The following text is an ethnographical study of relations in which care is shaped. On the example of care homes with special regime I describe how power is made and how different ideals are enacted in care of people with dementia. Through the analysis of daily activities' micro practice, I introduce two possible ways (modes of ordering) of care for frail elderly with cognitive impairment. The first of the modes is based on an enactment of ideals introduced into the practice by the Social Services Act and related system of quality standards: autonomy, individualisation, activation, and inclusion. It relies on standardisation of procedures, detailed specification of actions and management by objectives. The second mode of ordering, which could be located in the stories from care homes, is founded on an inevitable human dependency and vulnerability, and on general human need of giving and receiving care. In it, relationships and care improvisation here and now play the key role. My ethnographic fieldwork has shown that in everyday practice these two ways of doing good care co-exist - they complement each other, overlap and sometimes clash. People in care homes, striving for the better and the best care, either keep together, or hold apart these different and non-coherent ways of care. In discourse of...

The following text is an ethnographical study of relations in which care is shaped. On the example of care homes with special regime I describe how power is made and how different ideals are enacted in care of people with dementia. Through the analysis of daily activities' micro practice, I introduce two possible ways (modes of ordering) of care for frail elderly with cognitive impairment. The first of the modes is based on an enactment of ideals introduced into the practice by the Social Services Act and related system of quality standards: autonomy, individualisation, activation, and inclusion. It relies on standardisation of procedures, detailed specification of actions and management by objectives. The second mode of ordering, which could be located in the stories from care homes, is founded on an inevitable human dependency and vulnerability, and on general human need of giving and receiving care. In it, relationships and care improvisation here and now play the key role. My ethnographic fieldwork has shown that in everyday practice these two ways of doing good care co-exist - they complement each other, overlap and sometimes clash. People in care homes, striving for the better and the best care, either keep together, or hold apart these different and non-coherent ways of care. In discourse of...

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.