as significantly different