L'information des patients en ORL : législation, jurisprudence et incidences sur les pratiques

Abstract

The law of March 4, 2002 is the pedestal of legal responsibility in medicine in France. This law resumed data stemming from the jurisprudence but innovated also by establishing for example the “confidant” person and the direct access of the patient to his medical file. This law established or strengthened the rights of the patients: respect for dignity, respect for refusal of care, right to end-of-life care, right to adequate analgesia, right to the respect for professional confidentiality but also right to the information. The obligation of information is justified by the respect for the autonomy of the patient and by the necessity of obtaining a free and lit assent. Information is not only a preliminary to the medical act; it has to be done before, during and after. In case of complication, it will be reinforced. The information has to deal with the necessity of the medical act, the expected benefits, the possible urgency, the consequences, the normally predictable frequent or severe complications, the alternatives and the predictable consequences in case of refusal. The oto-laryngologist can refuse to perform an act prescribed by a colleague that he considers useless or too dangerous as compared to the benefit expected. The surgical oto-laryngologist in private practice has to prove that he informed his patient and it is his (compulsory) malpractice insurance that financially compensates the patient in case insufficient information leads the patient to lose his or her chance to refuse treatment. If the surgical oto-laryngologist practices in a public hospital, the establishment has to bring this proof of sufficient information, and in case of litigation, the hospital must provide compensation. One will note that the more difficult it is to justify the medical act, the less the judges tend to tolerate insufficient patient information. If the indication of the act is indisputable from a medical standpoint, then legally there is usually no ground for litigation due to insufficient information except possibly emotional damage.