Thèse de doctorat en Droit
Sous la direction de Marie-Laure Moquet-Anger.
Soutenue le 14-06-2016
à Rennes 1 , dans le cadre de École doctorale Sciences de l'homme, des organisations et de la société (Rennes) , en partenariat avec Université Bretagne Loire (ComuE) et de Institut du droit public et de la science politique (Rennes) (laboratoire) .
Quelle est la force juridique des RBP en matière sanitaire, en plein contentieux comme en recours pour excès de pouvoir? Quelles sont les différences d'approche entre la France et les Etats-Unis?
Legal strength of Clinical Practice Guidelines - Cross-countries analysis between France and the United States
What's the legal strength of CPGs in healthcare, in France and in the United States?The Institute of Medicine has defined as soon as 1992 Clinical Practice Guidelines as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." As they derive from various public and private bodies, and from the consensus of experts, CPGs are considered as consensus statements representing the prevailing standard of care in the medical profession. Clinicians and judges use clinical practice guidelines in their everyday life to appreciate individual situations and reach the best solutions for patients and plaintiffs: CPGs help improve their decision-making. But the legal strength of these tools is not totally consensual. In France, CPGs are seen as evidence of the standard of care expected from physicians. In theUnited States, where CPGs appeared some years earlier, they have been subject to questions, denounced as symptoms of a “cookbook medicine” and object of experiments by various States and insurance companies – not to mention lobbies. Their legal weight seems all the same better established in the U.S. than in France, although rulings in 2011 and 2016 by the french Conseil d’Etat have given them a more central role and a more recognized legal position in France.