Michel Penneau

Women who kill their children

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. Method:Our study was carried out at the Institute of Forensic Medicine in Angers over a 10-year period. All the victims were autopsied at the Institute of Forensic Medicine in Angers. Information concerning the mothers was collected from forensic medical files, police reports, and legal files. Interviews and forensic psychiatric examinations were available for consultation. Results:Our study concerns 17 observations of child-killing mothers and 19 child autopsies. In 2 cases, the issue was in fact a double murder, with the mother killing all the siblings. The mean age was 3.5 years for victims and 29.5 years for the women. The majority of the mothers were married or lived with their partners. They often had an occupation. Generally the economic status was average. Head trauma, strangulation, suffocation, and drowning were the most frequent means of filicide. However, some mothers used more active methods such as striking and shooting. Disturbed or disturbing behavior was documented in 15 perpetrators. Seven women tried to commit suicide. It was often possible to identify apparent motivation for the offense. Discussion:In our study, we can distinguish 2 types of killer mothers. We distinguished a first group made up of 5 mothers. These 5 women killed their children in a general context of abused children and present similarities with the neonaticide mothers (young, immature). The other group of filicide mothers is different. They are generally older, married, and employed. The crime is usually premeditated, committed with the direct use of hands and sometimes very violent. To understand the motives or the source of the impulse to kill, we can use a classification such as Resnicks classification: mothers from the first group fall within the framework of accidental filicides: the risk and prevention factors are those of infanticide and ill treatment. For the other mothers, we can distinguish altruistic filicides (8 cases) and spouse revenge filicides (2 cases). Few of the mothers suffered from real psychiatric problems; however, most of them presented troubles which could have been taken into account. A lot of women showed signs of suicidal tendencies prior to the event, displaying aggressive and angry behavior. In general, suicide attempts tend to prevail. These offenders act out of an acute sensitivity to social regulation. A variety of psychosocial stresses appears to have been a major factor. These stresses include lack of social or marital support, economic difficulties, family stress, and unrealistic expectations of motherhood. The precipitating stress may have been a dispute. Prevention begins with the identification of potential perpetrators. Therefore, medical doctors have a significant role in relation to the prevention of child murder.

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. Organ harvesting from cadaveric donors is permissible if the deceased did not make known his refusal during his lifetime (this may be recorded in the national registry set up for this purpose). The rule of presumed consent also applies in the case of organs taken after cardiac arrest. With regard to organ harvesting from living persons, a panel of experts is required to give approval. The recipients 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 recipients father or mother. The donor may be any person who provides proof of having lived with the recipient for at least two years. Some ethical questions will need to be resolved; for example the relevance of maintaining the EEG for brain death diagnosis, enforcement of the law on presumed consent, the real nature of the will of living donors and the definition of death.

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. French judges began compensating patients with MS at the end of the 1990s. One of the first judgments was given in 2001 by the Court of Appeal of Versailles when a pharmaceutical laboratory was held liable for the onset of MS following vaccination against hepatitis B. On appeal, the Court of Cassation overturned the judgment in September 2003, finding that the Court of Appeal judges had based their decision on a hypothetical causal link. However, the only reason why the Court of Appeal judgment was quashed was the contradictory evidence on which the judges had based their presumptions. Several of the judgments given since that date seem to confirm this hypothesis. On 25 May 2004, the 2nd civil law chamber recognized that MS which occurs following a vaccination against hepatitis B (a vaccination carried out for work-related purposes) could be considered as an accident at work, without questioning the possible causal link between the illness and the vaccine. This jurisprudence in the matter of hepatitis B vaccination shows the need for great care in expert practice. Effectively, when confronted with drug related imputability, the expert usually bases his reasoning on three points: the causal role of the generating factor, the chronology and other causes of damage. In terms of MS, all these factors are modified. More than ever, an expert must, in terms of imputability, be objective, prudent and clear in his conclusions.

Refus de soins du patient, le problème épineux des témoins de Jéhovah

Resume Le principe du respect de la volonte du patient est un principe international, retrouve dans plusieurs textes. En France, il a ete rappele dans le Code civil en 1994, lors des lois de bioethique, et il vient d’etre introduit dans le Code de sante publique (loi relative aux droits des malades du 4 mars 2002). Selon ces divers textes, la volonte du patient doit toujours etre respectee, meme en cas de risque vital. Il suffit d’avoir informe le patient du risque engendre par son refus. Le refus des temoins de Jehovah a l’egard des transfusions sanguines pose toujours un probleme. Lorsque, sans alteration de la conscience, un patient refuse une transfusion alors que le risque vital est engage en l’absence de ce traitement, quelle doit-etre l’attitude du medecin ? En juin 1998, la cour d’appel administrative de Paris, devant se prononcer sur cette question, a estime que « l’obligation faite au medecin de toujours respecter la volonte du patient… trouve sa limite dans l’obligation qu’a egalement le medecin (conformement a la finalite meme de son activite) de proteger la sante et la vie elle-meme du patient ». En octobre 2001, le Conseil d’Etat, saisi par un pourvoi, a en effet estime que, dans cette affaire, etant donne l’etat extreme du patient et l’absence d’alternative therapeutique, les medecins n’avaient pas commis de faute. Mais il a rappele clairement que le medecin est tenu de respecter la volonte de son patient et que cette obligation ne disparait pas devant le devoir de sauver la vie, contestant ainsi les juges de la cour d’appel. Deux questions Deux ordonnances de refere confirment la position des juges: passer outre la volonte du patient est un acte illicite. Ce n’est qu’en raison de circonstances extremes et bien definies que le medecin ne sera pas sanctionne pour cette illiceite. Deux questions se posent alors : le medecin peut-il soigner le patient contre sa volonte ? Que risque t-il s’il se soumet a ce refus alors que la vie du patient est en danger ?

F — Country Report France

In French law, the applicable rules concerning the protection of human rights and human dignity in biological and medical applications mainly result from the special laws that have been the object of a codification including them in the Code of Public Health. However, for certain aspects, these rules result from a case law interpretation of general legal principles or from the general provisions of the Civil Code and their observance of provisions of the Penal Code.