Martinet Y
Service de Pneumologie, CHU de Nancy, Hôpital de Brabois, Rue du Morvan, 54511 Vandœuvre-les-Nancy, France.
Rev Mal Respir. 2011 May;28(5):594-601. doi: 10.1016/j.rmr.2011.01.007. Epub 2011 Apr 8.
In the course of an investigation, judicial or not, the expert opinion encompasses several questions of a different nature, including the following one « did the patient die of a disease he/she was supposed to suffer from at time of death? » Based on a personal experience over one year in 2008, the goal of this paper is to tackle this question of imputability, which was asked in respect of 12 investigations, including ten of occupational diseases, one of nosocomial infection and one iatrogenic accident. Only two autopsies were carried out; one autopsy refusal was reported. In five out of 12 cases, the imputability of death related to an occupational disease or an iatrogenic accident was considered by the expert to be certain in one case, very probable in two cases, and possible in two cases; in seven out to 12 cases, imputability of death was unlikely, since the cause of death was unknown in two cases, or was not the suggested cause in five cases. The discussion considers several arguments that can help answer this question: evaluation of the vital prognosis of the disease, the importance of the quality of medical records, the contributions and limits of autopsy findings, deaths that result from multiple causes, and the concept of aggravating circumstances.
在一项调查过程中，无论是否为司法调查，专家意见都涵盖几个不同性质的问题，包括以下这个问题：“患者是否死于其在死亡时本应患有的疾病？”基于2008年一年的个人经验，本文的目的是解决这个可归责性问题，该问题是在12项调查中被提出的，其中包括10项职业病调查、1项医院感染调查和1项医源性事故调查。仅进行了两次尸检；报告了一次拒绝尸检的情况。在12个案例中的5个案例中，专家认为与职业病或医源性事故相关的死亡可归责性在1个案例中确定，在2个案例中极有可能，在2个案例中有可能；在12个案例中的7个案例中，死亡的可归责性不太可能，因为在2个案例中死亡原因不明，或者在5个案例中并非所建议的原因。讨论考虑了几个有助于回答这个问题的论据：疾病生命预后的评估、病历质量的重要性、尸检结果的贡献和局限性、多原因导致的死亡以及加重情节的概念。
