New Values, New Moral Attitudes, and New Dilemmas? the Metamorphoses of Professional Ethics Among French General Practitioners in a Renewed Primary Care Governance Context

French private GPs’ values have been historically structured by the ideological frame of the so-called “médecine libérale”. Although they have consented to collective conventions and regulatory fees, their individual consciousness is supposed to support professional ethics in the service of the patient. Public regulation has been suspected in damaging their professional commitment. This traditional settlement has been destabilized by new governance principles introduced to regulate (more from above than from inside) the professional autonomy through new professionalism criteria. We would like to examine how different types of reforms raise different ethical issues.

Some reforms have sought to give more content and opposability to classical professional morality (about continuous training, accountability, independence from the firms, respect for patients’ rights, fee moderation or acceptance of poor patients). Other ones have been presented in the name of rationalization or public health, but have equivocal moral implications on the way GPs treat their patients. For instance patient lists have been introduced for each doctor, and more prevention is required, both should lead GPs to develop a more collective perspective on the population they are in charge of and use systematic procedures: does it affect their consideration of patients’ personal complaints? does it made them aware of social inequalities in the care they dispend? A third kind of reform has introduced financial incentives and may threaten altruist motivations by treating GPs as common self-interested economic agents.

How do GPs deal with the moral implications of these inflections of their mandate, which intersect with concomitant changes in their own inclinations? Do they reaffirm classical professional ethics or adapt it? Does it lead to coherent changes in shared professional ethics, to new individual dilemmas, or to “moral fragmentation” between different medical sub-cultures? Our analysis will be empirically based on 100 interviews focused on preventive care.