[A difficult end of life]. / Une fin de vie difficile.

The law specifies how a doctor may write a medical certifcate and how a patient or his beneficiaries can obtain his medical records. It's important for a doctor to know this rules. A 56 years old patient was referred to our hospital for pulmonary adenocarcinoma cT2N2M1, the clinical stage was IV. The patient underwent radiotherapy and chemotherapy. During the treatment, the relations with the family were difficult. The patient refuse to accept the doctors tell his son any information and get married with his companion in secret. After patient's death, the son and the wife asked for many medical certificates. The doctors turned down so the son asked for the patient medical records. This observation asks the question of the medical certificates: how and when write them, which are obligatories? Moreover, how should a patient or his beneficiaries obtain medical records?

[Confidentiality in medical practice: tell no one]. / Le secret médical à tout prix?...

Medical confidentiality is sometimes difficult to impose on patient's families, especially in the field of oncology. Here, we describe the case of a 54-years-old woman with a T1N0M0 lung adenocarcinoma. After the diagnosis was made, she advised the medical team not to inform her family about her disease. Although the patient was aware of the high-risk of relapse, she was lost of follow-up after first-line treatment. Five years later, she presented with multi-metastatic recurrence and had to be admitted in an intensive-care unit for severe respiratory failure due to tumor progression. She kept refusing to inform her family, which in the end was contacted by the patient's sister, a few hours before her death. This observation highlights the absolute inviolability of medical confidentiality and led the French Association of Young Pneumologist to initiate a multi-disciplinary symposium on ethical problems raised by the management of patients with lung cancer.

[Withholding and withdrawal decisions in oncology: legal frame and practice]. / Limitation thérapeutique en oncologie: encadrement légal et mise en pratique.

Whereas medicine is progressing in illness treatment that used to be incurable, physicians are still faced with treatment failure. Hippocrates used to say: "primum non nocere" [1]. When the patient cannot expect benefit from potentially aggressive care, current or possible treatments have to be challenged to leave just the ones giving immediate benefice. To determine a legal frame and to protect people in the end of life, law n degrees 2005-370 concerning to the rights of ill people and end of life was declaimed during April 2005. After presenting a clinical course illustrating a situation of difficult end of life, we propose an introduction point by point of the law, opposing practical situations to law and medical deontological code. Withholding and withdrawal decisions theme is taken by the standpoint of the doctor initiating this thought, the patient request, and the case of patient who cannot express his will.

[A difficult diagnosis]. / Un diagnostic difficile...

The patient information and obtaining their consent before any therapeutic constitute a basis for medicine exercise. However, there are situations where the physician may be in default. In that case, concepts of benefit/risk balance, of clear and appropriate information, and of legal liability for medico-surgical staff takes all their magnitude. That was the case in our observation, with a 69 years old patient with history of smoking, presenting a suspicious lung opacity which will require, following an agreement by multidisciplinary meeting, an exploration by thoracotomy despite an acceptable but altered respiratory function, as a result of a post-smoking broncho-emphysema. The non-malignant character of the suspected lesion raise questions about the risks involved, the benefit/risk balance, and the legal risk scopes of the medicosurgical staff as defined in the Cancer programme framework.