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Abstract: Objectives: This paper considers the specific administrative procedures set up by managers of public healthcare establishments and those responsible for health and welfare policies to care for low-income pregnant women for whom 100% of the “price per act” (T2A) is refunded. What are the limitations and what improvements can be suggested? Patients and method: The results are based on an analysis of data from semi-structured interviews, legislation and documents. Results: The State, health insurance systems, public health establishments, local authorities, charities and outpatient services are involved in handling low-income parturients in different services and different establishments, both locally and regionally. A health and welfare policy comprising specific, coordinated actions and measures has been developed. The T2A “price per act” system may threaten its survival: the limited number of front-line facilities is often saturated and demand is increasing, treatment is often reduced to reactive management leading to unwanted readmissions, ethics are sometimes called into question and there is a risk of patient selection. Discussion and conclusion: This pilot study provided some encouraging information but also indicated the limitations of the approach adopted. However, it was still of interest to see whether it was possible to use this approach, which did not require considerable resources, to reveal useful markers. This appeared to be the case. Regional Health Agencies (ARS) and local authorities could support the system. Additional funding is needed. [Copyright &y& Elsevier]

Abstract: Donor and recipient sample biobanks are a precious tool in hemovigilance studies as well as in epidemiological and biological research, in particular with regards to safety against blood-borne agents. This paper describes the main transfusion biobanks existing in France and gives their advantages and limits. The National blood donation biobank, organized for medicolegal reasons, preserves samples of each blood donation for a 5-year period. The biobank of the Blood and Organ Transmissible Infectious Agents (BOTIA) project stocks paired donor–recipient samples with a research objective. Preserved over a long period of time, such transfusion biobanks will be useful in terms of public health, as a reflection of the biological state of a population at a given moment. [Copyright &y& Elsevier]

Abstract: Two recent laws have significantly reformed the French Public Health Code: the law of March 4th 2002, related to the patient''s rights and the quality of the health care system and the law of April 22nd 2005, related to the patient''s rights and the end of life. These changes have prompted health care professionals involved in perinatal and neonatal medicine to update their considerations on the ethical aspects of the end of life in neonatal medicine. Therefore, the authors examined the clauses of the law related to the patient''s rights and to the end of life, confronting them with the distinctive features of neonatal medicine. In this paper, the medical practices, which are either prohibited or authorized in the course of end of life are considered: prohibition of euthanasia, authorization for alleviating pain at the risk of shortening life, authorization for restricting, withholding or withdrawing treatments. Next, the justifications provided by the legislation to authorize these practices are analysed: prohibition of unreasonable obstinacy and respect for individual wishes. Then, the conditions required by the law to determine and to implement these acts are discussed: consultation with the healthcare staff and justified advice from a consulting physician, consideration of parental opinion, registration of the decision and its justifications into the patient''s medical file, protection of the dying patient''s dignity and preservation of his life quality by providing palliative care. Lastly, we report the terms of the ethical dilemma which may occur in the area of neonatal medicine in spite of genuine and persevering efforts in order to conciliate legal requirement and ethical responsibility. [Copyright &y& Elsevier]

Abstract: The “expertise” required by article L. 3213.8 of the Code of Public Health is exceptional within the statute of “compulsory hospitalization” (Police-instructed compulsory hospitalisation in France corresponds to the juridical or court-ordered hospitalisation in Anglo-Saxon law). This paper proposes a critical analysis of this “expertise” and of the ensuing situation of pathological criminals based on an extended practice of expertise and taking into consideration the recent evolution of the concept of dangerousness. [Copyright &y& Elsevier]