CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / O seguinte documento visa descrever e analisar as relaÃÃes entre auxiliares de perÃcia e mÃdicos-legistas bem como as suas concepÃÃes acerca da morte e do morto â elementos que sÃo rotina em sua profissÃo. A pesquisa foi realizada tendo como locus o NUTAF â NÃcleo de Tanatologia Forense, um setor da Coordenadoria de Medicina Legal da PEFOCE â PerÃcia Forense do Estado do Cearà localizada na Avenida Castelo Branco nÂ901 no Bairro Moura Brasil. Discuto as maneiras de como essa âmorte cotidianaâ apresenta-se no espaÃo estudado, bem como os olhares destes profissionais que apreendem o cadÃver como sendo uma âcoisaâ e as implicaÃÃes desta categoria quando aplicada aos mortos. / The following paper aims to describe and analyze the relationship between expertise and coroners aids as well as his views about death and the dead - elements that are routine in their profession. The survey was conducted as having locus the NUTAF - Center for Forensic Thanatology a Coordination sector of Legal Medicine of PEFOCE - Cearà State Forensics located at Avenida Castelo Branco 901 in the neighborhood Moura Brazil. Discuss ways of how this "daily death" presents the study space as well as the looks of these professionals perceive the body as a "thing" and the implications of this category when applied to the dead.

O presente trabalho construiu-se a partir dos novos paradigmas que permeiam a relação médico-paciente. Se o profissional não mais se encontra em uma posição de superioridade (ao menos do ponto de vista fático) em face de seu paciente, que por sua vez está mais sensível em virtude das transformações oriundas da sociedade de massa, o elemento informação ganhou contornos importantíssimos, inserindo-se no núcleo principal da prestação, ao lado dos cuidados relativos à saúde propriamente ditos. Nesse contexto, foi proposta uma nova visão do dever de informar na relação médico-paciente, tratando a informação como uma obrigação autônoma, que gera de per se em caso de ausência ou vício responsabilização civil. A reparação, em tal perspectiva, surge a partir da violação do direito à liberdade: se a autodeterminação é um atributo da personalidade do paciente, a afronta a esse direito acarreta danos indenizáveis. Os limites do dever de informar, assim, desempenham relevante papel, pois demarcam a tênue linha que distingue a informação viciada (que ensejará responsabilização civil) daquela transmitida diligentemente. Assim, o conteúdo e a extensão da informação foram abordados, confrontando-se aspectos subjetivos, objetivos e buscando uma solução ao mesmo tempo viável (do ponto de vista prático), jurídica e justa. Como o trabalho trata essencialmente do dever de informar na relação médico-paciente e das consequências jurídicas derivadas do inadimplemento dessa obrigação, foram destrinchados todos os elementos que compõem esse complexo vínculo, passando por sua evolução histórica, pelos princípios, valores e direitos que permeiam e iluminam esta relação e, finalmente, pelos sujeitos que a compõem. Aspectos processuais atinentes à prova do cumprimento do dever de informação foram, ainda, examinados. Diversas questões polêmicas, tais como recusa de tratamento, direito a não saber, privilégio terapêutico, dentre outros, foram também debatidos. / This study is based on the new paradigms that permeate the doctor-patient relationship. If the medical professional no longer holds a superior position (at least from the factual point of view) vis a vis the patient who, on the other hand, is more aware to changes originating from doctor-patient relationship in the mass society, information availability has gained highly important contours, inserting itself into the core of services rendered, together with health care services themselves. In this context, this study proposes a new vision of the duty to inform in a doctor-patient relationship, treating information as an autonomous obligation, that, per se, results in liability in the case of its absence or flaws. The compensation, in such perspective, arises from breach of the right to autonomous choice: if self-determination is a characteristic of the patients personality, the disrespect of this right results in damages subject to indemnification. Therefore, the limits of the duty to inform perform a relevant role since they demarcate the fine line that distinguishes flawed information (that can incur liabilities) from that transmitted diligently. Thus, the contents and the extension of the information were addressed, comparing subjective and objective aspects and seeking a solution at the same time viable (from the practical viewpoint), legal and just. Since this study essentially deals with the duty to inform in the doctorpatient relationship and of the legal consequences derived from noncompliance of this duty, all factors that compose this complex link were carefully examined, reviewing its historical evolution, the principles, values and rights that permeate and elucidate this relationship and, finally, the parties involved. Legal evidential procedures related to fulfillment of the duty to inform were also examined. Various controversial topics such as the refusal to undergo treatment, the right to not be informed, therapeutic privilege, among others, were also discussed.

Le projet ANR ACORFORMed, dans lequel s’inscrit cette thèse, a pour objectif la création (par des informaticiens) d’un agent conversationnel animé « patient » comme outil de formation à l’annonce, par la simulation et à l’aide d’un environnement virtuel. A l’aide de la méthodologie issue des études de la gestuelle et des apports de la littérature sur l’organisation des interactions, nous tentons de répondre à la question suivante : quelle est l’organisation structurelle globale de l’interaction patient-médecin, lorsque ce dernier se forme à l’annonce d’un dommage associé aux soins ? Les analyses menées dans cette thèse nous permettent de décrire l’interaction patient/médecin lors de formations à l’annonce en proposant différentes phases composants l’interaction, ainsi que des précisions quant à leur découpage et leurs articulations. Elles constituent une base indispensable et utilisable par les informaticiens pour concevoir et implémenter un agent conversationnel « patient » crédible qui pourra être utilisé dans la formation des médecins. Située au coeur d’un projet interdisciplinaire, cette thèse en linguistique permet donc de transposer les pratiques interactionnelles des médecins en vue de l’implémentation d’un agent virtuel par des informaticiens. / The ACORFORMed ANR project, in which this PhD project is integrated, aims at the creation (by computer scientists) of a "patient" animated conversational agent as a training tool for announcing, simulating and using a virtual environment. Using the methodology resulting from gestures studies and contributions of the literature on the organisation of interactions, we try to answer the following question: what is the overall structural organisation of the doctor/patient interaction, when this last is training to break the news of a damage associated with care? The analyses carried out in this thesis allow us to describe the doctor/patient interaction during training to break the news by proposing different phases that make up the interaction, as well as details about their division and their articulations. They are an indispensable and usable base for computer scientists to design and implement a credible "patient" conversational agent that can be used in physician training. Located at the heart of an interdisciplinary project, this thesis in linguistics makes it possible to transpose the interactional practices of physicians with a view to the implementation of a virtual agent by computer scientists.

À partir de deux enquêtes au sein d’établissements pour personnes âgées dépendantes, une ethnographie de la relation soignant-soigné tente de décrypter la cinétique relationnelle durant l’acte de la toilette. Loin de l’évidence, le refus exprimé parfois violemment par des personnes atteintes de maladie d’Alzheimer, est ressenti par les équipes comme une offense à l’aide proposée. Pourtant ce geste quotidien de bien-être et de confort, par sa fonction de modelage et d’apprivoisement corporel devient un espace de communication sensible permettant de renouer un lien identitaire en cours d’amoindrissement. La présente recherche propose une analyse sur les formes de contractualisation relationnelle des intimes en situation de maladie et d’accompagnement. Dégageant les influences sécuritaires d’une organisation médico-sociale, le temps de la toilette devient un soin protégé relevant d’un espace transitionnel. L’étude particulière d’un soin de toilette permettra de comprendre les processus relationnels dans le temps et l’espace à partir du travail des émotions. L’intime s’intersubjective dans des présences jusqu’au bout de la vie, interrogeant des interactions de reconnaissances mutuelles en mouvement.La méthodologique adoptée traduit ce parcours aux frontières des intimes d’un sujet et d’une démarche dans un contexte de configuration gérontologique. / From two surveys in institutions for the elderly, an ethnography of the doctor-patient relationship attempts to decipher the relational dynamic during the act of personal hygiene for the patient. Not at all obvious, the sometimes violent refusal from people with Alzheimer's disease, is interpreted as offensive to the proposed care. Yet this daily gesture of care-giving and comfort by the creation of familiarity and trust becomes a moment of communication that can strengthen a weakening bond.This research presents an analysis of the types of relationships in the personal context of the disease and of accompaniment. Setting aside the safety imperatives of a medico-social organization, the moment of personal hygiene is a priviledged transistional act. This particular approach to care-giving in personal hygiene can, over time, identify the relational processes from an emotional perspective. The intimate inter-subjectivity lasting until the end of life creating a dialogue of mutual respect and acknowledgement.An appropriate methodology traces this journey to the beginnings of intimacy, a topic and an approach in a context of a gerontological structure.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the ‘mobile and transitory’ discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators – and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the ‘in-between’ discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or ‘difficult’ parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

<p>The purpose of this essay is to analyze the view on sexuality held by Sweden’s first woman doctor Karolina Widerström, by using ideologycritical textanalysis on the written scriptures of dr. Widerström that focus on sexualpolitics. In doing this I use the theory of speech by Foucault. In this study I focus on Widerström’s scriptures, what she wrote about, how she wrote about it but also what she couldn't write due to the historical context and how omission can still speak of power. I mean that Widerström intentionally tried to write about immoral subjects in a moral way and that her sexualpolitic scriptures give a rare expression of a positive view on sexuality, which is even clearer in comparison with Elizabeth Blackwell, another woman doctor and gynaecologist active in USA. By examining the threats and ideals in their works I come to the conclusion that Widerström’s view on sexuality as beautiful, natural and positive is very different from Blackwell’s point of view.</p>

The purpose of this essay is to analyze the view on sexuality held by Sweden’s first woman doctor Karolina Widerström, by using ideologycritical textanalysis on the written scriptures of dr. Widerström that focus on sexualpolitics. In doing this I use the theory of speech by Foucault. In this study I focus on Widerström’s scriptures, what she wrote about, how she wrote about it but also what she couldn't write due to the historical context and how omission can still speak of power. I mean that Widerström intentionally tried to write about immoral subjects in a moral way and that her sexualpolitic scriptures give a rare expression of a positive view on sexuality, which is even clearer in comparison with Elizabeth Blackwell, another woman doctor and gynaecologist active in USA. By examining the threats and ideals in their works I come to the conclusion that Widerström’s view on sexuality as beautiful, natural and positive is very different from Blackwell’s point of view.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

The presence of a device meant to enhance the medical encounter may alter the nature of the doctor-patient interaction in a way that affects patient satisfaction. The focus of this study was to examine the social impact of introducing advanced exam-room technologies to the doctor-patient interaction. By comparing cohorts (young: 18-39 and older: 62-89) we examined a possible age-related interaction. Participants viewed one of several video conditions portraying a physician conducting a medical interview in which he uses one of various documenting technologies (Nothing, Pen and Paper, PDA, Desktop Computer, Wearable Computer). After viewing the interaction, participants completed a series of questionnaires evaluating their general satisfaction with the quality of care (QoC) given during the medical interview. Patient satisfaction levels did significantly vary depending on the technology condition, participant cohort, and participant gender. Overall, young adults and females rated the doctor more favorably. The favorability of ratings for each technology condition depended on the aspect of QoC examined.