Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.

Made available in DSpace on 2014-12-17T14:46:38Z (GMT). No. of bitstreams: 1 DeboraRG.pdf: 691114 bytes, checksum: bfcd9e6dbde057375b05e9ef4df4600f (MD5) Previous issue date: 2005-12-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aimed to seize the general social representations of doctors and nurses who work in ICUs on the process of death and dying. We also aimed to know the social representations of these professionals in relation to death and the process of dying of people who are under their care, identify factors that influence the construction of these representations and identify similarities and differences between the two professions. The study was conducted from the perspective of the Theory of Social Representations of Serge Moscovici and the Central Nucleus of Jean-Claude Abric. The study was conducted in the Intensive Care Unit of Natal Hospital Center, a private hospital of the city of Natal - Rio Grande do Norte. This is descriptive and exploratory research. Twenty-four (24) professionals were interviewed, twelve (12) nurses and twelve (12) doctors. Data were collected through two instruments: Test of Free Association of Words, semi-structured interview. Later, they were coded, categorized and analyzed according to Content Analysis of Bardin (1977). The words evoked after the use of inducing words - death and dying - and the interviews, led to three thematic categories: Death and dying as a biological event, death and dying as a psychosocial event, death and dying as a transcendental event. As final considerations, we believe that the social representations of the group are translated in death and dying as biological and psychosocial events and anchored in the transcendental aspects, we do not see obvious differences in the testimonies of doctors and nurses , and the factors that interfere the construction of these offices is the culture, including religion / O presente estudo teve como objetivo geral apreender as representa??es sociais de m?dicos (as) e enfermeiros (as) que trabalham em Unidade de Terapia Intensiva UTI sobre a morte e o processo de morrer. Tivemos ainda como objetivos conhecer as representa??es sociais desses profissionais em rela??o ? morte e o processo de morrer de pessoas que est?o sob os seus cuidados, identificar os fatores que influenciam na constru??o dessas representa??es e identificar converg?ncias e diverg?ncias entre as duas profiss?es. O estudo foi realizado sob a ?tica da Teoria das Representa??es Sociais de Serge Moscovici e do N?cleo Central de Jean-Claude Abric. A pesquisa foi realizada na Unidade de Terapia Intensiva do Natal Hospital Center, institui??o da rede privada da cidade de Natal Rio Grande do Norte. Trata-se de uma pesquisa do tipo descritiva e explorat?ria. Para atender os objetivos propostos entrevistamos 24 (vinte e quatro) profissionais, sendo 12 (doze) enfermeiros (as) e 12 (doze) m?dicos (as). Os dados foram coletados atrav?s de dois instrumentos: Teste de Associa??o Livre de Palavras e entrevista semi-estruturada. Posteriormente, foram codificados, categorizados e analisados de acordo com a An?lise de Conte?do de Bardin (1977). As palavras evocadas ap?s o uso das palavras-indutoras morte e morrer , bem como as entrevistas, deram origem a tr?s categorias tem?ticas: Morte e morrer como evento biol?gico; Morte e morrer como evento psicossocial; Morte e morrer como evento transcendental. Como considera??es finais, entendemos que as Representa??es Sociais do grupo est?o objetivadas na morte e morrer como eventos biol?gico e psicossocial e ancoradas nos aspectos transcendentais; n?o percebemos diverg?ncias evidentes nos depoimentos de m?dicos(as) e enfermeiros(as); e os fatores que interferem na constru??o destas representa??es ? o cultural, especialmente, a religi?o

This qualitative phenomenological study attempts to gain the physician's essences, meanings and understanding surrounding death and dying. Starting with themes revealed in literature, in-depth interviews were used to ask selected physicians providing care: How does death affect them? Are physicians receiving adequate training in end-of-life care? Does the medical culture still see death as failure? How do they find meaning in end-of-life care? Using three different groups of physicians: early in career, mid-career, and retired, this research attempted to examine the phenomena of death and dying over apparent time and developmental experiences of physicians. Results: Physicians have not been adequately trained to handle end-of-life care. Communications skills, specific end-of-life care training and support for physicians dealing with death and dying are needed.

Dying is not only a highly personal topic, but we cannot forget that it is also a social theme, because people who are near death are always affected not only by other people but by society as well. Social workers and those in services that help the dying to live a meaningful, dignified, and painless existence in the interim must make a number of decisions, many of which being uneasy or uncomfortable, even in some cases where they have no clear solution. It is these problematic cases that these workers meet in their daily life. This thesis is therefore focused on the dilemmas faced by social workers that work with the dying. The theoretical part introduces problems of social work in the context of the dying. In order to understand a particular context, it must be something about the problems of dying to know why their work occasionally works as terms like dying, death and palliative care. As a crucial part of the work is the problem of dilemmas, where I come from Musil (2004) concept of everyday dilemmas. The theoretical part is devoted only dilemmas that research has not been proven. Other dilemmas are more specified in the empirical part. In the empirical part, I am setting one main goal, in which I try to find out what some of the dilemmas are that the staff working in social services with the dying people experience (such as in hospices, nursing homes, and retirement homes) and how to solve those dilemmas. To that end, I set two main research questions and six sub-research questions. To collect my data I chose the qualitative research method of questioning through semi-structured interviews. For the research sample, I chose the method of random selection. The research had to meet a set of predetermined criteria. For my data processing research, I chose the method of case studies. The research occurred in phases, where the first stage was partial, and then subsequently I conducted my own research. My goal in this work was to identify the problems experienced by people who provide social services to the dying, and how these are solved. The results have shown that they are indeed faced with many challenges. The research revealed nine such examples, while some individual workers had repeated instances. Further research showed that workers in most cases solve dilemmas as best as their knowledge and conscience permit. Accumulated experience is probably the most valuable asset in dealing with such situations, and the majority of respondents considered it important to discuss the issues faced by a multidisciplinary team. I believe that my work goals were met successfully and the research questions provided answers. My work could serve as a basis for a conference or for a technical article dealing with these issues in more detail.

Esta dissertação de mestrado põe em questão o morrer, verbo tão elástico que confunde-se com a própria vida. Partindo do pressuposto que o morrer é um processo que cabe aos vivos e, por isso, é atravessado pelas relações do sujeito com a verdade, o seguinte trabalho pretende analisar, a partir do instante presente, como a sociedade moderna ocidental se organizou para dar conta dos infinitos mistérios que a morte desperta nos indivíduos em paralelo com o projeto de governo do Estado de gestão e controle da população, a partir das práticas biopolíticas e da legitimidade do saber médico que prescreve o que é uma vida, quais são os valores que a determinam e sob que códigos e condutas os seres devem se submeter para serem considerados existentes. Aliado ao filósofo Michel Foucault e Giorgio Agamben, propõe-se um percurso sinuoso da emergência do racismo biológico e do racismo de Estado para refletir sobre os grandes genocídios do século XX, sob a perspectiva de uma Tanatopolítica. Através do recurso do ensaio, este trabalho provocará a pergunta: como escrever sobre algo que não se fala O ensaio, mais do que um método, é um artesania capaz de costurar o tempo e a história em busca do passado de nossas verdades presentes e um convite ao leitor a um livre flanar pelos rastros de um conhecimento subsumido das cátedras acadêmicas, mas que clama por sua palavra e seu sepultamento. Ensaiar é permitir, também, que a ficção, a poesia e a literatura entrem pela porta da frente na obstinação do saber. Se a ciência moderna carece de evidências acerca do morrer e seus processos, o ensaio responde, sem ferir os mistérios do mundo, com mais questões que permitem criar outras realidades, fora das instituídas. Junto com Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart e outros filósofos, a dissertação problematiza a distância entre a pesquisa e a militância, flertando com o saber morrer e apostando no luto enquanto luta, ensaiando outras maneiras de dar sentido a ausência com a inventividade política dos movimentos de ocupação atuais para fazer frente ao projeto biopolítico. / This master's dissertation questions dying: a verb so elastic that it is confused with life itself. Based on the assumption that dying is a process that belongs to the living and is therefore crossed by the subject's relations with the truth, the following work intends to analyze, from the present moment, how modern Western society organized itself to address the infinite mysteries that death awakens in the individuals in parallel with the state governor's project of management and control of the population, from the biopolitical practices and the legitimacy of the medical knowledge that prescribes what a life is, what the values that determine it are and under what codes and behaviors living beings must undergo to be considered existing. Allied with the philosophers Michel Foucault and Giorgio Agamben, it is proposed a sinuous route of the emergence of the biological racism and the racism of State to reflect on the great genocides of century XX, from the perspective of Tanatopolitics. This work will provoke the question in the form of an essay: how do we write about something that is not spoken The essay, more than a method, is a craft capable of sewing time and history in search of the past of our present truths and an invitation to the reader to a free walk through the traces of a subsumed knowledge of academic chairs, but that claims by its word and its burial. Essaying is to allow, also, that fiction, poetry, and literature enter the front door in the obstinacy of knowledge. If modern science lacks evidence about dying and its processes, this essay responds, without hurting the mysteries of the world, with more questions that enable us to create other realities, other than those instituted. Along with Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart, and other philosophers, this dissertation problematizes the distance between research and militancy, flirting with the acceptance of dying, and betting on mourning while fighting, essaying other ways to make sense of absence with the political inventiveness of the current occupation movements facing the biopolitical project.

Esta dissertação de mestrado põe em questão o morrer, verbo tão elástico que confunde-se com a própria vida. Partindo do pressuposto que o morrer é um processo que cabe aos vivos e, por isso, é atravessado pelas relações do sujeito com a verdade, o seguinte trabalho pretende analisar, a partir do instante presente, como a sociedade moderna ocidental se organizou para dar conta dos infinitos mistérios que a morte desperta nos indivíduos em paralelo com o projeto de governo do Estado de gestão e controle da população, a partir das práticas biopolíticas e da legitimidade do saber médico que prescreve o que é uma vida, quais são os valores que a determinam e sob que códigos e condutas os seres devem se submeter para serem considerados existentes. Aliado ao filósofo Michel Foucault e Giorgio Agamben, propõe-se um percurso sinuoso da emergência do racismo biológico e do racismo de Estado para refletir sobre os grandes genocídios do século XX, sob a perspectiva de uma Tanatopolítica. Através do recurso do ensaio, este trabalho provocará a pergunta: como escrever sobre algo que não se fala O ensaio, mais do que um método, é um artesania capaz de costurar o tempo e a história em busca do passado de nossas verdades presentes e um convite ao leitor a um livre flanar pelos rastros de um conhecimento subsumido das cátedras acadêmicas, mas que clama por sua palavra e seu sepultamento. Ensaiar é permitir, também, que a ficção, a poesia e a literatura entrem pela porta da frente na obstinação do saber. Se a ciência moderna carece de evidências acerca do morrer e seus processos, o ensaio responde, sem ferir os mistérios do mundo, com mais questões que permitem criar outras realidades, fora das instituídas. Junto com Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart e outros filósofos, a dissertação problematiza a distância entre a pesquisa e a militância, flertando com o saber morrer e apostando no luto enquanto luta, ensaiando outras maneiras de dar sentido a ausência com a inventividade política dos movimentos de ocupação atuais para fazer frente ao projeto biopolítico. / This master's dissertation questions dying: a verb so elastic that it is confused with life itself. Based on the assumption that dying is a process that belongs to the living and is therefore crossed by the subject's relations with the truth, the following work intends to analyze, from the present moment, how modern Western society organized itself to address the infinite mysteries that death awakens in the individuals in parallel with the state governor's project of management and control of the population, from the biopolitical practices and the legitimacy of the medical knowledge that prescribes what a life is, what the values that determine it are and under what codes and behaviors living beings must undergo to be considered existing. Allied with the philosophers Michel Foucault and Giorgio Agamben, it is proposed a sinuous route of the emergence of the biological racism and the racism of State to reflect on the great genocides of century XX, from the perspective of Tanatopolitics. This work will provoke the question in the form of an essay: how do we write about something that is not spoken The essay, more than a method, is a craft capable of sewing time and history in search of the past of our present truths and an invitation to the reader to a free walk through the traces of a subsumed knowledge of academic chairs, but that claims by its word and its burial. Essaying is to allow, also, that fiction, poetry, and literature enter the front door in the obstinacy of knowledge. If modern science lacks evidence about dying and its processes, this essay responds, without hurting the mysteries of the world, with more questions that enable us to create other realities, other than those instituted. Along with Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart, and other philosophers, this dissertation problematizes the distance between research and militancy, flirting with the acceptance of dying, and betting on mourning while fighting, essaying other ways to make sense of absence with the political inventiveness of the current occupation movements facing the biopolitical project.

Although the curative model of medical care is predominant it is necessary to consider the palliative strategies at the end-of-life. The inter-relation of dying children, their families and pediatric palliative care teams are seldom analyzed outside Palliative Care. However, it is important to ethnographically think about the disturbing experiences of body and subject disintegration while people are directly experiencing them, even when the person is a child or a newborn baby. A central topic in this study is how personhood, body formation and disintegration, and childhood can be understood within the context of unevenly constructed and shared palliative communication with and without words. Hence, I analyze in this study how a Palliative Care Team in the city of Buenos Aires provides care, communicates, and ultimately produces a particular companionship to dying children and their families. This work is built on qualitative information gathered and produced during my four-month fieldwork with the Palliative Care Team. The ethnographic techniques (participant observation, non-participant observation and open-ended semi-structured interviews) I conducted show that their strategies of care and communication have as the main goal the process of companionship at the end of children’s lives. It is necessary to understand how patients, parents, and other family members are situated in this field of tensions between restorative and palliative medicine, and brought into this culture of Palliative Care in a public children’s hospital. My research asks, in what ways are pediatric Palliative Care practices exclusive to the social and cultural contexts of Buenos Aires? This work has three main sections: 1. care, 2. communication, and 3. companionship. In section one I focus on the clinical and non-clinical aspects of care involving the professionals’ and volunteers’ practices of giving care. In section two I concentrate my attention on the verbal and non-verbal aspects of the Palliative Care Team communication with children and families. In section three I consider the professional production of ‘companionship’. In this thesis I will demonstrate the significance of this concept according to the Palliative Care Team members and how care and communication are the base for the ‘production of companionship.’ / Arts, Faculty of / Anthropology, Department of / Graduate

In the medical context, it is an accepted (yet controversial) fact that doctors may sometimes legitimately hasten death when providing palliative care to dying patients. Or even, in relation to treatment decisions leading to withdrawal or omission, some doctors may choose death over life for certain patients and yet we seldom hear of doctors in the dock for intentional killing. Where complicity in suicide is concerned, it seems that the compassionate lay person has little reason to be fearful of criminal reprisal. The question, however, of whether a person suspected of complicity in suicide, or a doctor suspected of intentionally causing the death of a patient, will be greeted by sympathy or condemnation is a legal minefield. A range of diverse legal, moral and circumstantial factors will determine firstly, whether one is prosecuted and secondly, whether one will be subject to juridical disapproval and possible incarceration. This thesis sets out to explore whether continued obfuscation, together with turning a blind eye to possible breaches of the law, is the best approach to the moral dilemma over what should be permitted in assisted dying and end-of-life law. This is not a rhetorical question with a trite answer. Such obfuscation may be viewed as having certain advantages. This thesis explores the legal and ethical issues in the context of recent developments, societal concerns and international influences in order to examine whether the current legal position in respect of homicide and complicity in suicide is tenable. The analysis invites the conclusion that whilst some legal change is both desirable and necessary, any legal reform should seek to facilitate a cautious compromise that reflects the legitimate concerns of those opposed to legal change.

abstract: ABSTRACT The purpose of this thesis is to identify the key determinants of changes in the public’s perception and the historical and legal context for the current laws that govern the Right to Die in America. At its essence, the Right to Die Movement can be summarized in six selected narratives that were performed, told, debated, or reported for the public throughout history. Each of these six stories was presented with the most effective communication technologies available to the narrators in their respective eras. The thesis includes an original research study assessing the impact of a social media phenomenon on the Right to Die Movement. While the Brittany Maynard Farewell video may not have been solely responsible for the surge of public support for MAID, it certainly captured the sense of autonomy and individual rights Americans believe they have in 2014 and continuing at least through 2019. This belief in autonomy and individual rights influenced the American sense of who owns their bodies and who can control their deaths after they are given terminal diagnoses. The first key narrative introduced Natural Law and the Natural Rights that proceed from this universal law. The second opened up communication about death. The next three demonstrated to Americans what legal rights they had and which were withheld by tradition and law. The last narrative captured and embodied the American sense of autonomy and individual rights that a majority of Americans now feel they possess. The laws and policies that have resulted from the Right to Die Movement both define the boundaries of autonomy and construct an evolving understanding of human freedom. / Dissertation/Thesis / Masters Thesis Religious Studies 2020

Bakgrund: Dödshjälp är i dagsläget olagligt i Sverige, men många andra länder har valt att legalisera det. Det finns i dag två olika former, aktiv dödshjälp går ut på att läkaren administrerar den dödliga dosen av läkemedlet samt den assisterade dödshjälpen som går ut på att läkaren skriver ut den dödliga dosen och patienten själv administrerar det. Denna litteraturstudie fokuseras på den assisterade dödshjälpen, där komplexiteten i frågan utgörs av sjuksköterskans etiska ställningstaganden, religiösa aspekter samt patientens rätt till självbestämmande (autonomi). Syfte: Syftet med studien var att sammanställa evidensbaserad kunskap om sjuksköterskans upplevelser av assisterad dödshjälp. Metod: En litteraturstudie där resultaten från 10 vetenskapliga originalartiklar med kvalitativ ansats sammanställdes. Materialet samlades in från databaserna PubMed och Cinahl. Resultat: När resultatet sammanställdes framkom tre huvudteman kommunikations betydelse, patientens autonomi och sjuksköterskans värderingar och åtta subteman. Resultatet belyser hur viktig den personcentrerade vården och teamarbetet mellan sjuksköterskan och andra professioner är vid den assisterade dödshjälpen. Sjuksköterskans motsättningar till den assisterade dödshjälpen var moraliska och etiska aspekter. Slutsats: Sjuksköterskans värderingar kunde vara en motsättning till den assisterade dödshjälpen, men de flesta sjuksköterskorna skulle inte överge sin patient oavsett om denne valde assisterad dödshjälp eller inte.