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.

[Recovery of transportable organs after cardiac arrest].

The transplant of an allograft after cardiac arrest has been allowed in France since 2005 (decree of 2 august 2005: art R.1232-4-1, 2 and 3 of the public health code). Recently, according to the international scale, 4 situations that could lead to the realization of transplantable organs after cardiac arrest were identified according to a classification called "Maastricht" which describes the potential donors.

[Safety and accuracy of surgical procedures: case law evolution].

Surgeons, like other doctors, practice their profession within a framework of contractual liability defined by statute in 1936. This established that the doctor was subject to a contractual obligation to provide appropriate and diligent care. Care and technical acts should conform to those which would have been provided by a prudent doctor within the standards of knowledge and practice of his field; care which deviates from this standard would be considered medical error or fault.

Practitioner sex abuse: occurrence, prevention and disciplinary sanction.

Studies put forward figures for male practitioner sex abuse of around ten per cent. This practice, which is contrary to medical ethics, is highly reprehensible in ethical terms. The assaults range from uninvited meddling in patients' sexual lives to proven rape and inappropriate touching.

Recognition by French courts of compensation for post-vaccination multiple sclerosis: the consequences with regard to expert practice.

Over the past few years, despite scientific uncertainties, French courts have awarded compensation to sufferers of multiple sclerosis (MS) which occurred following vaccination against hepatitis B. These legal decisions have aroused fierce criticism in the medical world. Both a judgment given on 25 May 2004 by the Court of Cassation and a new publication in the journal Neurology have encouraged us to look once more at this controversial issue.

Healthcare law in France: towards healthcare emancipation for minors.

In France, since 1974 the rights of minors have been gaining ground. The first provisions to this end concerned medical acts in relation to the minor's sexuality (contraceptives and pregnancy termination). The law dated March 4, 2002, relating to patients' rights, gave more scope to this movement, by widening minors' rights so that they could demand confidentiality with regard to their parents.

Guidelines for doctors attending detainees in police custody: a consensus conference in France.

Medical practice in police custody needs to be harmonized. A consensus conference was held on 2-3 December 2004 in Paris, France. The health, integrity, and dignity of detainees must be safeguarded.

[More on compensation of the handicapped child].

By adopting a heading enTITREd "solidarity towards handicapped people" within the French law dated March 4, 2002 on health reform, the government hoped to put an end to the controversy that ensued after the so-called "Perruche" ruling. Since then, several rulings have been given by administrative jurisdictions and it seems that debate in this area is far from over. The first point developed concerns issues raised about the concept of 'characterized malpractice' introduced under this law, the only type of malpractice that may render a doctor liable.

Women who kill their children.

Unlabelled: The killing of a newborn on the day of its birth is known as neonaticide. A child aged 1 through 16 has a different role in the family, and their murder is perceived differently. We would expect mothers charged with filicide to be drawn from a slightly different population than other child-killing mothers.

Patients refusing medical attention: the case of Jehovah's Witnesses in France.

Respect for the wishes of a patient is internationally accepted as standard medical practice. In French law, this principle is enshrined in the Civil Code of 1994 which concerns bioethics. More recently in 2002, we find it included in the Code of Public Health (in the law concerning patient's rights).

Liability for pharmaceutical products: a difficult attempt at harmonisation.

On the 25 July 1985, the European Community adopted a Directive on liability for defective products. Doctors are very affected by this law because an injured person will possibly be able to take action against them. This directive had several aims: to harmonise member states' legislation concerning the legal protection of victims and to subject producers to the same framework of liability and competition rules.

[Patients refusal to be treated, the problem of Jehovah's witnesses].

The principle of respecting the patient's wishes is an international medical principle, found in several texts. In France, it was recalled in the 1994 Civil Code concerning bioethical laws and has recently been included in the Public health Code (law concerning patient's rights dated March 4, 2002). According to these various texts, the patient's wishes must always be respected, even in life threatening cases, so long as the patient has been informed of the risk.

Fatal blunt pancreatic trauma secondary to assault and battery: a case report.

The authors report on an fatal case of closed trauma of the pancreas in a context of violence. A 55-year-old man was found unconscious on the sidewalk and died a short time after being taken to the hospital. He had been hit with several punches to the face and abdomen 6 h before.

[Medical civil responsibility in the year 2000].

In France, during the last year, important jurisprudence was established by the French Supreme Court of Appeal concerning the physician's civil responsibility. On october 7, 1998, the Court decided that "the physician is not exempted for the obligation to provide information by the simple fact that these risks only materialize exceptionally". This means that from now, the physician must inform the patient of all risks that might influence the patient's decision, particularly information concerning life-threatening or severe consequences, but also, as in the past, concerning frequent even benign consequences.

[The obligation of means and the obligation of results].

Several important decisions were made in 2000 concerning the proof of malpractice and the fundamental principles of medical responsibility. In order to guarantee indemnities for victims of medical accidents, the French courts have facilitated the implication of medical responsibility for medical accidents. The notion of a "virtual fault" was developed allowing the courts to retain the responsibility of the surgeon for instance for injury to the sublingual nerve during extraction of a wisdom tooth or for injury to the popliteal artery (March 23, 2000).

[Intra-familial graft. Respecting public health regulation and professional confidentiality may be incompatible].

Under specific conditions, French law authorizes organ donation despite the donor's seropositivity for certain infectious conditions. The recipient must however be informed of the potential risk of graft-related infection. Anonymous donation being the rule, the rights of the donor are respected since his/her serological status remains a medical secret.

[Patient information: management in the beginning of the XXIth century].

The Conseil d'Etat, the supreme jurisdiction on legislative matters in France, rendered its decree on January 5, 2000, founding its decision on jurisprudence established in 1997 and 1998 by the supreme Court of Appeals. In accordance with this decision, physicians have a legal obligation to inform patients of all possible risks, including very exceptional risks. The information may be given to the patient in any appropriate form.

[Medical risk and liability in stomatology in the year 2000].

In the current context of scientific progress, the evolution of medical liability is directly related to the increasing potential danger of medical procedures, the widening field of medical intervention, the growing concern about becoming a victim, and the changing notions about responsibility. We present here recent changes in administrative and legal jurisprudence. As administrative instances have progressively acquired more and more freedom of action, they have successively accepted hypotheses of presumed misconduct, abandoned the prerequisite of major misconduct, and allowed cases of liability without misconduct.

Anatomical basis and results of the facial artery musculomucosal flap for oral reconstruction.

The facial artery musculomucosal (FAMM) flap is a newly designed buccal mucosal flap that was first described in 1992. The long rotational arc of this flap is particularly suitable for anterior palatal defects that are otherwise difficult to treat with local flaps. However, after the first clinical reports, some controversies arose about the reliability of this flap, so we conducted an anatomical study of the vascular pattern with a latex preparation in 10 cadavers.