Pour pouvoir porter atteinte au corps humain, l‘article 16-3 du code civil prévoit qu‘il faut être en présence d‘une nécessité médicale pour la personne, véritable condition de licéité des actes médicaux. Cette notion a succédé en 1999 à l‘ancienne exigence de nécessité thérapeutique, elle-même créée par la loi relative à la protection du corps humain du 27 juillet 1994. La réforme de la notion s‘est faite sans véritable débat à l‘occasion du vote de la loi relative à la «couverture maladie universelle ». Cette évolution n‘a pas suscité de questionnement majeur et la notion de nécessité médicale n‘a pas non plus fait l‘objet d‘études particulières. Aussi, il est difficile aujourd‘hui de donner une définition exacte de la notion et des actes qu‘elle permet de légitimer. Quels actes la notion de nécessité médicale permet-elle de rendre licites ? La première partie de l‘étude consiste à chercher la réponse à cette question en exploitant la potentialité de signification de la notion. L‘étude de chaque élément constituant la notion se révèle indispensable pour pouvoir ensuite étudier le potentiel de définition de la notion recomposée. À l‘existence potentielle et virtuelle de la notion doit logiquement succéder l‘étude de la réalité de l‘existence de la notion. Quels effets engendre-t-elle ? L‘utilisation de la notion de nécessité médicale révèle, pour partie, un usage indésirable de celle-ci. À l‘exact opposé du voeu affiché par la loi de 1994, la nécessité médicale permet parfois de passer outre l‘exigence de consentement de la personne. Paradoxalement, elle peut également permettre de rendre le corps humain davantage disponible pour la personne. Le constat de cette utilisation néfaste appelle la proposition d‘une utilisation souhaitable de la nécessité médicale correspondant à sa raison d‘être originelle : la protection du corps humain et donc de la personne humaine. / To be able to strike a blow at the human body, the article 16-3 of the civil code plans that it is necessary to be in the presence of a medical necessity for the person, which is the real condition of legality of the medical acts. This notion came in 1999 after the former requirement of therapeutic necessity, itself created by the law relative to the protection of the human body of July 27th, 1994. The notion was reformed without real debate on the occasion of the vote of the law concerning the "universal healthcare coverage". This evolution did not provoke major questioning and the notion of medical necessity did not either make the object of particular studies. For that reason, it is now difficult to give an exact definition of the notion and the acts which it allows to legitimize. Which acts can be considered to be licit when applying the notion of medical necessity ? The first part of the study consists in looking for the answer to this question by exploiting the potentiality of meaning of the notion. The study of each element of the notion seems to be essential to be then able to study the potential of definition of the entire notion. The study of the potential and virtual existence of the notion must be followed by the study of the reality of the existence of the notion. What can be the practical effects of this notion ? The use of the notion of medical necessity reveals, partly, an unwanted use of this one. At the exact opposite of the wish described by the law of 1994, the medical necessity sometimes allows to pass besides the requirement of the person‘s consent. Paradoxically, it can also permit to make the human body more available for the person. This misuse leads to make the proposal of a desirable use of the medical necessity corresponding to its original reason for being : the protection of the human body and thus the human person.

Pas de résumé en français / Pas de résumé en anglais

Confidential, not available. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

No description available.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Pulmonary embolism (PE) is an extremely common and highly lethal condition that is a leading cause of death in all age groups. PE is the third most common cause of death in hospitalized patients, with an estimated 0.24% annual death rate of the population. Its symptoms are often vague and its diagnosis is a major medical challenge, with 70% of missed diagnosis in people dying from PE in hospitals. If left untreated, approximately one third of patients who survive an initial PE subsequently die from a future embolic episode. Most patients succumb to PE within the first few hours of the event. However, when properly identified, an effective treatment consisting of anticoagulants or thrombolytics is administered that dramatically reduces the mortality rate of the disease. Typically, the diagnosis of PE is manually performed by radiologists on CT images. It is a time-consuming and error-prone process, in particular because of the huge amount of data and more specifically in the case of sub-segmental and peripheral clots, which are less visible. Indeed, a typical CT dataset that is used for PE diagnosis can have more that 600 slices, the size of the smallest visible volume being in the order of magnitude of one millimeter. The duration of that review process by radiologists, excluding acquisition time, is in the order of 5 to 10 minutes, depending on evidence of the clots. The duration of an exam may become a concern considering that there is currently a lack of radiologists, that is partly due to the availability of new modalities, the increasing complexity of existing ones, and the growing number of new applications of medical imaging (functional imaging, heart CT, etc.). In that context, a computer aid can be provided whose main goal would be to decrease the time required to perform an exam, by acting either as a safeguard for radiologists or even better, if sufficiently robust and conservative, as a preliminary detection step in a computer-aided diagnosis (CAD) system. The work presented in this thesis consists of a combination of a method for segmenting the pulmonary arteries (PA), two emboli detection methods as well as a scheme for the evaluation of the performance. The segmentation of the PA serves one of the clot detection methods, and is carried out through a region growing algorithm that makes use of a priori knowledge of vessels topology. Two different approaches for clot detection are introduced. The evaluation of the method is also discussed, and a scheme for measuring its performance in terms of sensitivity and specificity is proposed, including a practical approach to making reference detection data, or ground truths, by radiologists.