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Background: Decisions about technological support for children with life-limiting canditians are surrounded by uncertainty, and require families to weigh up complex issues around quality and prolongation of life. The limited evidence suggests there is inadequate information and support for decision-making, and potential for misunderstanding between families and professionals. Aim: To investigate parents' and young people's experiences of making decisions about technological support, focusing on artificial nutrition and assisted ventilation. Methods: A purposive sample of nineteen families of life-limited children and young people (twenty-five parents and five young people) who had considered the use of technological support was drawn from users of a children's hospice. In-depth interviews were carried out with this sample and the data subject to thematic analysis. Findings: Parents and young people wish to make the right choices, and consider a range of factors and information in an effort to become informed, even when there is no perceived choice in decisions they make. Quality of life is identified as the key decision factor, which as a fluid and evolving cancept underpins the process of assessing a child's needs and considering the potential impact of a proposed intervention. Wider features of the process also influence how families make decisions, and the research proposes an ecalogical framework which distinguishes between decision factors, used by families to cansider a proposed intervention; decision features, unique to the patient population in this case life-limited children; and process factors concerned with the wider context and health care environment. Conclusions: Decision features, which include the evolving role of parents and young people as decision makers, and process factors such as the role of professionals and access to information for decision-making, can either enable or constrain families during the decision process and influence both the perceived choice and the degree of uncertainty they experience.

This dissertation argues that the permitting of Physician Assisted Suicide (PAS) is not a desirable extension of patient choice. Should PAS be made permissible by making it a live option, then certain patients may request it and be harmed by wrongful death. Furthermore, the harm to patients who suffer wrongful death as a result of requesting PAS trumps the harm to patients who must endure unbearable suffering should PAS not be permitted. The line of argument in defence of these claims is, first, that contrary to the common view, agents may sometimes be harmed when they are presented with an additional option. Second, the harm that may result from having an additional option occurs as a result of certain features of the agent or the context in which the agent is choosing. This second argument goes beyond previous ones because it explains two additional harms to an agent from a new option. These are harms resulting from three types of weak character and resulting from normative features of what I term the context of choice. Third, in order to decide whether or not to extend patient choice by permitting PAS, the harm to patients who may request it and suffer wrongful death and the harm to patients who are suffering unbearably and who cannot relieve their suffering through PAS must be weighed against one another. This weighing of harms is possible through insights gained from types of need. Categorical needs trump instrumental ones, and are also parallel to categorical harms. So, the categorical harm of wrongful death trumps lesser harms, such as suffering unbearably. Since the harm to patients who suffer wrongful death, should PAS be permitted, trumps the harm to other patients who are suffering unbearably, permitting PAS is not a desirable extension of patient choice.

With advance decisions currently being the only legal means of expressing ones wishes about the end of life in the UK, the literature revealed that the assumed benefits of having an advance decision, can be challenged. The process of discussing the choices and wishes for the end of life appeared to be considered more valuable by older people, than the outcome of having an advance decision. With the debates about possible legalisation of euthanasia and assisted suicide ongoing in the UK, seven older people were interviewed to explore their position in this debate. The interviews were analysed using discourse analysis, with reference to the Foucauldian concepts of knowledge, power, subjectification and surveillance. Three main discourses emerged: confused and conflicted, an aged death and voiceless in the debate. A patchy knowledge about the nature of the acts fed into conflicting discourses. A self-determination discourse was eroded by discourses that involved family and physicians in the decision-making process. The medicalisation of dying appeared endorsed at several levels, through the physicians' knowledge, power, subjectification and surveillance processes. An alternative dying discourse emerged where healing and growth in death were considered possible. For this healing and growth to occur, family were present and the medical gaze absent. In the aged death discourse, participants talked about the anticipated changes in their physical and mental health before their death in old age. However, they expressed concern about becoming dependent on professional others and the quality of care they might receive at the end of their life. They appeared to disappear from any 'gaze and surveillance' and were concerned they would be treated like 'objects'. Euthanasia and assisted suicide were considered as options that could provide a sense of control and independence at the end of life. It is possible that the position of older people in society and their worthiness of care and attention might have been internalised by older people and hence contributed to their consideration of euthanasia and assisted suicide. The participants reported feeling voiceless in the debate, as they experienced difficulty engaging others in a debate about euthanasia and assisted suicide, attributing vulnerabilities to debating partners (children, friends, physicians), who would normally be considered as holding powerful positions. They expressed frustration about the fact that it appeared that arguments in favour of euthanasia and assisted suicide had to meet a 'higher standard of rationality', than the arguments presented against euthanasia and assisted suicide. Their confused knowledge about the exact nature of euthanasia and assisted suicide might also hamper their power position in any debate. Psychologists need to remain vigilant about the impact of conflicting discourses the older person might express and critical of the impact societal discourses about ageing may have on the older person as well as the health and social care provision.

The thesis presents quantitative and qualitative thematic analyses of a postal survey and interview study of members of Friends at the End (FATE), a Glasgow-based right to die society. This is one of the first UK studies aimed toward filling a gap in knowledge about who joins a UK right to die society, and their reasons for doing so. The thesis attributes responsibility for the right to die movement’s continuing existence to contemporary socio-cultural norms of individualism and self-determination in promoting desire for autonomy and choice surrounding dying and death. It shows how and why a distinct group of predominantly older and higher social class individuals, 22% of whom have health and social care professional backgrounds, have decided to join FATE. The right to die movement is shown to be a new social movement concerned with health, ageing and death activism that challenges contemporary biomedical models of managing dying and death. The thesis shows how ageing, social class, religiosity, socio-medical constructs of dying, risk management and altruism toward others all contribute toward the ongoing existence of pro-right to die attitudes and beliefs. It also shows how personal fears about the manner of future dying, both physical and existential are frequently informed by personal experiences, identified as critical factors in decisions made to join the movement. FATE exists in a culture in which assessing risk has become very pervasive, and joining FATE is, for many members, a risk-avoidance strategy, given their concerns that future dying and death may be unpleasant. Conditional desire for hastened death is also shown to be informed by desire to avoid placing burden on others, a form of reciprocal altruism in which hastened death benefits both the dying person and family members as well as society as a whole.

La Corse figure parmi les zones les plus criminogènes d'Europe alors que ceux qui y vivent, et les touristes qui la visitent, en parlent volontiers comme d'un paradis terrestre. Cette thèse tente d'interroger ce paradoxe en faisant appel aux concepts de la psychanalyse pour ouvrir de nouvelles pistes permettant d'éclairer autrement le phénomène de la violence insulaire dans un débat déjà largement ouvert par les spécialistes des sciences humaines et bien sûr les journalistes. En prenant appui sur la théorie du signifiant élaborée par Jacques Lacan nous analyserons le drapeau, cet emblème qui identifie une communauté à l'international et auxquels les membres de cette communauté s'identifient généralement. Deux versions historiques seront étudiées : celui à tête de Maure et celui à l'effigie de L'Immaculée Conception de la Vierge Marie qui lui succède pendant la révolution pour l'indépendance, en 1735. Cette confrontation permet de soutenir que, si la Corse ne parvient pas à passer de la horde à l'État, c'est en partie en lien avec les signifiants proposés aux insulaires par son héraldique lesquels ne favorisent pas la compréhension des lois exogamiques et donc les passages que constituent les complexes d'OEdipe et de castration. La définition du terrorisme comme « guerre psychologique » justifie le recours à la psychanalyse pour en détecter les ressorts à travers une thématique qu'elle connaît bien : la notion de limite et de franchissement des limites à l'oeuvre dans toutes les formes de terrorisme. / Corsica is one of the most crimogenic areas in Europe, even though the residents and visiting tourists refer to it as an earthly paradise. This dissertation attempts to examine this paradox by calling on concepts of psychoanalysis in order to explore new avenues that may be able to provide insight and otherwise shed light on the phenomenon of insular violence in a debate that is already largely open and discussed by social science specialists and, of course, journalists. Based on the theory of the Signifier, developed by Jacques Lacan, we will analyse the flag, the symbol which identifies a community to the rest of the world and to which members of this community generally identify themselves. Two historical versions will be studied: that of the Saracen's head and the effigy of the lmmaculate Conception of the Blessed Virgin, which succeeded it during the revolution for independence in 1735. Such a confrontation enables the supposition that if Corsica is unable to pass from mob rule to State rule, this is partly in connection with the signifiers suggested to the islanders by their genealogy which does not encourage the understanding of exogamous laws and thus the routes leading to Oedipus and castration complexes. The definition of terrorism as "psychological war" justifies the use of psychoanalysis to discover its origins by means of a thematic which it is very familiar with: the notion of limits and transgressing limits.

Deux faits interpellent le psychologue intervenant auprès des hommes auteurs de violences dans le couple : la responsabilisation et la prévention de la récidive en tant qu’ils constituent le moyen et la visée des interventions. À partir d’une analyse liminaire du fonctionnement des centres de prise en charge en France, la dimension de la répétition en tant que grille d’interprétation de ces violences, et en particulier en tant qu’elle structure la clinique, est interrogée. Pour ce faire, je développe le concept de répétition à l’appui de la théorie psychanalytique et analyse 8 témoignages d’hommes en m’intéressant aux fantasmes sous-jacents. Cinq constats sont ainsi relevés : la récurrence d’imagos paternelles et maternelles fortes, de composantes cruelles chez l’objet, de traits sadiques et de libido homosexuelle. Le développement théorique qui s’ensuit s’articule autour de quatre thématiques : l’identification à l’agresseur, le fantasme de la mère cruelle, le sadisme et la jalousie. / Two aspects of clinical interventions for male perpetrators of intimate partner violence are of concern to psychologists: the perpetrators’ responsibility and the prevention of recidivism insofar as they constitute the means and the aim of these interventions. From the initial analysis of batterer programmes in France, repetition, as a dimension for interpretating male intimate partner violence, in particular within a clinical intervention context, is examined. To this end, I develop the concept of repetition based on psychoanalytic theory and analyse 8 interviews of male perpetrators, focussing on the underlying fantasies. This approach led to five findings: the recurrence of strong paternal and maternal imagos, cruelty components within the object, sadistic traits and homosexual libido. The ensuing theoretical development hinged on four concepts: identification with the aggressor, the fantasy of the cruel mother, sadism and jealousy.

A universal human dignity, conceived as an inherent and inalienable value or worth in all human beings, which ought to be recognised, respected and protected by others, has become one of the most prominent and widely promoted interpretations of human dignity, especially in international human rights law. Yet, it is also one of the most difficult interpretations of human dignity to justify and ground. The fundamental problem rests on how one can justify bestowing an equal high worth to all human lives, whilst also attributing to all human life a worth that is superior to all non-human animal life. To avoid the speciesist charge it seems necessary to provide further reasons, over and above species membership, for why all humans have a unique worth and dignity. However, intrinsic capacities, such as autonomy, intelligence or language use, are too demanding for many humans (including foetuses or the severely cognitively disabled) to meet the required minimum standard, whilst also being obtainable by some non-human animals, regardless of where the level is set. This thesis offers a solution to this problem by turning instead to the significance of the relational ties between individuals or groups that transcend individual capacities and abilities, and consequently does not require that all individuals in the group need meet the minimum required capacity for full moral status. Rather, it is argued that a universal human dignity could be grounded in our social nature, the interconnectedness and interdependence of human life and the morally considerable relationships that can and do arise from it, especially in regards to our shared vulnerability and dependence, and our ability to engage in caring relationships. Care represents the antithesis to the dehumanizing effects of humiliation, and other degrading and dehumanizing acts, and as a relational concept, human dignity is often best realised through our caring relationships. The way that individuals and groups treat each other has a fundamental role in determining both an individual’s sense of self-worth and well-being, as well as their perceived public value and worth. Thus, whilst species membership is not in itself morally fundamental or basic, it often shapes the nature of our social and moral relations. These relational ties between humans, it is argued, distinguish us most clearly from other non-human animals and accord human relationships a special moral significance or dignity.

Cette thèse analyse la surmortalité par suicide sur le territoire du Pays COB au travers des facteurs psychosociaux et psychopathologiques et repose sur l'hypothèse d'interactions entre les conceptions sociales du suicide et les trajectoires personnelles des individus, freinant sa prévention. Une étude des représentations sociales du suicide montre qu’il existe des RS spécifiques en Bretagne et en Pays COB. L’étude des trajectoires de vie met en évidence une sur-représentation de la dépression et les troubles de la personnalité. On trouve aussi une faible estime de soi, une difficulté d'accès à la parole et à la demande d’aide, des violences transgénérationnelles et actuelles, un climat incestuel et une stigmatisation (auto et hétéro) liée aux RS du suicide, de la dépression et des « psy ». L’étude de l’effet d’un suicide montre qu’il a un impact sur les proches : traumatisme psychique individuel et familial, deuils traumatogènes. À la suite de ces résultats, des actions spécifiques pourront être menées sur ce territoire pour améliorer la prévention du suicide et des tentatives de suicide. / The present thesis analyzes the role of psychosocial and psychopathological factors in the abnormally high rate of deaths by suicide in the “Pays COB” territory. It is based on the hypothesis according to which the interactions between the social conceptions of suicide and the personal trajectories hinders suicide prevention. We studied the structure of social representations of suicide (SR) with Vergès’method (double analysis of the evocation rank) and uncover specific SR in Brittany and in “Pays COB”. A study of the life trajectories highlighted the excessive rate of depressions and personality disorders. We also found amoung suicide victims a weak self-esteem, a difficulty to talk and to ask for help, transgenerational and current violent tendencies, an incestual climate and (self-) stigmatization related to the SR of suicide, depression and psychiatric services. A study about the effect of a suicide showed that it has an impact on the close relatives: individual and family psychic trauma, traumatic grief. Following these results, specific actions can be carried out in this territory to improve the prevention of suicide and of suicide attempts.