Medecine & Droit最新文献

The Claeys-Léonetti law of 2 February 2016 provides a framework for the practice of deep and continuous sedation causing an alteration of consciousness maintained until death (SPCMD). In order to apply this measure, the doctor must implement a collegial procedure and respect certain conditions set out in the legislative provisions, but which are not defined and are therefore subject to interpretation. Moreover, the criteria for inclusion in the so-called “end-of-life” phase are not specified. This flexibility, deliberately chosen by the legislator, seems adapted to the complexity and variety of clinical situations and mobilizes the ethical deliberation of practitioners who must dialogue with the patient to implement an ad hoc medicine. However, this terminological vagueness may result in legal uncertainty and be a source of inequalities in the use of SPCMD. In any case, in order to promote the interests of patients and equal opportunities, it is urgent to reduce territorial inequalities in the provision of palliative care and to provide solid training on the law in force.

On 31 March 2021, a decree was published in the Official Journal concerning the procedures for the delivery of medical certificates to victims of violence. These victims can now obtain a copy of the certificate drafted by the doctor required by the judicial authorities, particularly as regards medical examiners.

Purpose

The aim of our study was to assess the impact of the March 31, 2021 decree on victims’ requests to the medical examiner for a copy of the medical certificate.

Methods

This prospective study was conducted among three forensic services receiving victims in consultation, using a paper questionnaire linked to Medlé data, over a three-month period.

Results

Of the 1,492 consultations conducted during the study period, a copy of the certificate was only given to the victim in 13.1 % of the consultations. It was requested spontaneously by the victim in 15.2 % of cases, most often to exercise his right (46.4 %). These were primarily consultations following an accident, psychological abuse, and assault. This copy was requested spontaneously by less than 3 % of victims of domestic violence. There was some disparity between the three centres regarding the minor victim.

Conclusion

This study is a small sample over a short period. The information of the victims, especially of domestic violence, on access to the copy of the medical-legal certificate seems still insufficient, and the principle of surrender, when it can help the victim in his efforts, can also be a source of confusion.

The law of February 25, 2008 introduced security detention. This is a post-sentence measure intended for offenders who have served their sentence. This may apply to people with personality disorders. Because of these disorders, they are considered too dangerous to be left in society but the importance of the disorders was not sufficient to benefit from the mechanism of criminal irresponsibility. Is the real objective of preventive detention, as indicated in the law, to treat disorders or, more pernicious, to eliminate ex-convicts from society?

Introduction

The declaration of death is the responsibility of every clinician. In the case of a suspicious, unexpected or violent death, the “obstacle médico-légal” (OML) must be ticked off on the death certificate. Published French studies on the OML concern exclusively pre-hospital doctors. The main objective of our study was to evaluate the knowledge and current practices of in-hospital physicians regarding the OML.

Material and methods

We carried out a descriptive, quantitative, multicentre study comprising firstly a retrospective collection of the number of certificates with OML issued in four hospitals in Maine-et-Loire (Angers University Hospital, Cholet Hospital, Saumur Hospital, CESAME) between 2017 and 2020, and then an anonymous questionnaire addressed to the post-graduate doctors and interns of these same hospitals, asking them about their knowledge and experience on the subject and including eight fictitious clinical cases on the situations most frequently encountered in practice. The free answers to the clinical cases were classified into four categories with the possibility of answering “I don’t know”.

Results

From 2017 to 2020, 1.7% (131/7484) of deaths at Angers University Hospital were concerned by an OML. The questionnaire collected a total of 386 responses out of 1596 people contacted (24.2%). The main obstacle to the installation of an OML was a “general lack of knowledge about the OML” (80.1% of participants). Having previous training in forensic medicine had a significant influence on the placement of an OML. Almost 50% of the participants would not apply an OML if there was a suspicion of misconduct during care. In all clinical cases, the majority response was category 1 (37% of responses).

Discussion and conclusion

The results of our study are similar to the current publications in the French literature concerning only pre-hospital doctors. The knowledge of clinicians about OML should be reinforced and they should be encouraged to seek advice from the on-call coroner at Angers University Hospital. Our study also addressed the problem of suspected medical malpractice situations, which represent an additional difficulty for doctors because of the conflict of interest generated and for which the OML procedure does not seem to be very suitable.

Medical law is written by jurisprudence and authors as well as by legislation. When a person is severely ill, in the case of emergency, and has no tutor to decide medical treatment, everybody may – and must – help him in that decision. “Good Samaritans” are so able to decide in certain circumstances. That is the right written by our Cour de cassation.

Brexit, by its magnitude, has many legal consequences, including the issue of access to healthcare. Although an exit agreement has been reached between the European Union and the United Kingdom, problems still arise regarding the social protection of European and British residents.

Compensation for professional damages in respect of young victims who remain disabled following an accident or assault remains problematic for personal injury compensation practitioners. However, such professional damages, recognized in principle by the Dintilhac group, were confirmed by the Court of Cassation in terms of full compensation for damages, both for loss of future earnings (PGPF), and professional incidence (IP). Though the burden of proof lies with the victim, experts have a major role to play in assessing these losses by setting out the foreseeable impact of the after-effects on the victim's professional activities, and on his or her professional potential before and after the injury, along with limitations in terms of the jobs the victim is subsequently able to do.

Though professional damages in respect of young personal injury victims are recognized in principle by the Dintilhac group, and confirmed by the Court of Cassation in terms of full compensation for damages suffered, the assessment of such professional damages remains difficult, and the source of myriad legal disputes. The recognition and assessment of professional incidence raises the question of the risk of double compensation: The cumulative award of lifetime compensation for lost future earnings and of compensation for professional incidence not recognized at first by the 2nd chamber of the Court of Cassation is a source of debate in terms of both doctrine and jurisprudence. Though a source of discussion, the cumulative award of compensation for professional incidence and for educational, academic or training damages (PSUF) is more consensual.

Though professional damages in respect of young personal injury victims are recognized in principle by the Dintilhac group, and confirmed by the Court of Cassation in terms of full compensation for damages suffered, the assessment of such professional damages remains difficult, and the source of myriad legal disputes. Assessment of lost future earnings requires a specific approach: As regards the benchmark salary, judges base this on the average or median salary in France, taking into account the social and family environment which may represent a loss of opportunity. The jurisprudence recognizes that the permanent incapacity of the victim entitles them to lifetime compensation, mostly in the form of an annuity. However, while the civil judge considers that the payment of an allowance for disabled adults (AAH) or an educational allowance for disabled children (AEEH) does not interfere with the calculation of lost professional earnings, the administrative judge takes the opposite stance.