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 

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

Léiomyosarcome de la veine rénale gauche dans un contexte de polyarthrite rhumatoïde sous méthotrexate

RésuméLe léiomyosarcome de la veine rénale est une tumeur maligne exceptionnelle dont la détection est délicate, le traitement mal codifié et le pronostic sombre. Nous décrivons le cas d’une patiente de 68 ans atteinte de polyarthrite rhumatoïde et développant un léiomyosarcome de la veine rénale gauche avec une issue fatale en moins d’un an. L’association à une polyarthrite rhumatoïde traitée par méthotrexate pose donc la question d’une combinaison fortuite ou d’un terrain favorisant compte tenu des études récentes qui tendent à prouver l’association entre ce rhumatisme et certains cancers

La recherche juridique sur les prélèvements biologiques réalisés dans le cadre des autopsies et objets de scellés judiciaires. Nécessité d'une adaptation législative

Currently, 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 will have the goal 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 the 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

Organ donation in France: legislation, epidemiology and ethical comments

The Bioethics Laws revised in 2004 have defined rules concerning organ donation and transplantation. They have also permitted the creation of the French Biomedicine Agency which guarantees the right of enforcement. In France there are three situations in which organs may be harvested: from cadaveric donors, from living donors and, since 2005, from non heart beating donors.Organ harvesting from cadaveric donors is permissible if the deceased did not make known his refusal during his lifetime (this may be recorded in the national registry set up for this purpose). The rule of presumed consent also applies in the case of organs taken after cardiac arrest. With regard to organ harvesting from living persons, a panel of experts is required to give approval. The recipient\u27s spouse, brothers or sisters, sons or daughters, grandparents, uncles or aunts and first cousins may be authorised to donate organs, as well as the spouse of the recipient\u27s father or mother. The donor may be any person who provides proof of having lived with the recipient for at least two years. Some ethical questions will need to be resolved; for example the relevance of maintaining the EEG for brain death diagnosis, enforcement of the law on presumed consent, the real nature of the will of living donors and the definition of death

Preface: Approaches and methods to improve risk management in volcanic areas

Active volcanoes can generate multiple types of geological hazards. Besides syneruptive threats (e.g., lava, pyroclastic flows or ash fall), other adverse events such as landslides or lahars can occur at any time. To manage these threats efficiently, three key objectives must be jointly addressed: (1) improving prevention tools, through the collection and acquisition of data on hazards and risks, and its dissemination as maps and scenarios; (2) improving crisis management capabilities, based on monitoring and early warning systems, but also reliable communications systems; and (3) reducing people’s vulnerability and developing recovery and resilience capabilities after an event has occurred. The special issue “Approaches and methods to improve risk management in volcanic areas” presents research results focusing on these three objectives. It demonstrates the utility of addressing them jointly, and particularly examines the case of volcanoes where little knowledge is available. These results were presented at the conference Integrated Approaches for Volcanic Risk Management (Hohenheim University, Stuttgart, 11/12 September 2012) of the European MIAVITA (MItigate and Assess risk from Volcanic Impact on Terrain and human Activities) project