Le mineur dans la relation de soin. Introduction

Dans le droit de la santé, les droits du mineurs se sont accrus. Le principe de l’autorité parentale est remis en cause dans plusieurs domaines, notamment celui de la contraception et de l’interruption de grossesse. En généralisant l’autonomie du mineur, la loi du 4 mars 2002, relative aux droits de malades, et celle du 9 août 2004, relative à la santé publique, ont amplifié ce mouvement. Cependant, le médecin peut se voir confronté à des situations délicates entre respect de ces nouveaux droits du mineurs et autorité parentale. En effet, l’autorité parentale reste le cadre naturel de la protection du mineur, notamment de sa santé, et le médecin se doit d’obtenir l’accord des parents avant de pratiquer les soins nécessaires. Quelle doit être l’attitude du médecin devant un éventuel conflit familial ? C’est la question à laquelle nous allons tenter de répondre durant cette journée

Comment initier une mesure de protection juridique ?

La réforme de mars 2007 est forte d’un impact non négligeable sur la façon d’initier une mesure de protection juridique concernant les majeurs vulnérables. À côté des mesures judiciaires de protection classiques (sauvegarde de justice, curatelle et tutelle), qui restent majoritaires, vient s’ajouter une nouvelle mesure de protection de nature conventionnelle : le mandat de protection future. Les auteurs se proposent de rappeler de manière pragmatique la procédure afin d’initier une mesure de protection

Homicide et enfant à naître : une occasion manquée

The ruling of June 30, 1999 was one of the first significant rulings given by the French Supreme Court with regard to the criminalization of unintentional feticide. The question posed essentially asked whether a physician who committed a fault leading to the death of a fetus could be accused of manslaughter, which is a criminal offense under Article 221-6 of the French Criminal Code? The Court ruled not to describe this as feticide. It upheld this position in several subsequent rulings, considering that the unborn child, even when viable, was not a human being equipped with a legal personality. Early on, the French doctrine displayed shock at the fact that no criminal offense was recognized and, in its majority, it condemned the Supreme Court\u27s position, both on legal arguments and extra-legal arguments. Case law was stable until February 4, 2014, when a criminal court sentenced a motorist for the manslaughter of a six-month old fetus, following its death in utero. On appeal, one year later, the Court ultimately upheld the position of the French Supreme Court

The problem with medical research on tissue and organ samples taken in connection with forensic autopsies in France

Currently, in France, it is legally impossible to conduct scientific research on tissue and organ samples taken from forensic autopsies. In fact, the law schedules the destruction of such samples at the end of the judicial investigation, and the common law rules governing cadaver research cannot be applied to the forensic context. However, nothing seems in itself to stand in the way of such research since, despite their specific nature, these samples from forensic autopsies could be subject, following legislative amendments, to common law relating to medical research on samples taken from deceased persons. But an essential legislative amendment, firstly to allow the Biomedicine Agency to become authorized to issue a research permit and secondly, to change the research conditions in terms of the non-opposition of the deceased to said research. Such an amendment would be a true breakthrough because it would allow teams to continue to move forward calmly in research, and allow this research to be placed within a legal framework, which would promote international exchanges

Proof of patient information: Analysis of 201 judicial decisions

INTRODUCTION: The ruling by the French Court of Cassation dated February 25, 1997 obliged doctors to provide proof of the information given to patients, reversing more than half a century of case law. In October 1997, it was specified that such evidence could be provided by "all means", including presumption. No hierarchy in respect of means of proof has been defined by case law or legislation. The present study analyzed judicial decisions with a view to determining the means of proof liable to carry the most weight in a suit for failure to provide due patient information. MATERIAL AND METHOD: A retrospective qualitative study was conducted for the period from January 2010 to December 2015, by a search on the LexisNexis JurisClasseur website. Two hundred and one judicial decisions relating to failure to provide due patient information were selected and analyzed to study the characteristics of the practitioners involved, the content of the information at issue and the means of proof provided. The resulting cohort of practitioners was compared with the medical demographic atlas of the French Order of Medicine, considered as exhaustive. RESULTS: Two hundred and one practitioners were investigated for failure to provide information: 45 medical practitioners (22±3%), and 156 surgeons (78±3%) including 45 orthopedic surgeons (29±3.6% of surgeons). Hundred and ninety-three were private sector (96±1.3%) and 8 public sector (4±1.3%). Hundred and one surgeons (65±3.8% of surgeons), and 26 medical practitioners (58±7.4%) were convicted. Twenty-five of the 45 orthopedic surgeons were convicted (55±7.5%). There was no significant difference in conviction rates between surgeons and medical practitioners: odds ratio, 1.339916; 95% CI [0.6393982; 2.7753764] (Chi test: p=0.49). Ninety-two practitioners based their defense on a single means of proof, and 74 of these were convicted (80±4.2%). Forty practitioners based their defense on several means of proof, and 16 of these were convicted (40±7.8%). There was a significant difference in conviction rate according to reliance on single or multiple evidence of delivery of information: odds ratio, 0.165; 95% CI [0.07; 0.4] (Chi test: p=1.1×10). DISCUSSION: This study shows that surgeons, and orthopedic surgeons in particular, are more at risk of being investigated for failure to provide due patient information (D=-0.65 [-0.7; -0.6]). They are not, however, more at risk of conviction (p=0.49). Being in private practice also appeared to be a risk factor for conviction of failure to provide due information. Offering several rather than a single means of proof of delivery of information significantly reduces the risk of conviction (p=1.1×10). LEVEL OF EVIDENCE: Level IV: Retrospective study

Le préjudice moral né du défaut d’information du patient

Le défaut d’information du patient sur les risques d’un acte médical pourrait-il être constitutif d’un préjudice moral dit « préjudice d’impréparation » alors qu’aucune perte de chance ne peut être retenue 

L’immunité indemnitaire du médecin salarié ne profite pas à son assureur. À propos de Civ. 1, 12 juillet 2007

Selon un arrêt du 12 juillet 2007 de la Cour de cassation, l’assureur de responsabilité civile de l’établissement de soins, tenu, en sa qualité de commettant, pour responsable du dommage causé par son préposé, peut exercer un recours subrogatoire contre l’assureur du salarié

Faut-il reconnaître l’« aléa chirurgical » ?

Depuis plusieurs années, la jurisprudence considère de manière distincte la faute de technique opératoire. L’obligation d’exactitude du geste opératoire s’est vue renforcée et depuis 1997, il semblait acquis que la faute technique puisse être retenue dès lors que le praticien « porte atteinte à un organe ou à un tissu qu’il n’était pas nécessaire de toucher pour réaliser l’intervention ». Pourtant, dans certaines situations, le dommage n’est pas en rapport avec un manquement aux règles de l’art, mais lié à une complication inhérente à la technique. La Cour de cassation avait toujours refusé l’idée d’un « aléa chirurgical » et reconnu que toute atteinte d’un organe, autre que ceux visés lors de l’intervention, révélait obligatoirement une imprudence du chirurgien. Pourtant, en reconnaissant comme fautif un chirurgien qui a respecté les règles de l’art, le juge risque de s’éloigner des principes de la responsabilité médicale. Des arrêts rendus ces trois dernières années nous amènent à rediscuter l’opportunité de reconnaître l’existence d’un aléa chirurgical

Updated review of postmortem biochemical exploration of hypothermia with a presentation of standard strategy of sampling and analyses.

Hypothermia is defined as a core body temperature below 35°C and can be caused by environmental exposure, drug intoxication, metabolic or nervous system dysfunction. This lethal pathology with medico-legal implications is complex to diagnose because macroscopic and microscopic lesions observed at the autopsy and the histological analysis are suggestive but not pathognomonic. Postmortem biochemical explorations have been progressively developed through the study of several biomarkers to improve the diagnosis decision cluster. Here, we present an updated review with novel biomarkers (such as catecholamines O-methylated metabolites, thrombomodulin and the cardiac oxyhemoglobin ratio) as well as some propositional interpretative postmortem thresholds and, to the best of our knowledge, for the first time, we present the most adapted strategy of sampling and analyses to identify biomarkers of hypothermia. For our consideration, the most relevant identified biomarkers are urinary catecholamines and their O-methylated metabolites, urinary free cortisol, blood cortisol, as well as blood, vitreous humor and pericardial fluid for ketone bodies and blood free fatty acids. These biomarkers are increased in response either to cold-mediated stress or to bioenergetics ketogenesis crisis and significantly contribute to the diagnosis by exclusion of death by hypothermia