Intervention in Libya is an anomaly in President Barack Obama's foreign policy during his eight years in the office. This thesis aims to analyze the decision-making process leading to this unprecedented step. Using Graham Allison's Bureaucratic Politics Model, the purpose of this analysis is to investigate the influence of some presidential advisors and allies on his final decision. Data for this study were collected using President Obama's public statements, biographies of several members of the administration, and secondary academic sources. After some general context, the thesis closely examines the selected period from the first protests in Libya on February 15 to the beginning of the Operation United Protector on March 31. This timeframe of forty-five days is further divided into the week-by-week process tracing analyses. The development on the ground in Libya is merged with changes of attitude in the American administration and changing alliances among the members of the advisory team of the President. The Bureaucratic Politics Model is used to analyze specific tactics used by American officials to impose their preferred scenario. The study also tests the applicability of several new methodological approaches within the Bureaucratic Politics Model like the palace politics perspective,...

Molntjänster har funnits sedan en lång tid tillbaka. Med åren har allt fler börjat använda dessa tjänster, vilket har gjort att det är ett högaktuellt ämne. Cirka 75 procent av företag använder sig av molntjänster och det ses som nödvändigt för digitaliseringen i svensk offentlig sektor. Trots det råder en debatt om komplexiteten vid användandet av molntjänster för myndigheter. Denna forskningsstudie kommer studera organisationers tankar kring molntjänster och dess prioritering för molntjänsternas olika risker, för att kunna skapa en förståelse kring varför organisationer tar de beslut de tar. Hur kan det komma sig att företag och myndigheter ser olika på användningen av molntjänster? För att ta reda på detta har en litteraturstudie genomförts för att inhämta tidigare forskning kring området, samt semistrukturerade intervjuer med företag och myndigheter för att få en fördjupad förståelse kring dess användning av molntjänster. Undersökningen visar på att det skiljer sig mellan företag och myndigheter när det kommer till anskaffningen av molntjänster. För myndigheter finns det regler och riktlinjer för hur de ska gå till väga. För företag saknas det riktlinjer, de har dock egna individuella beslutsprocesser. Företagen har enbart dataskyddsförordningen att ta hänsyn till samtidigt som myndigheter även har flertalet andra lagstiftningar att följa. Det skilde sig även åt mellan företag och myndigheter gällande de problem och hot som de ser, samtliga myndigheter ser fler hot än vad företagen gör. En likhetsom resultatet visar är att organisationerna hade liknande policys, där man inte får använda otillåtna molntjänster. Myndigheter hade även åtgärder i avsikt att förhindra skugg-IT, detta genom att fånga upp de anställdas behov och på så sätt hindra dem från att nyttja otillåtna tjänster. / Cloud computing has been around for a long time. Over the years, more people have started using these services, which has made it highly topical. 75 percent of companies use cloud services and it is seen as necessary for digitalisation in the Swedish public sector. Nevertheless, there is a debate about the complexity of using cloud services for authorities. This scientific research report will analyze organizations thoughts on cloud computing and identify the different risks of cloud computing, in order to create an understanding of what organizations base their decisionson. How come that companies and authorities have different views on the use ofcloud computing? To find out this, a literature study has been conducted to gather previous research on the area, as well as semi-structured interviews with companies and authorities to gain an in-depth understanding of the organizations use of cloud computing. The results and the conclusions of this study show that there are differences between companies and authorities when it comes to the acquisition of cloud computing. For authorities, there are rules and guidelines for how to proceed. There is a lack of guidelines for companies, they have their own individual processes. Companies only have the GDPR to take into account, while authorities have the majority of other legislation to follow. There was a difference between companies and the authorities problems and threats that they see. All authorities see more threats than companies do. A similarity in the result is that organizations had similar policies, where they are not allowed to use unauthorized clouds. Authorities also had measures in place to counteract shadow IT, this by raising the needs of the employees and thus preventing them from using unauthorized clouds.

In recent years, the development considerations within transport planning have started to examine needs from a more comprehensive perspective in order to shift the focus of planning away from favoring automobile travel. New approaches are emerging around the world to face the challenges we are confronted with, such as urbanization, dispersion of community structures, change in population structure, aging, climate change, and tightening budgets. Therefore, this thesis is aiming to gain more insight on new approaches in transport planning by comparing emerging systems in Sweden and in Finland. The comparison is focused on the renewed procedures at the early stages of transport planning; the methods to conduct multi-modal studies through collaborative decision-making processes in both countries. Thus, in this thesis the renewed preliminary transport planning in Finland and the Swedish method of Strategic Choice of Measures are compared based on implications from practice. The main purpose is to learn from practice and therefore, the data for comparison is based on conducted test cases that aim to develop the emerging planning processes in both countries. In Sweden, the preliminary version of the new planning method, developed by the Swedish Transport Administration, was tested with six cases during 2011. KTH was commissioned to conduct a study to examine the collaborative planning of involved actors in each of these cases, and the cases together. Thus, in the Swedish context, the data for comparison will be collected from the earlier study conducted by a KTH researcher John Odhage. In the Finnish context, a case study will be carried out for the data collection. The chosen case consists of a pilot study initiated in Finland in 2012 for the purpose of collecting ideas for the development of a renewed preliminary planning process. In general, both countries approaches aim at creating efficient procedures that would contribute to cost-efficiency and sustainable development as well as fulfilling other aims of the transport policy of each country.  The focus of the comparison is on the critical aspects of multi-modal studies and three features of a collaborative process; the choice of actors, the problem formulation, and the process management. The comparison is carried out based on theoretical implications and the experiences from practice are scrutinized against the ideal approach of each country. It has become apparent that three clearly distinctive differences between the approaches can be pointed out: the role of the transport administration, the creation of a steering committee, and creation of a concept for process guidance. In addition, the four-step principle is the multi-modal tool used in both countries approaches to generate alternative measures to transport related issues. The basic idea of the principle is in the first place to influence land use, transport demand, and choice of travel mode, and secondly to examine if the use of existing transport system can be optimized prior to construction. However, based on the experiences from practice, it seems that in both countries processes the focus of generating alternative measures is leaning more against minor or large new investments. Thus, the search for complementary measures to achieve considerable cost-savings and more importantly, sustainable development, is perceived challenging.

This research project focuses on decision-making about large hydropower dams, particularly the process and outcomes of impact assessment, involving state, corporations, and local Indigenous communities. The objective of the study is to investigate whether state-led impact assessment, as one tool of regulatory decision-making, can be a way to address environmental justice concerns for Indigenous peoples affected by natural resource infrastructure. The core of this research is a case study comparison between the Belo Monte dam (Brazil) and Site C dam (Canada) to examine the effectiveness of environmental impact assessment (EIA) and decision-making. I analyse these processes’ ability to address the inequities caused by disparate adverse effects of dams on Indigenous peoples. Despite evidence of the impacts of large dams on Indigenous peoples, there is limited literature on their experiences with large hydropower projects and their decision-making processes, and mechanisms that would account for Indigenous peoples’ experiences. This research aims to fill in that gap in the literature by exposing the limitations of impact assessment and proposing recommendations for environmental decision-making to address Indigenous peoples’ concerns and experiences. I start with a review of the development of the environmental justice (EJ) literature as the research’s analytical framework. Environmental justice focuses on diagnosing the inequities caused to localized communities under the argument of a necessary ‘smaller evil,’ so that the larger society may benefit from natural resources development. However, the research participants’ experiences pointed to the need to revise the EJ framework towards a more integral approach to environmental decision-making, recognising the fundamental relationship between land and human beings. This research project concludes that EJ for Indigenous peoples helps reinstate decision-making purposes – evaluating the impacts, proposing alternatives to projects, promoting transparency and accountability, and considering the possibility of rejecting projects – when done within a genuine government-to-government collaborative framework between state and Indigenous governments. / Graduate

Bakgrund: Digitaliseringens utveckling har under de senaste åren accelererat och innebär utmaningar för organisationer kring att snabbt kunna anpassa sig efter nya förhållanden och ställa om (Guinan et al., 2019). Chefsarbetet har därmed blivit alltmer komplext då chefer behöver ha inblick i den tekniska utvecklingen (Zeike et al., 2019). Till följd av förändringar i omgivningen ligger fokus på att ha en välutvecklad strategi för att kunna möta de utmaningar som uppkommit (Liedtka, 2000). Beslutsprocesserna har under distansarbetet blivit mindre effektiva och tar längre tid. Organisationer behöver se över sin strategi och utveckla arbetsformer för att anpassa dem till det flexibla arbetssätt som digitaliseringen medfört (Gabryelczyk, 2020). Syfte: Med hjälp av studien ämnar vi skapa en förståelse kring de utmaningar och möjligheter som uppkommit vid strategiska beslutsprocesser till följd av digitaliseringen. Ämnet belyses utifrån en kommunal verksamhet, vilket Almeida et al. (2020) menar inte forskats kring i stor utsträckning tidigare. Metod: En kvalitativ metod användes för studien. Semistrukturerade intervjuer genomfördes med åtta personer som underlag för empirin. Förutom det, samlades även två dokument in som komplement till intervjuerna. Slutsats: Den digitala transformationen genomsyrar hela organisationen och bör tas i beaktande vid det strategiska beslutsfattandet. De faktorer som enligt det empiriska resultatet påverkat den strategiska beslutsprocessen är informationstillgänglighet, begränsad kommunikation samt deltagande. Det empiriska resultatet visar att den faktorn som påverkat de strategiska beslutsprocesserna mest till följd av digitaliseringen är att information blivit mer lättillgänglig. Till följd av detta går det enklare att få fram information till beslutsunderlag och beslutsunderlagen kan därmed hålla en högre kvalitet. Dessutom har digitaliseringen skapat möjligheter till bättre omvärlds- och konsekvensanalyser. Informationstillgängligheten antas bidra till att chefer kan vara mer rationella i sitt beslutsfattande. Den andra faktorn som empiriskt identifierats är begränsad kommunikation i form av att informationsöverföringen mellan personer brister i viss mån och att diskussioner blir stelare under digitala möten. Resultatet visar att det trots detta, genom digitaliseringen rent tekniskt finns resurser för att kommunicera samt dela information. När den mänskliga faktorn kopplas in framkommer dock att diskussioner i själva verket blir stelare vid digitala möten jämfört med i ett fysiskt rum. Digitaliseringen kan alltså i viss mån antas gynna beslutsprocessen i och med att5effektiviseringar kan göras om de digitala verktygens potential utnyttjas, men beslutsprocessen kan även missgynnas på grund av stelare diskussioner. Den tredje faktorn är att deltagandet har främjats till följd av digitaliseringen. Resultatet visar att möjligheten till ett ökat deltagande genom att bemöta digitaliseringens möjligheter har bidragit till en större möjlighet till att deltagare, problem, lösning och beslutstillfälle sammanfaller. / Background: The progress of digitalization has been incremental in recent years which poses challenges for organizations to adapt promptly to new conditions and change (Guinan et al., 2019). Therefore, the managerial work has become even more complex as managers need to be aware of the technical development (Zeike et al., 2019). The focus remains on having a well-developed strategy and strategic decision making to adapt to the changes in the environment (Liedtka, 2000). The decision-making process has become less efficient and is more time consuming since people are working remotely. The organizations need to reevaluate their stratgies and develop their working methods to implement digitalization (Gabryelcyk, 2020). Purpose: The study conducted intends to create an understanding of the challenges and opportunities that have arisen in the strategic decision-making process due to digitalization. This subject shed light based on a municipality operation which according to Almeida et al. (2020) is not a subject that has been extensively researched before. Method: A qualitative method have been used for the study. Semi-structured interviews were conducted with eight people as a basis for empiricism. Moreover, two documents were added as a complement to the interviews. Conclusion: The digital transformation impacts the entire organization and should be taken into consideration in strategic decision-making. The factors that due to the empirical results have affected the strategic decision-making process are information accessibility, limited communication, and participation. The empirical findings shows that due to digitalization the factor that has influenced the strategic decision-making processes most is that information has become more accessible.Consequently, it is easier to obtain information for decision making. Thus, the decision foundation retains a greater quality. In addition, digitalization has created opportunities for better environmental and consequence analysis. The accessibility of information to managers is assumed to contribute to better rational decision making.The second factor empirical identified is limited communication. During digital meetings, the exchange of information has a propensity to be miscommunicated and sometimes part of the information is omitted, as well as discussions tends to be stiffer. On the other hand, the study results show that despite this, through digitalization, there are technical resources to7communicate and share information. However, when the human factor is involved, it seems that discussions become stiffer in digital meetings compared to physical ones. Hence, digitalization can to some extend benefit the decision-making process in terms of efficiency whilst utilizing the potential of the digital tools. Yet, it has also a disadvantage due to stiffer discussions.The third factor is that participation has improved because of digitalization. The results show that the opportunity for improved participation, through digitalization, has contributed to a greater opportunity for participants, problems, solutions, and decision making to coincide.

This thesis establishes that the knowledge is limited in customer experience and meal-kit subscriptions written from a business perspective. The current coronavirus pandemic has contributed to a rapid surge for an industry already expected to take more significant portions of the global food market. In conjunction with an attractive business model and increasing competition, there are reasons to believe that a positive customer experience will be of the highest importance for the future of meal-kit subscriptions. The research has chosen the segment of young adults to demonstrate areas for companies to improve. The findings will eventually present solutions for companies to reach a highly desired customer segment before the competitors. Furthermore, the research summarizes how companies can develop the customer experience based on consumer values.

The Covid-19 pandemic, as a health and economic crisis, has significantly affected consumers, businesses and industries in all parts of the world. In this study, the aim was to investigate how situational factors, the covid-19 pandemic, affected consumer behavior regarding food purchases via e-commerce instead of physical stores. This has been done through a qualitative method in the form of 15 semi-structured interviews that have taken place via the Zoom program. The study sample consisted of a combination of both a goal-directed and convenience sample, where the authors chose the interviewees based on their circle of acquaintances and based on three different criterias, (1) the interviewees live in either the Salem or Södertälje municipality, (2) the interviewees need to be at least 18 years old to participate in the study and (3) the interviewees must have purchased food via e-commerce after the emergence of the covid-19 pandemic. The study's question is: How has the covid-19 pandemic affected consumers over the age of 18 in Södertälje and Salem municipalities when buying food, from shopping in physical stores to shopping via e-commerce? The authors analyzed the empirical data with regard to the study's theoretical frame of reference. The results of the study showed that the situational factor, the covid-19 pandemic, has been a contributing force in a change in consumer behavior when purchasing food starting from physical stores to e-commerce. This has been demonstrated by the fact that the interviewees' subjective norm, attitude and evaluation of alternatives have been influenced by the situational factor. Some trends have also been found in the empirical study, where one of the trends concerns the perceived behavioral control, which has been shown to have the opposite effect. Post-purchase evaluation in The Consumer Purchase Decision-Making Process has been shown to be for the most part positive in the interviewees answers and finally, WOM-communication has had an impact on consumer behavior inconnection with the impact of the covid-19 pandemic. / Covid-19-pandemin, som både en hälso- och ekonomisk kris, har väsentligt påverkat konsumenter, företag och industrier i alla delar av världen. I denna studie var syftet att undersöka hur situationella faktorer, covid-19-pandemin, påverkat konsumentbeteendet gällande inköp av livsmedel via e-handeln istället för fysiska butiker. Detta har genomförts via en kvalitativ metod i form av 15 semistrukturerade intervjuer som skett via Zoom-programmet. Studiens urval bestod av en kombination av ett målstyrt och bekvämlighetsurval, där författarna valde intervjupersonerna utifrån deras bekantskapskrets och utifrån tre olika kriterier, att (1) intervjupersonerna bor i antingen Salem eller Södertälje kommun, (2) intervjupersonerna behöver vara minst 18 år gamla för att delta i studien och (3) intervjupersonerna måste ha handlat livsmedel via e-handeln efter covid-19-pandemins uppkomst. Studiens frågeställning lyder: Hur har covid-19-pandemin påverkat konsumenterna över 18 år i Södertälje och Salem kommun vid inköp av livsmedel, från att handla i fysiska butiker till att handla via e-handel? Författarna analyserade empirin med hänsyn till studiens teoretiska referensram. Studiens resultat visade att den situationella faktorn, covid-19-pandemin har varit en medverkande kraft i ett ändrat konsumentbeteende vid inköp av livsmedel från fysiska butiker till e-handeln. Detta har påvisats genom att intervjupersonernas subjektiva norm, attityd och utvärdering av alternativ har påverkats av den situationella faktorn. Även en del trender har upptäckts i empirin, där en av trenderna berör den upplevda beteendekontrollen, vilket har visats ha en omvänd effekt. Utvärdering efter köpet i  The Consumer Purchase Decision-Making Process har visats vara för den övervägande delen positiv och slutligen har WOM-kommunikationen haft en påverkan på konsumentbeteendet i samband med covid-19-pandemins inverkan.

Människor fattar inte alltid optimala och rationella beslut, och det finns olika teorier som förklarar dessa mer irrationella beslutsprocesser. Naturalistiskt beslutsfattande handlar om att undersöka hur människor faktiskt fattar beslut i verkliga situationer. Studien ämnade att kvalitativt undersöka hur beslutsprocessen vid näthandel av kläder och skor kan se ut. I studien ingick fyra personer i åldrarna 19 till 36 år. Studien bestod av två delar; en observationsdel där deltagaren skulle leta upp ett plagg hen skulle vilja köpa, samtidigt som hen tänkte högt med think aloud-metoden, samt en avslutande intervjudel med öppna intervjufrågor. Tran- skriberingarna analyserades med en narrativ analys. Studien resulterade i fyra olika berättelser och beslutsprocesser; en om att shoppa utifrån behov och intresse, en om att söka information, en om att shoppa under kort tid och impulsivt och en om att shoppa under kort tid och vara obeslutsam länge. Det visade att beslutsprocessen vid näthandel inte var enbart rationell och bland annat påverkades av hur deltagarna hanterade den stora mängden information de fick på nätet, vilken motivation de hade till shoppingen samt vilket mål de hade med den. Näthandel verkade dessutom innefatta mer än att bara göra ett köp. Att undersöka en så komplex process genom naturalistiskt beslutsfattande kan alltså ge unika insikter. / People do not always make optimal and rational choices, and there are different theories that explain more irrational decision-making processes. Naturalistic decision-making concerns how people make decisions in real life situations. This qualitative study aims to explore what the decision-making process may look like in online shopping of clothes and shoes. The study consisted of four people aged 19 to 36 years old. The procedure contained two parts; one observational study, where the participant was instructed to search for and find an item of clothing online that they would like to buy, while thinking aloud with the think-aloud method, and a final interview part with open-ended questions. The transcriptions were then analysed with a narrative analysis. This resulted in four different stories and decision-making processes; one about shopping out of needs as well as spontaneous interests, one about searching for information, one about shopping impulsively and intensely and one about shopping for a short amount of time but being indecisive for a long time. The decision-making process in online shopping was found to not be solely rational and was, among other things, influenced by how the participants handled the large amount of information they received online as well as their motivation for and goals with the shopping. Furthermore, the objective with the participants’ shopping was found to be more than to just make a purchase. This indicates that examining such a complex process through naturalistic decision making can give unique insights.

Dans cette thèse, un système personnalisé de stadification automatique du sommeil est proposé, combinant fusion symbolique et système de contrôle rétroactif. La fusion symbolique est inspirée par le processus décisionnel mis en œuvre par les cliniciens experts du sommeil lors la reconnaissance visuelle des stades de sommeil. Il commence par l'extraction de paramètres numériques à partir des signaux polysomnographiques bruts. L'interprétation symbolique de haut niveau se fait par l'intermédiaire de l'extraction de caractéristiques à partir des paramètres numériques. Enfin, la décision est générée en utilisant des règles inspirées par les recommandations internationales en médecine du sommeil. Les symboles et les valeurs des caractéristiques dépendent d'un ensemble de seuils, dont la détermination est une question clé. Dans cette thèse, deux algorithmes de recherche différents, Differential Evolution et Cross Entropy ont été étudiés pour calculer la valeur de ces seuils automatiquement. La variabilité individuelle a souvent été ignorée dans les systèmes automatiques de stadification du sommeil existants. Cependant, elle a été démontrée dans plusieurs travaux de recherche vis à vis de nombreux aspects du sommeil (comme les enregistrements polysomnographiques, les habitudes de sommeil, l'architecture du sommeil, la durée du sommeil, les événements liés au sommeil, etc.). Afin d'améliorer l'efficacité des classificateurs des stades de sommeil, un système automatisé de sommeil automatique adapté aux différentes personnes et tenant compte de la variabilité individuelle a été exploré et évalué. / In this thesis, a personalized automatic sleep staging system is proposed by combining symbolic fusion and feedback system control technique. Symbolic fusion is inspired by the decision-making process of clinical sleep staging. It starts from the extraction of digital parameters from raw polysomnography signals and it goes up to a high-level symbolic interpretation through a features extraction process. At last, the decision is generated using rules inspired by international guidelines in sleep medicine. Meanwhile, the symbols and the features computations depend on a set of thresholds, whose determination is a key issue. In this thesis, two different search algorithms, Differential Evolution and Cross Entropy, were studied to compute these thresholds automatically.Individual variability was often ignored in existing automatic sleep staging systems. However, an individual variability was observed in many aspects of sleep research (such as polysomnography recordings, sleep patterns, sleep architecture, sleep duration, sleep events, etc.). In order to improve the effectiveness of the sleep stages classifiers, a personalized automatic sleep staging system that can be adapted the different persons and take individual variability into consideration was explored and evaluated.The perspectives of this work are based on evaluating the complexity and the performances of these algorithms in terms of latencies and hardware resource requirements, in order to target a personalized automated embedded sleep staging system.

Les amyotrophies spinales infantiles (ASI) de type 1 (subdivisées en type 1 vrai et 1 bis), sont des maladies neuromusculaires qui paralysent progressivement l’enfant, mettant en jeu son pronostic vital lors de l’atteinte des muscles respiratoires. L’assistance respiratoire invasive par trachéotomie évite son décès, mais soulève un questionnement éthique compte-tenu de la gravité du handicap moteur. L’ASI de type 1 vrai représente la forme la plus grave. Ces enfants étant totalement paralysés et pouvant très difficilement communiquer, ils ne sont pas trachéotomisés et décèdent dans la petite enfance. Le type 1 bis étant un peu moins sévère avec possibilité pour l'enfant de s'exprimer, les équipes médicales françaises se positionnent généralement en faveur de la trachéotomie, ce qui ne fait pas l’unanimité au niveau international. Cette question soulève donc un questionnement éthique, car lorsque les professionnels évaluent la vie qu’elle va imposer à l’enfant ainsi qu’à sa famille, ils redoutent éventuellement qu’elle représente une obstination déraisonnable de soins. Mais qu’ils y soient favorables ou au contraire défavorables, ils ne peuvent décider seuls de la démarche à entreprendre et il leur est impossible d’exclure les parents du processus décisionnel. Au regard de ces problématiques, ce travail porte une attention particulière aux parents de ces enfants avec 2 thématiques de recherche approchées par des études qualitatives : L’une sur leur vécu de la prise de décision de recourir ou non à la trachéotomie, avec la réalisation de deux études phénoménologiques : une auprès de parents dont l’enfant est décédé sans trachéotomie, l’autre auprès de parents ayant un enfant vivant avec une trachéotomie. L’autre sur les conséquences de la trachéotomie pour l’enfant et sa famille, menée auprès de mamans d’enfants trachéotomisés. Les résultats de ces travaux mettent en exergue les difficultés d’être exposé à une telle prise de décision en tant que parent, et le cheminement ainsi que les évènements qui les mènent à un moment ou un autre à se positionner sur la question. Ils interrogent également la place dans la société de l’enfant tétraplégique, trachéotomisé et ventilo-dépendant. Son état représente un paroxystique degré de vulnérabilité physique et sociale, considérablement majoré par le fait qu’il ne peut pas, comme l’adulte, tenter de prendre sa vie en main. Ce sujet n’étant jamais évoqué dans la presse non spécialisée, ces situations restent souvent dans l’ombre alors qu’elles représentent des vies qui ont grandement besoin de tolérance et de solidarités humaines (individuelles et collectives) pour ne pas s’éteindre. Ces dernières déterminent en partie le devenir de l’enfant et favorisent ou au contraire, empêchent la création de sa place légitime au sein de la société / Childhood spinal muscular atrophy (SMA) type 1 (divided into true type 1 and 1a), are progressively paralyzing neuromuscular diseases that afflict children, affecting their prognosis when respiratory muscles are involved. Invasive ventilatory support by tracheotomy prevents death, but raises ethical issues in view of the severity of motor impairment. SMA type 1 represents the most severe form. These children are completely paralyzed and communicate only with great difficulty; they are not tracheotomized and die in infancy. For Type 1a, being somewhat less severe with the possibility for children to express themselves, French medical teams are generally positioned in favor of tracheotomy, which is not an internationally unanimous approach. This question raises an ethical issue because when professionals assess the life that will result for the child and family, they sometimes fear that it represents unreasonable and excessive care. Whether their views are favorable or unfavorable regarding ventilatory support, they cannot decide alone which approach should be undertaken; it is impossible to exclude parents from decision making. Given these issues, this study pays particular attention to parents of children with two research themes through qualitative research : One focus was on parents’ experience of deciding whether or not to accept tracheotomy, which was examined through two phenomenological studies: one with parents whose child died without a tracheotomy, the other with parents with children living with a tracheotomy. The other focus was on the consequences of a tracheotomy for the child and family, conducted among mothers of children with tracheotomies. The results of these studies highlight the difficulties of being faced with such a decision as a parent, and the journey and events that lead to one point or another on this issue. They also question the place in society of the quadriplegic child with a tracheotomy and ventilator dependence. The child’s condition represents a paroxysmal degree of physical and social vulnerability, significantly increased by the fact that he/she cannot, as adults, take his/her life in hand. This subject is never mentioned in the lay press; these situations often remain in the shadows while there are lives that are in dire need of tolerance and human solidarity (individual and collective) to not be extinguished. This partly determines the future of the child and promotes or, on the contrary, prevents the creation of his/her rightful place in society.