The French medico-legal concept of aptitude and fitness appraisal by occupational physicians: an ethical issue?

For many years, medical aptitude in occupational health, a French exception, did not raise any particular issue. However, from the 1980's onwards, this concept has been approached from a more critical point of view, authors questioning its compatibility with personal liberty. The increase in precarious working conditions have but reinforced such criticism, raising the question of the confrontation of such a concept with due respect of the right to work and the right for health protection. Special decrees, in particular the CMR decree (relating to carcinogenic, mutagenic and toxic substances for reproduction), issued in 2001, have added further force to the debate, particularly with regard to the problematic compatibility between the notice of aptitude and the respect of medical ethics and deontology. After having exposed the reasons behind the debate on aptitude in occupational health, and having identified the associated ethical issues, we will discuss the eventuality of the concept's abolition, together with possible replacement solutions.