Ethical issues arising from the requirement to sign a consent form in palliative care.

International audienceFrench healthcare networks aim to help healthcare workers to take care of patients by improving cooperation, coordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the network should be given to patients when they enter a healthcare network. The law requires that this document be signed. Ethical issues arise from this legislation with regard to the validity of the signature of dying patients. Signature of the consent form by a guardian or trustee, a designated person--the Person of Trust--transforms the doctor-patient relationship into a triangular doctor-patient-third-party relationship

[Neonatal resuscitation and unreasonable obstinacy: a hospital ordered to pay damages].

International audienc

[Principles and stakes of external communication of healthcare networks: the case of heathcare networks for health services accessibility]

International audienceHealthcare networks which purpose is to manage patients through better coordination of the care, need to develop a communication strategy to be recognized by the public and by healthcare professionals and to be inserted in the healthcare landscape. We firstly will present legal requirements related to external communication of healthcare networks. Then, we will describe the different tools which can be used to communicate about healthcare networks in its area, with the example from a healthcare network for health services accessibility. In the French Public health code, the legal status and the ethical charter of the healthcare network have to be delivered to the healthcare professionals in its area and to the patients. Moreover, the example healthcare network informed collectively and individually the healthcare professionals of its area about its activities. It made it known to the public by the way of departmental prevention manifestations and health education sessions in community social associations. From these examples, we will conduct an ethical reflection on the modalities and stakes of the external communication of healthcare networks

Maltraitance envers les enfants et Covid-19

En France, au début de l’année 2020, environ 690 000 vies ont pu être épargnées grâce au confinement général de la population et aux mesures restrictives de lutte contre la Covid-19. Conséquence inattendue, ces mesures ont eu un impact sur une autre frange vulnérable de la population : celle des jeunes enfants, pour lesquels il a été démontré une augmentation des maltraitances subies à cette période. À partir de données de la littérature et de l’apport de nos travaux de recherche dans le domaine, nous proposons une documentation de cette crise des violences intra-familiales, intriquée dans la crise sanitaire de la Covid-19

Why did most French GPs choose not to join the voluntary national pay-for-performance program?

BACKGROUND: In 2009, a voluntary pay for performance (P4P) scheme for primary care physicians was introduced in France through the 'Contract for Improving Individual Practice' (CAPI). Although the contract could be interrupted at any time and without any penalty, two-thirds of French general practitioners chose not to participate. We studied what factors motivated general practitioners not to subscribe to the P4P contract, and particularly their perception of the ethical risks that may be associated with adhering to a CAPI. METHOD: A cross-sectional survey among French general practitioners using an online questionnaire based on focus group discussion results. Descriptive and multivariate statistical analyses with logistic regression. RESULTS: A sample of 1,016 respondents, representative of French GPs. The variables that were associated with the probability of not signing a CAPI were "discomfort that patients were not informed of the signing of a P4P contract by their doctors" (OR = 8.24, 95% CI = 4.61-14.71), "the risk of conflicts of interest" (OR = 4.50, 95% CI = 2.42-8.35), "perceptions by patients that doctors may risk breaching professional ethics" (OR = 4. 35, 95% CI = 2.43-7.80) and "the risk of excluding the poorest patients" (OR = 2.66, 95% CI = 1.53-4.63). CONCLUSION: The perception of ethical risks associated with P4P may have hampered its success. Although the CAPI was extended to all GPs in 2012, our results question the relevance of the program itself by shedding light on potential adverse effects

Ethical issues arising from the requirement to provide written information in palliative care.

French Healthcare Networks aim to help healthcare workers take care of patients by improving co-operation, co-ordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care, including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the Network should be given to patients when they enter a Healthcare Network. Ethical problems arise from this legislation with regard to providing terminal patients with explicit information upon their entry into the palliative phase of the disease, and requiring them to sign the document. It highlights the limitations of this practice, and the gap between the legislation and the nature of the physician-patient relationship in palliative care

: ITT: recommandations en pratique clinique

10 pages. Recommandations pratiques s'inscrivant dans le prolongement de la publication des recommandations professionnelles de la Haute autorité de santé en octobre 2011International audienceTotal incapacity to work (TIW) is a legal concept that allows magistrates to assess the severity of violence against persons. The TIW is the duration of the victims' inability to fulfil their usual activities and is determined by physicians. Professional guidelines from the French National Authority for Health indicate that TIW applies both to physical and psychological problems. The law of 9 July 2010 makes explicit reference to TIW in cases of psychological violence and intimate partner harassment. Prosecutors base criminal penalties on the duration of TIW in cases of assault and battery. Whatever the physician, they should describe the mental state of the victim and identify the signs that may indicate the mental impact of reported assaults. Identifying combinations of symptoms can be useful in deciding whether the duration of TIW should be increased because of the psychic state. In case of stalking, assessment of TIW can allow prosecutors to link the reported facts to a criminal offence. In complex situations, the physician may be unable to assess a duration of TIW and can suggest expert assessment. In all cases, the duration of TIW needs to be based on functional criteria. The extent of harm to the life of relationships results from suffered violence, from the victim's reaction, and from the perception of their family and friends. In this area, we suggest to limit the first assessment of TIW to a few days and to reassess it later, according to real information reported by the victims, to careful observation of their behaviour, and to results of a questioning that should be as little suggestive as possible. At either end of the age scale and in case of preexisting functional impairment, assessment of TIW should take into account the actual and global capacity of the person before the assault

Hospitalization for physical child abuse: Associated medical factors and medical history since birth

International audienceBackground: Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population. Objective: To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France. Participants and setting: We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS). Methods: To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability). Results: Over the 2009–2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8–2.7]), male sex (aHR = 1.3[1.2–1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4–2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5–4.7]) with being hospitalized for physical abuse. Conclusion: These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason

[The irresponsible psychiatric patient, the new actor of the criminal procedure: the evolution of the notion of penal irresponsibility].

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Le patient psychiatrique irresponsable, nouvel acteur de la procédure pénale

Au cœur d’une société où les valeurs sont en mutation, le malade irresponsable, jusqu’alors écarté des procédures, se voit intégré dans le processus judiciaire pénal. Même si le Code pénal et le Code civil sont à ce jour inchangés, le Code de procédure pénale connaît un remaniement majeur. Le Code de santé publique pourrait également connaître une révision prochaine. Ainsi, si la loi du 25 février 2008 clôt une quinzaine d’années de réflexion et d’évolution autour de la notion de l’irresponsabilité pénale pour trouble psychique, elle ouvre parallèlement tout un champ de nouvelles pratiques. La présence du patient psychiatrique lors du procès pose une difficile question d’équilibre. Pour le malade d’abord, entre respect de ses particularités et de son statut de citoyen à part entière qui doit répondre de ses actes lorsque son état le permet. Pour les victimes ensuite : équilibre entre le respect de leur place nouvelle si durement acquise au coeur des procédures judiciaires et le sens fondamental de l’action judiciaire qui ne peut considérer que les intérêts individuels. Ces remaniements nous font nous interroger sur le rôle du médecin psychiatre auprès du malade et de la société