New French legislation governing organ removals for therapeutic and scientific purposes.

In France the general principles of organ donation are: consent, absence of financial gain, anonymity, advertising is prohibited, healthcare safety. As regards organ removals from living persons, a panel of experts is required to give approval. The recipient's 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's father or mother. The donor may also be any person who provides proof of having lived with the recipient for at least two years. As regards organ removals from Deceased Persons for Therapeutic Purposes, removals may be practised if the deceased did not make known their refusal during their lifetime (this may be recorded in the national registry set up for this purpose). The doctor must not seek the family's opinion, but rather ensure that the deceased did not express opposition to organ donation during his lifetime. The rule of presumed consent should apply, unless there is any danger to the health of the general public. This paper describes and discusses in detail the new legislation and its relationship to existing French legal codes.

[The person of trust, a new tool in the physician-patient relationship]. / La personne de confiance, nouvel outil de la relation médecin patient.

THE NOTION OF A PERSON OF TRUST: Introduced by the law dated March 4th 2002, the person of trust is there to accompany the patient in all his/her measures of care; this person is also conceived as an helper in medical decisions or when the patient participates in biomedical research protocols. DESIGNATION MODALITIES: Any adult, unprotected patient can designate a person of trust, whose intervention is not only limited to hospitalisation (the nursing staff are obliged to propose such a person), but can also intervene during care at home or at the doctor's. The designation is made in writing and can be revoked at any time. The person of trust can be a relative, a friend or even the treating physician. A SPECIFIC ROLE: The person of trust can be of help in medical measures in routine medicine when the patients needs to be accompanied, and in the case of diagnosis or serious prognosis, and when the patient is incapable of expressing him/herself.

[Surgery and transfusion in Jehovah's witness patient. Medical legal review]. / Chirurgie et transfusion chez les patients témoins de Jéhovah. Mise au point médico-légale.

The religious convictions of the witnesses of Jehovah leads them to refuse transfusion of blood, of its major components and of blood sparing procedures breaking the physical contact between the patient and his blood. We recall the rules of good practice in case of elective surgery concerning exhaustive information of the patient within multidisciplinary team associating anesthetist and surgeon advised by the forensic pathologist. This consultation must, to our point of view, be concluded by a report which summarizes what is accepted or not by the patient. This report will be initialed by the patient. This consultation can never lead the physician to swear to never use a transfusion whatever the circumstances. In case of emergency if and only some conditions are met (everything was made to convince the patient, vital emergency, no therapeutic choice, therapeutic care adapted to the patient heath status), the physician can be brought to overpass the patient's will to not receive blood transfusion. Current jurisprudence has, to date, never recognized as faulty the physicians having practiced such transfusions whenever they took place within a precise framework.

Legislative recognition in France of psychological harassment at work.

The recent French Law on Social Modernisation of 17 January 2002 introduced into the French Labour Code and into the French Criminal Code, the concept of "moral" harassment. The definition of psychological harassment under this law adopts quite a broad conception of the notion of psychological harassment. The legislator has established a means for "friendly" settlement of disputes: mediation. When it has not been possible to settle the dispute internally, the Courts have a number of sanctions available to them. The French Labour Code provides that any termination of the contract of employment resulting from a situation of psychological harassment is automatically null and void. Such nullification should therefore be applicable whatever the nature of the termination: dismissal, resignation or negotiated departure and it punishes psychological harassment at work by imprisonment for one year and a fine of 3,750 Euros. The French Criminal Code prescribes penalties of one year and 15,000 Euros.

Postoperative bilateral vertebral artery dissection: a case report.

With the improvement of medical imaging and surgical techniques, surgery on cervical vertebral is more frequent. Some cases of complications of this type of surgery have been described. We report a case of postoperative bilateral vertebral artery dissection. It concerns a 58 year-old woman who suffered from a left cervico-brachial C6 neuralgia with paresthesiae of the thumb. She underwent discectomy at C5-C6 and C6-C7 followed by setting up intersomatic cages. In subsequent days, an irreversible coma developed. Supra-aortic echographic study revealed bilateral vertebral artery thrombosis. CT scan revealed ischemic lesions of the brain stem and cerebellum. Cerebral death was declared five days after the operation. Autopsy was performed to determine whether death was the consequence of the intervention. The cause of death was determined to be ischemic brain injury of the brain stem and cerebellum resulting from bilateral traumatic occlusion of the vertebral arteries caused by the surgery.