La décision médicale et la relation médecin–patient en oncologie

The announcement of the cancer diagnosis and his treatment is an important moment in the set up of the doctor–patient relationship. The law of contracts has long governed the relationship between the doctor and the patient. But the legislature clearly demonstrated its will to consider the patient as full actor of his health, leaving the regime of medical decision, the shared decision. This shared decision is based on an obligation to inform the patient on his health and knows many exceptions (minor patients or adults under guardianship, emergency). In Oncology, the medical decision is a decision coordinated between doctors in the multidisciplinary consultation meetings. This decision is considered as a guarantee of the quality of the medical care. It does not preclude the time of the doctor–patient relationship.     

Sciences médicales et droit

How does Law unravel and seize Medicine? The relationship between Law and Medicine is tremendously complex. At first sight, Law understands medicine as being a medical science, an applied science, and imposes requirements in this regard, such as respect for the “established scientific knowledge” or “tested medical knowledge”. But Medicine turns out to be “Art”, a clear and authentic expertise which requires techniques reiteration. Seen by Law, Medicine is not classified into either both of these scientific or technical dimensions. Borrowing from human sciences also allows to set requirements for medical humanism.     

De l'argumentation comme métamorphose

Linguistic rhetoric and argumentative reasoning are generally identified. Certain types of problems, however, make use of non-verbal systems of representation, and, among them, image. Image is not just matter but also form, and computer processing in AI makes it possible to grasp this form by linguistic means (logico-mathematical languages). The synthesis of animated images has made it possible to represent metamorphoses, the thought of the unexpected. The fact that language produces image (and conversely) does not fail to transform the standard ways of thinking about epistemology.

     

Vers une métrique absolue dans les épreuves d'évaluation subjective: La méthode fonctionnelle

The functional method is a new construction method of subjective evaluation tests such as personality, values or competences. Its approach differs from the usually used methods that are directly inherited from the works of Spearman that are tests of maximal performances. The latter tests were developed (almost one hundred years ago) for selection purposes in a differential perspective that suggests certain “underlying” aptitudes from which the level is simply obtained by a sum of the right answers. Thus, the subjective evaluation tests have no unique underlying aptitude and do not give a sum of correct answers, but it shows a global and multidimensional vision of oneself. The functional method points out this multidimensional specificity and offers a model of the subject's answers that reveals his or her strategy that is projected into a hyper-spherical measurement space defined by the characteristics of the items. This measurement space allows the calculation of scores that are the projections (scalar products) of vectors onto one another. The very interests of this method are a better reliability, a clinical intra-personal evaluation of the subjects (that are much more efficient than the simple differential approach that is also described in the article) and, finally, a more informative control upon the intake conditions (test biases, suitability of the test for a person, etc.).     

Effet du niveau d’études sur les performances en mémoire épisodique chez des adultes âgés : rôle médiateur de la métamémoire

Educational level is a factor of cognitive reserve and older adults with a higher level of formal education have a better memory performance than those having a lower educational level (Angel et al., 2010; Van Der Elst, Van Boxtel, Van Breukelen, & Jolles, 2005). Memory functioning can also be modulated by the beliefs and knowledge of a person about his/her own memory, that is, by his/her metamemory (Hultsch, Hertzog, & Dixon, 1987). The objective of this study was to examine the role of metamemory as a potential mediator of the effect of educational level on memory performance. Eighty-three older adults (60–80 years) participated in the experiment, they have been divided into two subgroups according to their educational level (high: 14.36 years and low level: 9.85 years). Episodic memory was evaluated with a cued recall task and metamemory by the Metamemory in Adulthood questionnaire (MIA). As shown by previous studies, results indicated that educational level had a significant effect on memory and metamemory, higher educational level was associated to better memory and metamemory capacities. At the MIA questionnaire, older adults with a high educational level affirmed using more internal and external strategies for learning, having higher motivation and perceiving less memory change with aging than older adults with a lower educational level. They also showed that the metamemory dimensions associated to the memory performance differed according to the educational level. For participants with a lower educational level, memory performance was correlated to the participants’ perception about their memory capacity and their knowledge about memory tasks, while for participants with a higher educational level, memory performance was correlated to the dimensions linked to memory control (strategies and motivation). Finally, the group effect was mediated by metamemory, specifically by the use of internal strategies. These results suggest that a prolonged educative experience would be associated to a better capacity to implement adapted strategies, which led individuals to maintain an optimal memory performance.     

La métaphore vive ou la représentation de l'Irreprésentable

Pointe extrême de la métaphore, l'oxymore postule, dans le théâtre claudélien, une altérité essentielle entre l'Amant et l'Amante, entre Dieu et sa créature, altérité que ne contredirait pas cependant l'identité existentielle: l'Incarnation. Prouhèze déploie sous nos yeux la bannière divine dont le signe est, comme dans les versets de Raymond Lulle, un homme mort. Si la corde de l'amour est tissée à coups de languissements de soupirs et de pleurs par le poète-dramaturge, la Croix est symétriquement désignée dans ses drames comme l'Arbre de Vie.Un personnage aussi étrange — car bien peu théâtral — que l'Ombre Double duSoulier de Satin résume ce paradoxe dans la mesure où la représentation qu'elle offre de la tension amoureuse crée un lien insécable entre la Terre et l'Ailleurs; l'Ombre Double témoigne de ce que l'Amant et l'Amante comme Dieu et sa créature peuvent concorder dans la béatitude sans pour autant fusionner. Autrement dit, selon Claudel, que l'homme soit à l'image de Dieu ne suffit pas à sa foi, encore faut-il qu'il ne cesse de manifester sa ressemblance à Dieu. Seule, la métaphore vive, c'est-à-dire la métaphore ayant gardé en mémoire les paradoxes et les tensions de l'oxymore, respecterait le mystère d'une relation où la présence croît a proportion de l'absence et fonderait cette parole sacrée et compensatoire d'une resseblance mille fois déjouée.     

L’indépendance du médecin à nouveau proclamée

In the must-known “Vincent Lambert case”, many jurisdictions have had to adjudicate on what was submitted to them. The latest decision from Châlons-en-Champagne's administrative court almost went unnoticed. However, the judgment turns out to be truly significant. It reminds that the principles of medical doctor's independence and freedom of action are simply fundamentals and unavoidable. The patient management practitioner shall not be regarded as a mere executor of an earlier decision taken by a medical colleague.     

La méthode agile,une nouvelle méthode pour promouvoir l’accompagnement inclusif

Over the past fifteen years, the health and social care policies in charge of vulnerable population, have evolved and have urged professionals to change their practices to promote the values of an inclusive society. Personal support has reached a consensus in response to fostering empowerment and coordinating efforts for actions undertaken. However, for lack of new methods capable of shaping outreach differently, practices are struggling to free themselves from phased management processes organized on a logic of support. This article aims at presenting an original method called “agile” that meets current expectations. It is based on six principles of action guaranteeing not only mobility and resources of the situation but also the empowerment of the accompanying and the accompanied.     

Le consentement en droit médical

Medical law, which derogates from ordinary law, interests and questions by its particularities. However, the Mercier decision of 1936 seems to have denied this by forcing an ordinary “medical contract” between the doctor and his patient. But the medical relationship, far beyond a contractual logic, seems to be unable to blend into the civil law elements of contract law. As such, consent, keystone of this medical matter, does not meet the standards of contract law yet imposed by the Court of Cassation. This article aims to unravel and clarify the scope and regime of this consent not quite like the others.     

La méta-analyse en psychologie sociale : principe,méthode et illustration

For several decades, the meta-analysis technique emerges as the most employed method to synthesize a whole of research relating to the same topic, the same process… While synthesizing, statistically, the studies, meta-analysis makes possible to measure the effect-size of a phenomenon and to see which factors influence this phenomenon. This method, well-developed in the Anglo-Saxons' reviews, is little known in France in particular by social psychologists. The following paper presents the basis of the meta-analysis technique, its advantages and the way to use this method if statistical data are presented in frequencies form (a second paper with continuous data and correlation measurements will be submitted later). A case-study presenting the meta-analysis interest is proposed with the help of real data resulting from the comparative study of two well-known psychosocial processes.     

La réception juridique de l’incertitude médicale

As regards medical responsibility, the proof of an unquestionable causal link between the damage and the fault of the expert are made difficult in the presence of uncertainties related to the etiology of certain pathologies. The article raises the question of the reception of this uncertainty by the judge and the legislator, and wonders in particular about the founded good of the recourse to law and judicial presumptions within the framework of the dispute of the victims of multiple sclerosis developed following vaccination against hepatitis B.     

L’expertise médicale fondée sur les faits

The concept of evidence-based medicine applies to medical activity in general in order to rationalize it. The medical expertise, constantly looking to improve its quality, can no longer ignore this concept. This is the best tool to meet the mission entrusted to experts of assessing the conformity of care to the scientific-acquired features, without neglecting the assessment of the involved practitioner's skills and the particular circumstances of the plaintiff. This article develops the new concept of “Medical expertise based on facts”.