L'accès des consommateurs à la justice: de la résolution extrajudiciaire des conflits de consommation à la procédure collective : étude de droit suisse et droit comparé

INTRODUCTION : 1. L'OBJET ET L'INTÉRÊT DE LA THÈSE : DES BARRIÈRES D'ACCÈS À LA JUSTICE L'accès à la justice est un droit fondamental garanti par les art. 29a Cst. et 6 CEDH. Il s'agit d'un droit social mis en place par l'avènement de l'Etat providence qui accorde à chacun le droit à ce qu'un tribunal connaisse de toute contestation relative à ses droits et obligations de caractère civil. Aussi a-t-il pour effet de rendre efficace la législation mise en place par un Etat. Ainsi dans le cas particulier du droit de la consommation, l'élaboration des règles de droit matériel ne suffirait pas à concrétiser la protection des consommateurs voulue par le constituant et le législateur fédéral si une voie d'accès à la justice n'était pas ouverte afin de permettre aux consommateurs dont les droits sont violés d'en obtenir réparation. Si le droit formel permet à chacun de poursuivre la réalisation de ses droits par la voie judiciaire, y compris pour les consommateurs, il n'en demeure pas moins que ces derniers, dans la pratique, rencontrent plusieurs obstacles qui, souvent, les découragent de faire valoir leurs droits en justice. En effet, les tribunaux, victimes de leur succès, ont de plus en plus de peine à faire face à la masse des litiges qui leur sont soumis. L'engorgement de l'institution judiciaire est responsable de longs délais avant qu'une affaire soit jugée. A cela s'ajoutent des problèmes d'ordre financier : le coût de la justice comprenant le coût de la consultation juridique et de la représentation, des frais de consultation d'experts qui, parfois, peuvent dépasser le montant même du litige, sans oublier le risque, pour le consommateur, de devoir assurer, en cas d'échec du procès, les frais de l'autre partie. Puis on trouve des barrières d'ordre psychologique liées à la complexité et au formalisme qui accompagnent certaines procédures judiciaires civiles. Enfin, il y a la situation très complexe du litige revêtant un caractère intercantonal ou international (litiges transfrontaliers). S'agissant de litiges de faible valeur litigieuse (petits litiges ou small claims en anglais), ces barrières prennent une importance telle que de nombreux consommateurs renoncent tout simplement à faire valoir leurs droits en justice et subissent parfois la violation de ceux-ci. La valeur limitée de l'enjeu économique du litige peut rendre la durée de la procédure judiciaire démesurée et son coût disproportionné. En ce qui concerne le coût de la justice, nous illustrons ce propos par l'exemple reproduit sous l'annexe I ci-dessous. Il est également bon de signaler une étude couvrant 15 Etats membres de l'Union européenne réalisée en 1995 par la Commission européenne selon laquelle " le coût moyen (frais de justice + frais d'avocat, hors TVA) d'un règlement judiciaire d'un litige intracommunautaire portant sur un montant de 2'000 écus s'élève, dans la meilleure des hypothèses pour la partie demanderesse, à un montant d'environ 2'500 écus ". Après avoir relevé l'importance de l'accès à la justice pour le consommateur et les différents obstacles qui se dressent sur son chemin, nous allons nous intéresser aux solutions proposées pour minimiser voire supprimer ces barrières. A cet égard, on se posera la question de savoir dans quelle mesure les moyens extrajudiciaires, tels que des institutions d'ombudsmans et des organismes paritaires existant dans certains secteurs de la consommation, peuvent constituer des alternatives efficaces à la saisine des tribunaux. Puis on se demandera de quelle manière il faut alléger les formalités de procédure afin de permettre aux consommateurs non assistés de mandataires professionnels de saisir la justice et par-là même de diminuer le coût lié à celle-ci. Enfin, vu les difficultés qu'affrontent les consommateurs agissant individuellement, la question de l'opportunité de procédures collectives sera abordée. Comme ces interrogations touchent de près ou de loin les alinéas 2 et 3 de l'art. 97 Cst. nous avons jugé opportun d'exposer à titre liminaire la genèse de cette disposition. De plus, comme celui qui entreprend de traiter l'accès des consommateurs à la justice se doit de commencer par définir ce que l'on entend par consommateur, nous aborderons les notions de consommateur et de litige de consommation avant d'entrer dans le vif de la matière.

Travail militant, action collective et rapports de genre

In that paper we propose a gendered approach to social movements and political activism, based on a critical review of the litterature in French and English. In social movements and militantism studies, gender lines of division are most of the time ignored. Social movements are perceived as being « gender neutral ». However, that dimension is a determinant factor of collective action at the macro level of political opportunities and contexts, at the meso level of organisations and their modes of functionning, at the micro level of the logics of individual commitment and the division of militant labor.

Speed-cohesion trade-offs in collective decision making in ants and the concept of precision in animal behaviour

In decision making, speed-accuracy trade-offs are well known and often inevitable because accuracy depends on being well informed and gathering information takes time. However, trade-offs between speed and cohesion, that is the degree to which a group remains together as a single entity, as a result of their decision making, have been comparatively neglected. We combine theory and experimentation to show that in decision-making systems, speed-cohesion trade-offs are a natural complement to speed-accuracy trade-offs and are therefore of general importance. We then analyse the decision performance of 32 rock ant, Temnothorax albipennis, colonies in experiments in which accuracy of collective decision making was held constant, but time urgency varied. These experiments reveal for the first time an adaptive speed-cohesion trade-off in collective decision making and how this is achieved. In accord with different time constraints, colonies can decide quickly, at the cost of social unity, or they can decide slowly with much greater cohesion. We discuss the similarity between cohesion and the term precision as used in statistics and engineering. This emphasizes the generality of speed versus cohesion/precision trade-offs in decision making and decision implementation in other fields within animal behaviour such as sexually selected motor displays and even certain aspects of birdsong. We also suggest that speed versus precision trade-offs may occur when individuals within a group need to synchronize their activity, and in collective navigation, cooperative hunting and in certain escape behaviours.

Self-reported adherence and associated factors regarding antihypertensive medication in Seychelles

Introduction. Adherence to medication for asymptomatic disease is often low. We assessed factors associated with good adherence to medication for high blood pressure (HBP) in a country of the African region. Methods. A population-based survey of adults aged 25-64 years (N=1240 and participation rate=73%). Information was available in knowledge attitude and practice, SES and other variables. One question assessed adherence. Good adherence to treatment was defined as answering "I forget very rarely" vs "I forget on 1-2 days in a week" or "I forget on 3 or more days in a week". Results. In a univariate model adherence was strongly associated with belief that hypertension is a long-term disease (OR 2.6, p<0.001) and was negatively associated with concomitant use of traditional medicine (OR 0.36, p<0.005). The following variables tended to be associated with good adherence for HBP treatment: age, SES, BMI, belief that HBP is not symptomatic, going to government's clinics, medium stress level, controlled hypertension, taking statins. The following variables were not associated with good adherence for HBP treatment: education, higher BP, knowing people who had a stroke/MI, suffering from another chronic condition. In a multivariate model, pseudo R2 was 0.14. Conclusion. We built a multidimensional model including a wide range of variable. This model only predicted 14% of adherence variability. Variables associated with good adherence were demographics or related to knowledge attitude and practice. The latter one is modifiable by different type of interventions.

Collective symbolic coping with disease threat and othering: A case study of avian influenza

Much research studies how individuals cope with disease threat by blaming out-groups and protecting the in-group. The model of collective symbolic coping (CSC) describes four stages by which representations of a threatening event are elaborated in the mass media: awareness, divergence, convergence, and normalization. We used the CSC model to predict when symbolic in-group protection (othering) would occur in the case of the avian influenza (AI) outbreak. Two studies documented CSC stages and showed that othering occurred during the divergence stage, characterized by an uncertain symbolic environment. Study 1 analysed media coverage of AI over time, documenting CSC stages of awareness and divergence. In Study 2, a two-wave repeated cross-sectional survey was conducted just after the divergence stage and a year later. Othering was measured by the number of foreign countries erroneously ticked by participants as having human victims. Individual differences in germ aversion and social dominance orientation interacted to predict othering during the divergence stage but not a year later. Implications for research on CSC and symbolic in-group protection strategies resulting from disease threat are discussed.

Evaluation des risques liés aux nanomatériaux pour la population générale et pour l'environnement : rapport d'expertise collective

Une expertise collective sur l'évaluation des risques liés aux nanomatériaux pour la population générale et pour l'environnement a identifié plusieurs centaines de produits de grande consommation contenant des nanomatériaux, présents dans notre quotidien : textiles, cosmétiques, alimentaires, équipements sportifs, matériaux de construction... Des études nouvelles suggèrent la possibilité de risques pour la santé et pour l'environnement de certains produits. Face à cette situation d'incertitude, l'Afsset recommande d'agir sans attendre au nom du principe de précaution et de 1) Rendre obligatoire la traçabilité des nanomatériaux. Cela passe par une obligation de déclaration par les industriels, 2) la mise en place un étiquetage clair qui mentionne la présence de nanomatériaux dans les produits et informe sur la possibilité de relargage à l'usage, 3) d'aller jusqu'à l'interdiction de certains usages des nanomatériaux pour lesquels l'utilité est faible par rapport aux dangers potentiels, 4) l'harmonisation des cadres réglementaires français et européens pour généraliser les meilleures pratiques : déclaration, autorisation, substitution. En particulier, une révision de REACh s'impose pour prendre en compte les nanomatériaux manufacturés de manière spécifique et quel que soit leur tonnage. L'expertise fait également des recommandations pour construire une méthode renouvelée d'évaluation des risques sanitaires qui soit adaptée aux spécificités des nanomatériaux. Pour cela l'Afsset a testé les méthodologies classiques d'évaluation des risques sur 4 produits particuliers et courants : la chaussette antibactérienne (nanoparticules d'argent), le ciment autonettoyant et le lait solaire (nanoparticules de dioxyde de titane), la silice alimentaire à l'état nanométrique. Ces 4 produits représentent bien les voies d'exposition de l'homme (cutanée, inhalation, ingestion) et la possibilité de dispersion environnementale. Ces travaux font apparaître une urgence à faire progresser les connaissances sur les expositions et les dangers potentiels des nanomatériaux. Aujourd'hui, seuls 2% des études publiées sur les nanomatériaux concernent leurs risques pour la santé et l'environnement. Le premier effort devra porter sur la normalisation des caractéristiques des nanomatériaux. Les priorités de la recherche devront cibler la toxicologie, l'écotoxicologie et la mesure des expositions. Enfin, l'Afsset prévoit de s'autosaisir pour définir en 2 ans, avec son groupe de travail, un outil simplifié d'évaluation des risques. Il s'agit d'une grille de cotation des risques qui permet de catégoriser les produits en plusieurs gammes de risques. Face à ce chantier considérable, une mise en réseau entre les organismes européens et internationaux pour se partager le travail est nécessaire. Elle a commencé autour de l'OCDE qui coordonne des travaux d'évaluation des risques et de l'ISO qui travaille à la mise en place de nouvelles normes. [Auteurs]

Compliance with medication among outpatients with uncontrolled hypertension in the Seychelles.

Owing to increasing rates of hypertension and cardiovascular-related diseases in developing countries, compliance with antihypertensive medication is major public health importance. Few studies have reported on compliance in developing countries. We determined the compliance of 187 patients with uncontrolled hypertension in the Seychelles (Indian Ocean), by assessing the presence of a biologic marker (riboflavin) in the urine. The urine tested positive in 56% of the cases. Compliance varied from one physician to another (highest 72% versus lowest 33%, P = 0.003), improved with the level of literacy (62% versus 45%, P = 0.024), and depended on the presence absence of diuretics in the medication (respectively, 45% versus 66%, P = 0.005). The ability of patients to report correctly the number of antihypertensive pills to be taken daily was a predictor of compliance (62% of the patients who gave appropriate answers had positive urine for the marker versus 31% for those giving inappropriate answers).

Exploring the implementation of a medication adherence programme by community pharmacists: a qualitative study

BACKGROUND: Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). OBJECTIVE: To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. SETTING: Community pharmacies in French-speaking Switzerland. METHOD: Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. MAIN OUTCOME MEASURE: Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme. RESULTS: Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians. CONCLUSION: A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.

Medication exposure during pregnancy: a pilot pharmacovigilance system using health and demographic surveillance platform.

BACKGROUND: There is limited safety information on most drugs used during pregnancy. This is especially true for medication against tropical diseases because pharmacovigilance systems are not much developed in these settings. The aim of the present study was to demonstrate feasibility of using Health and Demographic Surveillance System (HDSS) as a platform to monitor drug safety in pregnancy. METHODS: Pregnant women with gestational age below 20 weeks were recruited from Reproductive and Child Health (RCH) clinics or from monthly house visits carried out for the HDSS. A structured questionnaire was used to interview pregnant women. Participants were followed on monthly basis to record any new drug used as well as pregnancy outcome. RESULTS: 1089 pregnant women were recruited; 994 (91.3%) completed the follow-up until delivery. 98% women reported to have taken at least one medication during pregnancy, mainly those used in antenatal programmes. Other most reported drugs were analgesics (24%), antibiotics (17%), and antimalarial (15%), excluding IPTp. Artemether-lumefantrine (AL) was the most used antimalarial for treating illness by nearly 3/4 compared to other groups of malaria drugs. Overall, antimalarial and antibiotic exposures in pregnancy were not significantly associated with adverse pregnancy outcome. Iron and folic acid supplementation were associated with decreased risk of miscarriage/stillbirth (OR 0.1; 0.08 - 0.3). CONCLUSION: Almost all women were exposed to medication during pregnancy. Exposure to iron and folic acid had a beneficial effect on pregnancy outcome. HDSS proved to be a useful platform to establish a reliable pharmacovigilance system in resource-limited countries. Widening drug safety information is essential to facilitate evidence based risk-benefit decision for treatment during pregnancy, a major challenge with newly marketed medicines.

Predictors of favourable outcome in first-episode patients who refuse medication: results from the FEPOS study

There are suggestions that some first-episode psychosis (FEP) patients can have favourable outcome without antipsychotic medication. However, there is very limited data regarding patients' characteristics on which the decision to propose medication free treatment could be based. FEPOS is a fi le-based study of an epidemiological sample of 704 FEP patients treated at EPPIC, Melbourne, between 1998 and 2000. Among the 661 patients where data was available, 108 consistently refused medication during the entire duration of their treatment at EPPIC. In this paper we compared, within this sub-group, patients who had a favourable outcome with those who did not. Patients were aged between 15 and 29 years (M = 21.9, SD = 3.40) and the majority were male (70.4%, n = 76). Symptomatic remission data was available on 105 patients; of these patients 41.0% (n = 41) had achieved remission. Functional remission data was available on 100 patients; of these patients 33.0% (n = 33) had achieved functional remission. Combined remission was evident in 23.0% (n = 23) of patients. Three factors were associated with symptomatic remission: better premorbid functioning (based on GAF, OR = 1.07, p = 0.006), higher number of years of education (OR = 1.43, p = 0.020), and being employed or studying at service entry (OR = 2.59, p = 0.034). Three factors were associated with functional remission: shorter duration of prodrome (OR = 0.50, p = 0.043), severity of psychopathology (CGI-S, OR = 0.51, p = 0.024), and vocational status at service entry (OR = 4.29, p = 0.003). While various aspects of pre-morbid functioning seem to correlate with the possibility of a favourable outcome in FEP patients who refuse medication, various limitations need to be taken into account in this study.