In matters of bioethics, France has made the singular choice of not leaving it to experts alone to decide what medicine can or must do. This choice results in the articulation of three inseparable pillars which are the CCNE (National Consultative Ethics Committee for Life and Health Sciences), bioethics laws and the States General of Bioethics.
By organizing the 2026 edition of the Estates General in a complex international and national geopolitical context, we wanted to honor this French originality which is to convene a space for national deliberation on the questions of life, care and biomedical innovations, before a revision of the law relating to bioethics in 2028.
Health innovations with unprecedented power
We are witnessing an unprecedented acceleration of health innovations. Genomic medicine, organoids, neuroscience, the prospects of xenotransplantation or organ regeneration and the emergence of artificial intelligence in healthcare practices are modifying the capabilities of medicine and the boundaries between the possible and the legitimate.
Perhaps tomorrow, we will be able to have an unprecedented power: that of acting directly on the very foundations of the human being. What will we do with this power? This question leads us to question what the notion of “progress for the person” really covers.
To respond to this, bioethical reflection must be shared with society and be based on essential principles, recalled in particular by the Council of State in 2018: the dignity of each person; individual freedom, guaranteeing respect for private life, autonomy and consent; finally, solidarity, which is reflected both in the French concept of donation, anonymous and altruistic, and in the attention paid to the most vulnerable people.
20,000 participants and 1,000 scientists consulted
The approach to this new meeting with society, a few years after the health crisis linked to the Covid-19 pandemic, was based on a broad mobilization combining hearings with institutional and scientific stakeholders, territorial events and citizen work, supplemented by expert seminars.
This dynamic made it possible to involve around 20,000 participants and more than 1,000 scientists across the entire territory and to structure a debate covering the main themes of a broader vision of bioethics articulated on future generations, ranging from genetics to digital health, including prevention and territorial inequalities.
Make no mistake, the Estates General of Bioethics does not constitute a survey on the state of French opinion on questions that concern many of us. But leading a public debate by meeting citizens, without aiming to obtain a consensus, contributes to gathering most of the arguments expressed in response to questions such as: should preconception genetic screening be offered?
Can the desire to have a child, as legitimate as it may be, be honored if it must involve attacks on the integrity of women, even those who are voluntary and altruistic in their approach? Does the development of neurotechnologies raise fundamental questions about the privacy of each person and their free will? How can we ensure that consent to organ donation is truly respected in a system that relies essentially on silence as assent?
Going beyond the logic of care to move towards “good health”
The question of proper care was also at the heart of the discussions held during these meetings. It invites us to question the limits of ever-increasing medicalization, or even over-medicalization with a quasi-industrial system focused on care and not on good health. From this perspective, sobriety in health can lead to changes in access to care practices, by confronting them with the requirements of the general interest.
But what does “being fair” to a patient actually mean? Should we question the principle of equality in the face of illness to achieve a more equitable distribution of health goods and services? If the 2018 consultation highlighted the central place of the citizen, user or future user, in the medicine of tomorrow, that of 2026 highlights the anchoring of bioethics in a renewed conception of life and progress. This is no longer seen as a mastery of life, but as the recognition of our interdependencies, in their strength as well as their fragility.
This more global approach to health, which goes beyond purely curative logic, makes it possible to reconcile different dimensions, starting with prevention. It also calls for better consideration of the social and environmental determinants of health, as well as inequalities in access to care, particularly visible in overseas territories.
Intergenerational solidarity and consent to care
Other significant facts were also highlighted, in particular the need to think about new conditions for exercising consent or developing the caregiver-patient relationship.
Finally, the young public occupied a privileged place in these meetings. If he can be worried, even pessimistic about his future, he nonetheless remains attached to more intergenerational solidarity which must also be in both directions. This aspiration was expressed in particular through the words of one of them: “The medicine of the self is inseparable from the medicine of the we. »
These States General do not only represent a consultation exercise, but a structuring time for public decision-making in bioethics. They are now calling for explicit consideration of the choices that will be made during the next revision of the law.
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