Academic literature on the topic 'Aided Dying'

Physician aid in dying is a broader topic than euthanasia in that the latter usually refers to active euthanasia, while physician assistance also encompasses the issue of assisted suicide. Volumes could be and have been written on physician-assisted death. But my purpose here is to address a specific aspect of the topic: the policy implications with regard to proposed legislation on physician-aided death.Although the title's reference to physician assistance suggests a focus on the role of the professional, what people often take to be most important and at the heart of the topic is the issue of the patient's rights, usually seen as being manifested in four different ways. First is the right to a dignified death, as free from pain and suffering as possible. In crossing national boundaries and preceding the organization of the professions and the creation of societies, this right is viewed as one that ought to be recognized.

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

Physicians have long aided their patients in dying in an effort to ease human suffering. It is only in the nineteenth and twentieth centuries that the prolongation of life has taken on new meaning due to the powers now available to physicians, through new drugs and high technology interventions. Whereas earlier physicians and patients could readily acknowledge that nothing further could be done, today that judgment is problematic.Most often, aiding the dying took the form of not doing anything further to prolong life. Morally, this act of restraint was not difficult, because few options could have been considered. However, some physicians, rarely, would help patients die either by hastening death directly or by increasing pain control with the risk of hastening death, the so-called double effect. When directly hastening death, physicians either directly caused the death of the patient through euthansia, or supplied the means to the patient to bring about death with or without encouragement to use these means. The latter is physician-assisted suicide (PAS).

Over 100 free-ranging adult California sea lions ( Zalophus californianus) and one Northern fur seal ( Callorhinus ursinus), predominantly adult females, were intoxicated by domoic acid (DA) during three harmful algal blooms between 1998 and 2000 in central and northern California coastal waters. The vector prey item was Northern anchovy ( Engraulis mordax) and the primary DA-producing algal diatom was Psuedonitzschia australis. Postmortem examination revealed gross and histologic findings that were distinctive and aided in diagnosis. A total of 109 sea lions were examined, dying between 1 day and 10 months after admission to a marine mammal rehabilitation center. Persistent seizures with obtundation were the main clinical findings. Frequent gross findings in animals dying acutely consisted of piriform lobe malacia, myocardial pallor, bronchopneumonia, and complications related to pregnancy. Gross findings in animals dying months after intoxication included bilateral hippocampal atrophy. Histologic observations implicated limbic system seizure injury consistent with excitotoxin exposure. Peracutely, there was microvesicular hydropic degeneration within the neuropil of the hippocampus, amygdala, pyriform lobe, and other limbic structures. Acutely, there was ischemic neuronal necrosis, particularly apparent in the granular cells of the dentate gyrus and the pyramidal cells within the hippocampus cornu ammonis (CA) sectors CA4, CA3, and CA1. Dentate granular cell necrosis has not been reported in human or experimental animal DA toxicity and may be unique to sea lions. Chronically, there was gliosis, mild nonsuppurative inflammation, and loss of laminar organization in affected areas.

This article will explore pediatric consent through the analysis of a clinical case study using the principles of biomedical ethics approach. Application of the principles of autonomy, nonmaleficence, beneficence, and justice will be dissected in order to attempt to establish resolution of the ethical dilemma. The main conflict in this case study deals with whether the wishes of an adolescent for end-of-life care should be followed or should the desire of his parents outweigh this request. In terminal cancer, the hope of early palliative care and dignity in dying serve as priorities in therapy. Application of the moral principles to both sides of the dilemma aided in providing an objective resolution to uphold pediatric consent.

Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.

ABSTRACTThis article aims to locate English republican thought and writing in a wider European context and to understand the personal connections that aided the distribution and reception of English republican ideas abroad. It does so through the case-study of a little-known pamphlet published by the English regicide Edmund Ludlow during his exile in Switzerland after the restoration of the Stuart monarchy in 1660.Les juges jugez, se justifiants(1663) was a French translation of the dying speeches and other miscellaneous texts of some of the English regicides, produced in Geneva and subsequently printed in Yverdon with the help of Ludlow's local Protestant network. Rather than propagating a secular republican ideology, Ludlow offered his work to a European Protestant audience in the language of Geneva, promoting a primarily religious cause in an attempt to make martyrs out of political activists. It is therefore to Ludlow's Protestant networks that we need to turn to find out more about the transmission of English republican ideas in francophone Europe and beyond.

ObjectivesIn the English National Health Service, the patient’s vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient’s risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS).DesignLogistic regression model development and external validation study.SettingTwo acute hospitals (YH—York Hospital for model development; NH—Northern Lincolnshire and Goole Hospital for external model validation).ParticipantsAdult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2).ResultsThe risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups.ConclusionsAn externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems.

In California’s mixed-conifer forest, which historically had a regime of frequent fires, two conifers, Sequoiadendron giganteum and Pseudotsuga menziesii, were previously known to produce epicormic sprouts from branches. We found epicormic branching in a third mixed-conifer species, Abies concolor, 3 and 4 years after a wildfire in the central Sierra Nevada Mountains of California. Sprouting occurred only from the boles. We investigated (1) whether the degree of crown loss and the extent of epicormic branching were independent; and (2) whether epicormic branching differed by tree size. The vertical extent of epicormic foliage increased with increasing severity of crown loss. There was a significantly greater proportion of large diameter-class (>50 cm diameter at breast height [dbh]) trees with epicormic branching than small/medium diameter-class (25–50 cm dbh) trees. These results suggest large diameter Abies concolor may survive high levels of crown loss, aided by crown replacement through epicormic branching, but that reiterative green foliage may not appear for up to 3 years after fire damage. If this response is widespread, it would suggest some ‘dying’ trees logged under current salvage guidelines could survive, and that higher-intensity fire may substantially reduce the density of small post-fire suppression white fir, while retaining many larger overstory trees.

Toba Samosir Regency is one of the centers of ulos weaving in North Sumatera. Most of the weaving processes are carried out traditionally by small-size enterprises. However, it is identified that there are 8 ulos weaving industries that utilize loom machine. To date, no holistic environmental impact assessment has yet been conducted on weaving industry in Toba Samosir. This study aims to assess potential environmental impact caused by weaving industry in Toba Samosir. The scope of this study covers gate-to-gate stages in ulos production, consisting mangiran, washing, dipping, drying, dying, boiling, sun-drying, weaving, and manirat. The functional unit of this study is 182 kg of ulos, representing one batch of production. The assessments are conducted by two approaches; these are Life Cycle Assessment and Eco-efficiency Index measurement. The LCA modeling and computation of environmental impacts are aided by openLCA software. From LCA, it is revealed that the potential environmental impacts associated with ulos weaving are Eutrophication Potential (5.28E+01 kg PO4 eq - 8.41E+01 kg PO4 eq), Climate Change Potential (7.17E+02 kg CO2 eq - 5.74E+02 kg CO2 eq), and Photochemical Oxidation Potential (3.40E+00 kg CFC-11 eq - 4.68E+01 kg CFC-11 eq). The major stressors causing these impacts are using firewood. The calculation result of Eco-Efficiency Index (EEI) for weaving industry in Toba Samosir Regency falls between 0,1 and 0,4, which indicates the product is affordable but not sustainable..

A l’heure où la prise en charge médicale s’avère de plus en plus nécessaire pour accompagner la fin de vie, il nous apparait que sa place est de plus en plus importante et de moins en moins questionnée. Or, réduire la fin de vie à la question du mourant et de sa prise en charge est pour le moins problématique. L’arrêt d’hydratation et d’alimentation, les différentes formes de sédation, l’euthanasie, le suicide assisté, les soins palliatifs résument-ils à eux seuls ce que l’on peut dire de la fin de vie ? Peut-elle se résumer uniquement à une question d’ordre médical ? N’est-elle pas avant tout une question d’ordre existentiel où, à l’heure de notre déclin, nous sommes confrontés à l’agonie ? Souffrance et finitude se trouvent au cœur de notre interrogation et nous poussent à nous confronter au pâtir de la vie, nous dévoilant ainsi comme être de chair. Grâce à la philosophie henryenne, l’agonie va peu à peu se dévoiler comme une occasion ultime de révélation de soi à soi en tant que soi. Face à l’aporie du mal qui frappe, nous découvrons les hommes capables toujours d’y faire face par un effort de repersonnalisation. C’est cet effort nécessaire qui va se dévoiler tant dans le champ métaphysique, que dans le champ éthique, et que dans le champ politique. C’est ce même effort qui amène l’homme à prendre ses responsabilités et à répondre aux questions existentielles. La subjectivité de chacun se doit alors de devenir le centre de l’institution soignante. L’agonie devient possibilité de repenser la place de la personne au sein du système hospitalier : place de la personne soignante, de la personne soignée, de ceux qui accompagnent, tout en développant une éthique de l’accompagnement qui doit ensuite se décliner dans une politique. Car si, métaphysiquement, vivre son agonie ne peut se justifier que par l’Amour, éthiquement, il nous faut construire une nouvelle poétique de l’action faisant place à la fraternité issue de la chair, à l’imagination de l’homme pour répondre à l’appel d’autrui et de la vie, et à la subsidiarité, afin que chacun soit respecté dans son agir et sa conscience. Politiquement, cela nous ouvre alors à un système hospitalier respectueux de chaque « Je Peux » qui se déploie en son sein. Le respect du consentement du patient reste ainsi la pierre angulaire du système hospitalier ; mais il ne peut se construire que dans une alliance avec les soignants
In the context of today’s world, medical care is becoming increasingly necessary to assist patients at the end of life. It appears that this care is taking on more and more importance and is subject to fewer and fewer questions. is less and less questioned. However, confining the end of life to the state of dying and its medical support is problematic. Can the end of life be resumed as stopping hydration and artificial feeding, sedation in its different forms, euthanasia, assisted suicide, and palliative care? Can it be summed up as a simple medical question? Isn’t the end of life, first and foremost, linked to an existential question in which, at the time of our decline, we come face to face with agony? Finiteness and suffering are at the heart of our questioning as we confront life’s hardships, revealing the mystery of the flesh. With the help of Michel Henry’s philosophy, agony will gradually reveal itself as an ultimate opportunity for self-revelation. Faced with the paradox of evil, we find Man capable of coping with an effort of re-personification. This necessary effort will unfold in the metaphysical, ethical and political fields. This same effort allows Man to take responsibility for himself and to contemplate existential questions. The subjectivity of each person must become the center of the healthcare institution. Agony becomes the possibility to rethink the place of the individual person within the hospital system: the care giver, the care receiver and those supporting them, all while developing an ethical personal assistance which must then translated into policies. Because even if metaphysically, living out agony cannot be otherwise justified but by Love, ethically we must build a new way of operating. We must leave room for fraternity as a consequence of being of the flesh, to imagination in order to respond to our fellow man and our life’s calling, and to subsidiarity so that everyone is respected in his actions and consciousness. Politically, it opens up the possibility of a hospital system respectful of each "I Can" which is echoed within its walls. Respect for the patient's consent remains the cornerstone of the hospital system but can only be built with an alliance with caregivers

abstract: Advocacy groups work across many aspects of “death with dignity” practice and treatment, and provide insight across multiple aspects of “death with dignity”. This study argues that key advocacy groups in the American death with dignity movement influenced the broader conceptualization of death with dignity in a way that makes patients more able to achieve it. This influence has been a dynamic process across different periods of practice starting the discussion of “death with dignity” in 1985 through today, although this thesis extends only to 2011. The question in this study is how do the three main historical advocacy groups in the US: the Hemlock Society, Compassion in Dying, and Compassion and Choices, conceptualize death with dignity with regards to patient and doctor relationship, legal and policy factors, and medical technologies and protocols? This study found that the Hemlock Society (1980-2005) characterized death with dignity as a terminally ill patient being able to “self-deliver” from suffering via autoeuthanasia regardless of medical community approval or legality. Compassion in Dying (1993-2007) characterized death with dignity as involved advocacy work with terminal patients and their communities to pursue palliative care and hospice up to the point of assisted death. This organization was also involved in the passing of Oregon Death with Dignity Act. Compassion and Choices (2007-present) characterized death with dignity similarly to Compassion in Dying but also advocated for adequate management of pain and suffering symptoms in palliative care to prevent people from desiring death over the illness. Conceptualizing death with dignity is important for understanding why patients want death with dignity and better accommodating their end of life needs when they are suffering with terminal illness.
Dissertation/Thesis
Masters Thesis Biology 2019

碩士
國立臺灣科技大學
纖維及高分子工程系
90
The capability of yarn dyeing fabric has a great improvement recently. Applying wrinkle-free processing feature to traditional cotton or linen blended woven fabric can be the direction for future research, especially under the situation that the textile industry is looking for good marketing. In this thesis, fishbone diagram and factor-analysis are applied to analyze the important influent elements for wrinkle-free processing . The Taguchi method is used to find relative processing factors, such as pick-up, curing, temperature, resin agent and reaction speed. Based on the quality requirement of wrinkle-free of yarn-dyeing cotton- linen blended woven fabric, the back-propagation neural network is applied to find the optimal processing parameters for manufacturing. The try- and- error method used by the textile industry in the past to test this processing method has not only wasted the costs but also made it impossible to get the best conditions for manufacturing, and it caused the problem of repeatability. Instead, the mode adopted in this research will provide one of the best methods for producing this kind of fabric.

Au cours de l’été 2014, le cas d’un patient conscient, dépendant d'un respirateur, ayant demandé un arrêt de traitement vital et exprimé le souhait de faire don de ses organes a secoué la communauté québécoise du don d’organes et de la transplantation. Ce fut le début d’une réflexion importante quant à l’acceptabilité du don d’organes chez des personnes conscientes et aptes ayant choisi de mettre fin à un traitement vital. Cette réflexion était d’autant plus pertinente que le gouvernement québécois préparait sa Loi concernant les soins de fin de vie qui allait rendre légale l’aide médicale à mourir (AMM). Puisqu’il était cliniquement possible pour certains patients de faire un don d’organes suite à une AMM, il était probable que la légalisation de cette pratique augmente le nombre de patients conscients désirant donner leurs organes alors qu’ils auraient choisi de mourir. La littérature sur les enjeux éthiques soulevés par ce type de dons d’organes était alors quasi inexistante et, au moment de débuter le projet de recherche, des lignes directrices de pratique n’existaient pas au Québec et au Canada. Il devenait donc impératif de mieux identifier les enjeux éthiques et de les analyser afin de contribuer à l’encadrement de ces nouvelles pratiques. Il n’y avait également aucune étude décrivant les perspectives des professionnels de la santé face à de tels dons. Les objectifs de ce projet de thèse étaient i) d’identifier les enjeux éthiques soulevés par le don d’organes chez un patient conscient et apte demandant un retrait de thérapie de maintien des fonctions vitales ou une AMM; ii) d’analyser ces enjeux à l’aide de théories éthiques; iii) de connaître et comprendre les perspectives des professionnels de la santé sur les enjeux soulevés par le don d’organes dans ces contextes particuliers; iv) finalement, de mettre en relation les perspectives des professionnels et les politiques qui ont été adoptées au Québec depuis sa mise en route. Nous avons donc mené une étude exploratoire qualitative par le biais d’entretiens avec des professionnels du don d’organes susceptibles d’être impliqués à un moment ou un autre dans le processus du don d’organes par un patient apte ayant demandé un retrait de thérapie de maintien des fonctions vitales ou une AMM. Notre échantillon comprenait médecins et infirmiers des soins intensifs, de la salle d’opération ou impliqués en don d’organes dans deux centres hospitaliers montréalais très actifs au niveau du don d’organes (CHUM et l’Hôpital Sacré-Cœur) et à Transplant Québec. Nous avons identifié les enjeux éthiques à l’aide d’une revue de littérature et par l’analyse des perspectives des professionnels. Les principaux enjeux éthiques sont liés au respect de l’autonomie des patients, à l’information à fournir ou non aux donneurs potentiels, à l’objection de conscience par les professionnels, à la possibilité pour les receveurs de refuser ou non les organes provenant de l’AMM, à l’acceptabilité du don d’organes suite à une AMM confidentielle, à la règle du donneur décédé́, à la possibilité de diriger un don d’organe vers un receveur désigné par le donneur et à l’acceptabilité de choisir l’AMM pour rendre possible le don d’organes. Nous avons d’abord analysé ces enjeux éthiques à l’aide du modèle de l’équilibre réflexif large de Norman Daniels et nous avons ensuite intégré à notre analyse les perspectives des participants sur les différents enjeux selon le modèle de l’équilibre réflexif- normatif empirique. À la lumière de nos résultats, nous pouvons conclure que : i) le don d’organes pour les patients aptes demandant une AMM ou un retrait de thérapies de maintien des fonctions vitales était, de manière générale, éthiquement acceptable dans le contexte légal en vigueur au moment de notre recherche; ii) les patients demandant l’AMM et souffrant d’une maladie compatible avec le don d’organes devaient être informés de la possibilité qui s’offre à eux de faire un don d’organes; iii) les objections de conscience devraient être respectées dans la mesure où elles ne compromettent pas l’accès aux soins des patients; iv) la possibilité de refuser des organes provenant de l’AMM devrait être offerte aux receveurs lors de leur inscription sur la liste d’attente et v) un patient désirant faire don de ses organes suite à une AMM qu’il désire garder confidentielle devrait être informé de toutes les implications liées au contexte particulier du prélèvement et consentir à un bris de la confidentialité afin de minimiser les risques de nuire au don d’organes. Certaines de ces conclusions sont contraires aux politiques en vigueur. Notre étude a contribué à mieux cerner les enjeux éthiques soulevés par le don d’organes dans ces nouveaux contextes. De plus, nous identifions les enjeux pour lesquels une réflexion plus poussée , et possiblement une révision des lignes directrices, s’imposent. Plusieurs questions demeurent et de nouvelles questions surgissent alors que des modifications aux critères d’admissibilité à l’AMM sont entrevues à court ou à moyen terme (AMM en dehors de la fin de vie, en cas de maladie mentale ou pour les patients inaptes ayant fait une demande anticipée).
In the summer of 2014, the case of a conscious patient, respirator dependent, who requested a withdrawal of life-sustaining therapy and expressed the wish to donate his organs shook the Quebec organ donation and transplantation community. It was the beginning of an important reflection on the acceptability of organ donation in conscious and competent people who have chosen to stop vital treatment. This reflection was timely as the Quebec government was preparing its End-of-Life Care Act, which would make medical assistance in dying (MAID) legal. Since it was clinically possible for some patients to donate organs following MAID, it was likely that the legalization of this practice would increase the number of conscious patients wishing to donate their organs when they would have chosen to die. The literature on the ethical issues raised by this type of organ donation was then almost non-existent and, at the time the research project began, practice guidelines did not exist in Quebec and Canada. It therefore became imperative to identify these ethical issues and to analyze them in order to contribute to the guidance of these new practices. There was also no study describing the perspectives of health professionals regarding such donations. The objectives of this doctoral project were (i) to identify the ethical issues raised by organ donation in a conscious and competent patient requesting withdrawal of life sustaining therapy or MAID; (ii) to analyze these issues using ethical theories; (iii) to obtain and understand the perspectives of health professionals on the issues raised by organ donation in these particular contexts; (iv) finally, to compare the perspectives of professionals to the policies that have been adopted in Quebec since its inception. We therefore conducted a qualitative exploratory study through interviews with organ donation professionals likely to be involved in the organ donation process by a conscious patient who has requested withdrawal of life-sustaining therapy or MAID. Our sample included physicians and nurses in intensive care, operating room or involved in organ donation in two Montreal hospital centers that are very active in organ donation (CHUM and Hôpital Sacré-Cœur) and at Transplant Québec. We identified ethical issues through a literature review and by analyzing the perspectives of professionals. The main ethical issues are related to respect for patient autonomy, information to be provided to potential donors, conscientious objection by professionals, the possibility for recipients to refuse organs procured after MAID, the acceptability of organ donation following a confidential MAID, the dead donor rule, the acceptability of directing an organ to a specific recipient designated by the donor and the acceptability of choosing MAID in order to make organ donation possible. We first analyzed these ethical issues using Norman Daniels' wide reflexive equilibrium model and then incorporated participants' perspectives on the various issues using the normative empirical - reflexive equilibrium model into our analysis. Based on our results, we can conclude that : (i) organ donation for competent patients requesting MAID or withdrawal of life-sustaining therapies was generally ethically acceptable within the legal context in effect at the time of our research; (ii) patients requesting MAID and suffering from a disease compatible with organ donation should be informed of the possibility of organ donation; and (iii) conscientious objections should be respected as long as they do not compromise patients' access to care; iv) recipients should be offered the opportunity to refuse organs procured after MAID when they are placed on the waiting list; and v) a patient who wishes to donate his or her organs following MAID that he or she wishes to keep confidential should be informed of all the implications related to the specific context of the procurement and should consent to a breach of confidentiality in order to minimize the risk of undermining public trust in organ donation. Some of these conclusions are contrary to current policies. Our study has contributed to a better understanding of the ethical issues raised by organ donation in these new contexts. In addition, we identify issues that require further reflection and possibly a revision of the guidelines in place. Many questions remain and new ones arise as changes to the MAID eligibility criteria are foreseen (MAID outside of the end-of-life context, in cases of mental illness or by advanced request).

Introduction : L’entrée en vigueur de l’aide médicale à mourir (AMM) au Québec et au Canada pose la question de l’élargissement de cette prestation, notamment à des mineurs. La présence accrue des infirmières au chevet du patient les amène à recevoir des demandes liées à l’AMM. C’est pourquoi il appert pertinent de s’interroger sur leurs perceptions de ce soin pour des adolescents en fin de vie afin de mieux connaître leur opinion, de leur offrir plus d’outils et ainsi, de répondre plus adéquatement aux besoins du patient. Objectif : Le but de cette étude est d’explorer les perceptions d’infirmières œuvrant en service d’oncologie pédiatrique au regard de l’élargissement de la possibilité, pour des adolescents de plus de 14 ans, de demander l’AMM. Méthodologie : Un devis qualitatif exploratoire a été utilisé. Six infirmières œuvrant en soins oncologiques (n=3) ou palliatifs pédiatriques (n=1) ou étant en contact direct avec des adolescents en fin de vie dans le cadre de leur travail d’infirmières (n=2) ont participé à une entrevue individuelle semi-dirigée. La collecte de données et l’analyse ont été réalisées de manière simultanée en se basant sur l’analyse thématique. Résultats : Les résultats de cette recherche mettent en exergue que : 1) les infirmières reconnaissent leur rôle de soutien et leur implication dans les soins du patients en fin de vie, 2) la plupart ont une opinion professionnelle positive de l’AMM pour les adultes et distingue celle-ci de leur opinion personnelle, 3) elles apprécient les discussions autour de l’AMM pour des adolescents bien qu’elles soient préoccupées par les balises qui entoureraient ce soin, et 4) une longue expérience engageait plus de préoccupations sur l’élargissement mais aussi plus de confort à fournir des informations à ce sujet. Discussion et conclusion : Cette étude montre que les discussions autour de l’élargissement de l’AMM s’alimentent de plus en plus en soins pédiatriques de fin de vie. Cependant, des infirmières avec peu d’expérience dans ce milieu reflètent un inconfort vis-à-vis de l’AMM. Ainsi, les établissements universitaires et de santé pédiatrique doivent évaluer et répondre au besoin de formation des infirmières sur l’AMM afin de les outiller davantage face à de telles situations et ainsi, mieux répondre aux besoins de leurs patients. Mots clés : Perceptions, infirmières, soins palliatifs pédiatriques, oncologie, aide médicale à mourir, adolescents.
Introduction: With the recent introduction of medical assistance in dying (MAID) in Quebec and Canada, the extension of this health benefit, particularly to minors, is becoming increasingly important. The role and position of nurses close to patients puts them in the forefront of requests for MAID. This is why it seems relevant to examine their perceptions of this benefit for adolescents at the end of life: in order to better understand their opinions, and so to offer them more tools and thus to respond more adequately to patients' needs. Objective: The purpose of this study is to explore the perceptions of nurses working in pediatric oncology wards regarding medical aid in dying for adolescents at the end of life, in the event MAID comes into effect for this population. Methodology: An exploratory qualitative approach was chosen for this study. The sample consisted of seven nurses working in pediatric oncology (n=3) or palliative care (n=1) or who are in contact with this population in the course of their nursing work (n=2). Data collection and analysis were conducted concurrently, using thematic analysis. Results: The results of this research highlight that: 1) nurses recognize their supportive role and involvement in the care of patients at the end of life, 2) most have a positive professional opinion of MAID for adults and distinguish that from their personal, private opinion, 3) they appreciate discussions about MAID for adolescents although they are concerned about the markers that would surround this care, 4) more experienced nurses were more concerned about expanding MAID but at the same time more comfortable in providing information about it. Discussion and conclusion: This study shows that discussions about extending MAID are increasing in pediatric palliative units. However, nurses with little experience in these units reflect discomfort with MAID. Academic and pediatric health care institutions must assess the training needs of nurses regarding requests regarding MAID in order to better equip them to deal with such situations and thus better meet the needs of their patients. Key words: Perception, nurses, palliative pediatric cares, oncology, medical aid in dying, adolescents.

Thèse réalisée en cotutelle avec l'Université de Lausanne
Cette thèse porte sur l’administration des demandes de mort à partir de deux modalités controversées, l’aide médicale à mourir au Québec (Canada) et l’assistance au suicide dans le canton de Vaud (Suisse). Au Québec, l’assistance à mourir est un service public médical, tandis que dans le canton de Vaud, elle est un acte privé toléré par l’État et mis en œuvre par des associations. Selon la façon dont la question de l’assistance à mourir est posée dans les deux contextes, différentes réponses y sont apportées qui reflètent des formes variées de concernement pour cette pratique. Je suggère que ces deux régimes contrastés d’assistance à mourir peuvent être compris dans un même mouvement analytique, malgré les différences qui les séparent. Suivant une perspective comparative et ethnographique, cette thèse explore les façons dont sont mises en œuvre les quatre conditions de possibilité de l’assistance à mourir que j’identifie, et ce à plusieurs échelles, des débats publics aux expériences immédiates des personnes directement concernées. L’enquête repose sur quatre années de recherche, croisant des entretiens, des observations, une revue de presse, ainsi que des analyses de sources documentaires. Cette thèse arrive au constat que les régimes québécois et vaudois d’assistance à mourir se rejoignent autour de maximes morales pratiques employées par les personnes concernées. Ces maximes, qui se matérialisent dans des paroles quotidiennes et des dispositifs institutionnels, encadrent le trouble suscité par l’assistance à mourir et répondent aux quatre conditions de possibilité identifiées. Cette éthique en actes balise l’espace étroit que les personnes concernées doivent naviguer pour rendre l’assistance à mourir possible. J’examine finalement ce qui guette les protagonistes, ainsi que la société, lorsque ces conditions ne sont pas réunies. Plus généralement, la comparaison de l’administration des demandes de mort dans ces deux régimes contrastés ouvre sur une interrogation des frontières de la médecine, du droit et de la vie. L’analyse des conditions de possibilité et des contours du trouble contribue également aux réflexions sur la mise en œuvre des droits, dont celui à la liberté de conscience.
This thesis is about the administration of death requests from two controversial modalities, medical aid in dying in Quebec (Canada) and assisted suicide in the canton of Vaud (Switzerland). In Quebec, assistance in dying is a public medical service, while in the canton of Vaud it is a private act tolerated by the state and implemented by associations. According to how the assistance to dying question is raised in both contexts, different answers are given which reflect different forms of concern for this practice. I suggest that these two contrasting regimes of assistance in dying can be understood in the same analytical movement despite their differences. From a comparative and ethnographic perspective, this thesis explores how the four conditions that enable the possibility of assistance in dying that I identify are put into practice at different scales, from public debates to the experiences of people who are directly involved. The research is based on four years of investigation relying on interviews, observations, a press review, and analyses of documentary sources. This thesis concludes that the assistance in dying regimes of Quebec and Vaud have practical moral maxims used by the people involved in common. These maxims, which emerge in everyday words and institutional arrangements, frame the trouble that arises from the confrontation with assistance in dying and meet the four enabling conditions identified. This ethics in action circumscribes the narrow space that the people involved must navigate to make assistance in dying possible. Finally, I examine what awaits the actors, as well as the society, when these conditions are not met. More generally, comparing the administration of death requests in these two contrasting regimes leads to questioning the boundaries of medicine, law and life itself. Analyzing these enabling conditions and the bounds of the trouble contributes to the reflections on the implementation of rights, including the right to freedom of conscience.

For many patients, dying from cancer has been an ever-present reality from the time they were diagnosed with incurable recurrent or metastatic cancer. Treatment may have delayed the inevitable, but there does come a point where aggressive management no longer improves the prognosis or can only prolong life that is of such a poor quality that it is not valued by the patient. It sometimes is easier to continue with treatment than to take the time with the patient to discuss the reasons why further treatment is not appropriate. For patients with advanced cancer and whose condition is deteriorating, a number of questions should be considered before initiating treatment aimed at prolonging life. Is this the final stage of a progressive deterioration or an acute event? Are the causes of this deterioration reversible? Are there any further oncological treatments that may improve the prognosis? What is the patient’s perception of their quality of life? Is there a realistic chance of return to a quality of life that will be of value to the patient? Is the patient dying? The ICU is usually not appropriate for patients with advanced cancer. Treatment of correctable causes (e.g. obstructive uropathy, chest infection) may still not be in the patient’s best interest if they recover only to face a period of further deterioration and distressing symptoms before they die. However, patients and their families must be included in discussions as to the level of further intervention and the reasons for stopping active treatment.

“Sweetening Death” presents a comparative analysis of the role of sugar and its transformation in funeral foods, remembrance rituals, documenting the ways the dead are perceived and understood as active or passive actors in their afterlives. Sugar, though widely available in the contemporary world, was initially utilized in memorialization and funereal practices because it connoted a particular status to the dead, though it is now ironically a staple of the lower classes and a symbol of malnutrition. The comparison in food bereavement and memorialization rituals highlights a distinct difference between the function of food on the American table in comparison to the Mexican or Chinese context, revealing that while food functions to largely aide the bereaved and reintegrate the grieving into their social network without the deceased in the American context, it literally functions to feed the dead in Mexico and China.

This chapter discusses how death loomed over the nineteenth-century encounter between Christianity and the peoples of the Gold Coast. It highlights the evangelists who sought to overturn established values and ways of life in order to challenge the very idea of mortality itself: by abandoning idolatry and embracing the salvation offered by Christ. If African religious practice was resolutely this-worldly, aimed at maintaining the beneficence of deities and ancestors in order to defer death, Christianity was distinctly otherworldly, seeking to wash away sin so that the repentant might enjoy a blissful life beyond the grave. The chapter explores how the Akan and their neighbours regarded death, and explains the centrality of the doctrine of eschatology to the Christian message. Finally, the chapter assesses the further expansion of the Christian faith into Asante and the acceleration of conversion in the era of colonial rule. New perceptions of life after death, new funerary customs, and new ways of dying were crucial components of this religious transformation.

This chapter is aimed as an obituary of William Faulkner. It describes Faulkner as an arrogant and ill-mannered individual in a way that is peculiarly “Southern”: in company he usually failed to reply when spoken to, or when he spoke there was something grandiose in the profusion with which he sprinkled his remarks with “Sirs” and “Ma'ms.” No matter how great a writer he may be, the public gets increasingly tired of Faulkner; his death seems to remove the obligation to read him. Nevertheless, the chapter regards Faulkner as the greatest American novelist after Henry James since the 1930s. It cites five masterpieces written by Faulkner: The Sound and the Fury, As I Lay Dying, Sanctuary, Light in August, and The Hamlet.

This chapter defines the concept of archaeological mentality and suggests that it is a useful tool in characterizing archaeological thinking and practice. It is argued that pre-designed interviews, even considering their limitations (see Everill 2009: 105–7), are a good method of studying contemporary archaeological mentalities. For this purpose, the chapter presents an ethnoarchaeological investigation among a group of central Italian archaeologists, researchers, and field archaeologists involved in the study of the past peoples of the region, who are or have been engaged in pre-Roman funerary archaeology, the field of study of the author of this chapter. The study was aimed at exploring different attitudes central Italian archaeologists have towards their work, its various aims, guiding principles, and possible outcomes. This research was carried out as part of the preparatory phase of the Remembering the Dead project (Rajala 2008), with the duration of its field phase defined by financial and time constraints. The idea was to investigate the local archaeological context of the project in its planning phase, and this pilot study fulfilled its purpose from this view point. For archaeologists, the discovery, recovery, and study of human remains can be the most direct encounter with past individuals they have, giving a way to interpret the character of ancient customs, rituals, and communities (Parker Pearson 1999). Archaeologists are constantly dealing with the dead either indirectly, when trying to reconstruct the living conditions of past peoples, or directly when excavating and studying funerary remains. Although much effort has been devoted to understanding different funerary contexts (e.g. Parker Pearson 1982; Morris 1987; Lucy 2002; Tarlow 2011), less emphasis has been put upon understanding how our modern concerns and experiences may affect our work (Rajala 2007; Leighton 2010). In contrast, attitudes towards death have already been studied among other professions engaged in handling the dying and the dead (e.g. Cooper and Barnett 2005). Most of the archaeological treatises of the subject at the time of this study have been accounts of archaeologists’ own personal reactions or descriptions of specific cases (cf. Kirk and Start 1999; Reeve and Cox 1999).