by Ching Nai-Tsung. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 145-146). / ABSTRACT --- p.iv / TABLE OF CONTENTS --- p.v / LIST OF TABLES --- p.x / LIST OF FIGURES --- p.x / ACKNOWLEDGEMENTS --- p.xi / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Chapter I. --- Purpose of Study --- p.2 / Chapter II. --- The Client Organization --- p.2 / Chapter A. --- A Brief Description --- p.2 / Chapter B. --- The Need and Reason for Consultation --- p.4 / Chapter C. --- The Commitment of the Management Team --- p.4 / Chapter III. --- Organization of Chapters --- p.5 / Chapter CHAPTER TWO --- METHODOLOGY AND SCOPE OF CONSULTATION --- p.6 / Chapter I. --- Methodology --- p.6 / Chapter A. --- Action Research --- p.7 / Chapter B. --- Data Feedback Cycles --- p.12 / Chapter C. --- Advantages for Choosing Action Research and Data Feedback Cycles --- p.13 / Chapter II. --- Scope of Consultation --- p.13 / Chapter III. --- Consultation Approaches --- p.15 / Chapter A. --- Participation of Organization Members --- p.15 / Chapter B. --- Role of Consultant --- p.15 / Chapter CHAPTER THREE --- BACKGROUND OF MCHK --- p.17 / Chapter I. --- A Brief History --- p.17 / Chapter II. --- Organization Structure --- p.18 / Chapter A. --- Decision-Making Function --- p.18 / Chapter 1. --- Conference --- p.18 / Chapter a. --- Ministerial Session --- p.20 / Chapter b. --- Representative Session --- p.20 / Chapter 2. --- Standing Committee --- p.21 / Chapter 3. --- Conference Office --- p.22 / Chapter 4. --- Conference Committees --- p.22 / Chapter B. --- Coordinating Function --- p.23 / Chapter 1. --- Executives' Meeting --- p.23 / Chapter 2. --- Circuits --- p.23 / Chapter 3. --- Parish Coordination Committee --- p.24 / Chapter C. --- Execution Function --- p.24 / Chapter 1. --- Local Churches --- p.24 / Chapter 2. --- Chapels and Meeting Places --- p.25 / Chapter 3. --- Schools and Centres --- p.25 / Chapter D. --- Strategic Development Committee --- p.25 / Chapter III. --- Organizational Resources --- p.25 / Chapter A. --- Human Resources --- p.26 / Chapter 1. --- Pastoral Workers --- p.26 / Chapter 2. --- Non-pastoral Workers --- p.26 / Chapter 3. --- Lay Members --- p.27 / Chapter a. --- Local Preachers --- p.27 / Chapter B. --- Financial Resources --- p.27 / Chapter C. --- Physical Resources --- p.28 / Chapter CHAPTER FOUR --- CONSULTATION PROCESS: PHASES ONE TO SIX --- p.29 / Chapter I. --- Key Executive Perception of Problems (Phase 1) --- p.29 / Chapter A. --- Task of the Strategic Development Committee --- p.29 / Chapter B. --- Problems Perceived by the Executives' Meeting --- p.30 / Chapter II. --- Entry and Meeting with Consultant (Phase 2) --- p.31 / Chapter A. --- The First Meeting --- p.31 / Chapter B. --- The Annual Representative Meeting --- p.32 / Chapter III. --- Data Collection (Phase3) --- p.32 / Chapter A. --- Methodology --- p.32 / Chapter B. --- Data Collection --- p.33 / Chapter C. --- Survey and Interview Results --- p.35 / Chapter 1. --- Organization Structure --- p.36 / Chapter a. --- Meetings --- p.37 / Chapter b. --- Decision-Making Process --- p.37 / Chapter c. --- Standing Committee and Laity Representatives --- p.39 / Chapter d. --- "Balance of Preaching, Social Services, and Education" --- p.39 / Chapter e. --- The Circuits --- p.40 / Chapter f. --- Role of the Conference --- p.40 / Chapter g. --- Chairman of Conference --- p.41 / Chapter h. --- Summary --- p.41 / Chapter 2. --- Human Resources --- p.42 / Chapter a. --- Understaffing and Workload --- p.42 / Chapter b. --- Stationing --- p.42 / Chapter c. --- Recruitment --- p.43 / Chapter d. --- Support from Conference --- p.44 / Chapter e. --- Staff Benefits --- p.44 / Chapter f. --- Summary --- p.44 / Chapter 3. --- Relationship between Conference and Local Churches --- p.45 / Chapter a. --- Functions and Activities --- p.45 / Chapter b. --- Laity Participation in Conference Activities --- p.46 / Chapter c. --- Offering Contribution --- p.46 / Chapter d. --- Summary --- p.47 / Chapter 4. --- Management of the Conference Office --- p.47 / Chapter 5. --- Relationships among Local Churches --- p.48 / Chapter IV. --- Diagnosis by Consultant (Phase 4) --- p.48 / Chapter A. --- Organization Structure --- p.50 / Chapter B. --- Decision-Making Process --- p.51 / Chapter C. --- Laity Participation --- p.52 / Chapter D. --- Relationships between Conference and Local Churches --- p.53 / Chapter E. --- "Recruitment, Stationing, and Human Resources Management" --- p.54 / Chapter F. --- Staff Relations and Team Spirit --- p.55 / Chapter V. --- Feedback to Client (Phase5) --- p.57 / Chapter VI. --- Discussion (Phase6) --- p.59 / Chapter VII. --- Summary and Recommendations --- p.60 / Chapter CHAPTER FIVE --- CONSULTATION PROCESS: PHASES SEVEN AND EIGHT --- p.64 / Chapter I. --- Introduction to Feedback Cycle Two --- p.64 / Chapter II. --- Data Collection (Phase 7) --- p.65 / Chapter A. --- Methodology --- p.65 / Chapter B. --- Data Collection --- p.65 / Chapter III. --- Diagnosis by Consultant (Phase 8) --- p.66 / Chapter A. --- Factors for Consideration --- p.67 / Chapter 1. --- Core Values and Strengths --- p.67 / Chapter a. --- The Threefold Ministry Concept --- p.67 / Chapter b. --- The Check and Balance Mechanism --- p.69 / Chapter c. --- The Democratic Spirit --- p.69 / Chapter 2. --- Limitations and Other Important Factors --- p.69 / Chapter 3. --- Summary --- p.71 / Chapter B. --- Direction of Diagnosis --- p.71 / Chapter C. --- Analysis of Organization Structure --- p.72 / Chapter 1. --- Committee Structure --- p.73 / Chapter a. --- Analysis --- p.73 / Chapter i) --- Standing Committee --- p.73 / Chapter ii) --- Executives' Meeting --- p.73 / Chapter iii) --- Conference Committees --- p.75 / Chapter b. --- Recommendations --- p.81 / Chapter i) --- Ex-officio members --- p.81 / Chapter ii) --- Re-grouping of Conference Committee --- p.82 / Chapter iii) --- Duties and Responsibilities of Committees --- p.83 / Chapter iv) --- Status of the Conference Executive Secretary --- p.84 / Chapter c. --- Summary --- p.85 / Chapter 2. --- Line of Authority and Reporting Relationships --- p.86 / Chapter a. --- Analysis --- p.86 / Chapter i) --- Relationships between Local Churches and Circuit --- p.87 / Chapter ii) --- Relationships between Local Churches and Other Lines of Authority --- p.89 / Chapter iii) --- The Executives´ة Meeting --- p.90 / Chapter b. --- Recommendations --- p.91 / Chapter i) --- Reporting Relationships for Local Churches --- p.91 / Chapter ii) --- The Executives' Meeting and the Standing Committee --- p.93 / Chapter c. --- Summary --- p.95 / Chapter D. --- Analysis of Decision-Making Process --- p.96 / Chapter 1. --- Analysis --- p.97 / Chapter a. --- Application for Candidacy for Ministerial Work --- p.97 / Chapter b. --- Application for Financial Subsidy --- p.102 / Chapter c. --- Stationing --- p.103 / Chapter 2. --- Recommendations --- p.106 / Chapter a. --- Layers/Number of Meetings/Committees --- p.106 / Chapter b. --- Size of Meeting --- p.107 / Chapter c. --- Responsibility and Authority --- p.109 / Chapter 3. --- Summary --- p.110 / Chapter E. --- Relationship between Conference and Local Churches --- p.111 / Chapter 1. --- Analysis --- p.111 / Chapter 2. --- Recommendations --- p.115 / Chapter 3. --- Summary --- p.117 / Chapter IV. --- Conclusion --- p.118 / Chapter CHAPTER SIX --- PROPOSED CORRECTIVE ACTIONS: A COMPREHENSIVE VIEW --- p.119 / Chapter I. --- Introduction --- p.119 / Chapter II. --- Organization Structure --- p.121 / Chapter A. --- Decision-Making Function --- p.121 / Chapter 1. --- Conference --- p.122 / Chapter 2. --- Standing Committee --- p.123 / Chapter 3. --- "Executives, Meeting" --- p.123 / Chapter 4. --- Conference Office and Conference Executive Secretary --- p.125 / Chapter 5. --- Conference Committee --- p.125 / Chapter a. --- Re-grouping of Committees --- p.125 / Chapter b. --- Ex-officio Members --- p.128 / Chapter c. --- Size of Committees --- p.131 / Chapter d. --- Duties and Responsibilities --- p.131 / Chapter 6. --- Reporting Relationships --- p.132 / Chapter B. --- Execution Function --- p.133 / Chapter C. --- Coordination Function --- p.135 / Chapter III. --- Conclusion --- p.136 / Chapter CHAPTER SEVEN --- CONSULTATION PROCESS: PHASE 9 --- p.137 / Chapter I. --- Introduction --- p.137 / Chapter II. --- Feedback to Client (Phase 9) --- p.137 / Chapter A. --- The Feedback Meeting --- p.137 / Chapter B. --- Feedback from Organization Members --- p.138 / Chapter III. --- Conclusion and Recommendations --- p.139 / Chapter CHAPTER EIGHT --- CONCLUSION --- p.143 / BIBLIOGRAPHY --- p.145

Dans une société démocratique, il faut que la relation entre l’État et ses citoyens soit égale, et que laparticipation du citoyen à la vie politique soit envisagée non seulement comme le critère d’évaluationdu niveau de démocratie d’un pays, mais encore comme la condition de légitimité du pouvoir desgouvernants. En bref, dans un État de droit, le peuple doit être le centre et l’origine des pouvoirspublics. Les organes essentiels de l’appareil d’État doivent être, directement ou indirectement,désignés par le peuple. Les problèmes les plus importants du pays doivent être consultés par le peuple,avant la prise de décisions définitives par l’autorité. Le droit de vote, d’éligibilité et le droit departicipation aux consultations populaires sont des droits politiques fondamentaux du citoyen. Enréalité, pour différents motifs, la mise en oeuvre de ces droits n’est pas respectée dans plusieurs pays.Comment ces droits sont-ils exercés et garantis au Vietnam ? Quelles sont les solutions appropriées àrenforcer pour une meilleure garantie de ces droits est donc le thème de notre étude qui répondra à unesérie de questions : la participation du citoyen vietnamien à la vie politique est un droit acquis ou droitdonné ? Dans quelles circonstances et pourquoi y participe-t-il ? Quelles sont les restrictions envers saparticipation ? Les cadres juridiques sont-ils suffisants pour sa participation ? Quelles sont lesinfluences issues de sa participation sur le Parti communiste toujours au pouvoir ? Que faut-ilentreprendre pour faciliter et garantir une vraie participation du citoyen dans l’avenir ? La pratique dela démocratie directe et la tendance du renforcement de la démocratie locale vers un État de droit sontilscompatibles avec le régime moniste ? Une participation active du citoyen à la vie politique dansl’avenir contribue-t-elle à changer en quelque sorte son statut actuel dans sa relation avec l’État ?...etc.Nous donnerons au lecteur les réponses adéquates à ces questions, pour qu’il puisse mieuxcomprendre le statut du citoyen au Vietnam dans les différentes périodes de l’histoire. / In a democratic society, it is necessary that the relationship between the State and its citizens is equal.Citizen participation in political life should be considered not only as the criterion for assessing thelevel of a country's democracy, but also as the condition of the legitimacy of the power of rulers. Inshort, in the rule of law, the people must be the center; the origin of government. Vital organs of theState apparatus must be directly or indirectly appointed by the people. The most important problems ofthe country must be consulted by the people before the authorities make any final decisions. The rightto vote, eligibility and the right to participate in popular consultations are the basic political rights ofcitizens. But in reality, for various reasons, these rights are not respected in many countries. How theserights are they exercised and guaranteed to Vietnam, what are the appropriate solutions to strengthenfor a better guarantee of these rights is the theme of our thesis, which answers a series of questions: Isthe participation of a Vietnamese citizen’s political life an acquired right or a given right? Under whatcircumstances does a citizen participate? What are the restrictions to a citizen’s participation? Are thelegal frameworks adequate to encourage participation? What are the influences from its participationin the Communist Party in power? In the current context, what should be done to facilitate and ensuregenuine participation of citizens in the future? Are the practice of direct democracy and the tendencyof strengthening grassroots democracy enough to build a rule of law that is compatible with the Party-State system? Active participation of citizen in political life in the future could help to change hiscurrent status in the relationship with the State? We hope to give the reader adequate answers to thesequestions, so they may better understand the status of Vietnamese citizen throughout different periodsof history.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2007. / Titre provenant de l'écran-titre. 60 f. : cill. Bibliogr. f. 59-60.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2007. / Titre provenant de l'écran-titre. 91 f. : ill. Bibliogr. f. 87-90.

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

I Sverige utgör medborgardialog ett obligatoriskt moment i den svenska samhällsplaneringen genom samråd. Dock har tidigare forskning visat att det obligatoriska samrådsmomentet inte är tillräckligt för att skapa ett medborgardeltagande som är jämlikt och representativt. Studien syftar till att undersöka hur Norrköping som en växande medelstor kommun ser på vilka utmaningar som finns med att bedriva medborgardialog, samt vilka arbetssätt som idag används och hur dessa kan förbättras. Detta har sedan analyserats utifrån de två teorierna kommunikativ planering och deliberativ demokrati. För att besvara studiens syfte har tre tjänstepersoner inom Norrköpings kommun intervjuats, samt en forskningsassistent inom fältet för medborgardialog. Intervjustudien har även kompletterats av en dokumentanalys med relevanta samrådsredogörelser. Resultatet visar att många utmaningar som redovisas i tidigare forskning även finns i Norrköpings kommun. Det visar även att kommunens ansvar sträcker sig utanför de traditionella ramarna och att nya tillvägagångssätt konstateras som avgörande för målet om ett mer representativt medborgardeltagande. / In Sweden, citizen dialogue becomes a mandatory moment in Swedish urban planning through consultation. However, previous research has shown that the mandatory consultation element is not sufficient to create civic participation that is equal and representative. The study aims to examine how Norrköping, as a growing medium-sized municipality, views the challenges involved in conducting citizen dialogue, as well as the working methods used today and how these can be improved. This has since been analyzed based on the two theories of communicative planning and deliberative democracy. To answer the purpose of the study, three officials in the municipality of Norrköping were interviewed, as well as a research assistant active in the field of citizen dialogue. The interview study has also been supplemented by a document analysis with relevant consultation reports. The results show that many challenges reported in previous research also exist in Norrköping municipality. It also shows that the municipality’s responsibility extends beyond the traditional framework and that new approaches are found to be crucial for more representative citizen participation.

L’étude de la participation du public à l’élaboration des normes environnementales contribue à l’analyse de la mutation contemporaine de l’action publique. Elle démontre plus précisément que la participation, consacrée sous la forme d’un principe juridique à destination des États et sous la forme d’un droit subjectif à destination des administrés, est appréhendée différemment, mais de manière complémentaire, par les droits international, européens et national. Tenant aussi bien au désir des pouvoirs publics de restaurer leur légitimité qu’à leur volonté d’améliorer le contenu des décisions environnementales, par nature très complexe, la participation vise le perfectionnement des modalités de détermination de l’intérêt général mais n’en change pas la nature intrinsèque. Elle redessine ainsi le fonctionnement du régime représentatif en donnant plus d’importance aux citoyens et aux groupes d’intérêts, sans pour autant faire émerger une réelle post-modernité juridique dans laquelle l’État se contenterait de n’être qu’un simple agent de régulation. Elle est en outre à l’origine d’un renouvellement des modalités de participation politique, les pouvoirs publics créant peu à peu une véritable « trame participative », qui permet au public d’influencer – encore marginalement – le contenu des décisions ayant une incidence sur l’environnement. / The study of Public Participation in Environmental Decision-making demonstrates that participation contributes to Modern state's mutation. International, europeans and french laws offer from now on various perspectives for the public to influence the construction of environmental decisions. If it does not change the nature of the french notion of general interest, it surely modifies the way to elaborate such interest. The study emphasizes more precisely the role of individuals and groups of interest in this new procedural democracy. It underlines furthermore the conditions in which public participation can really satisfy its two main objectives, the legitimization of public action and the improvement of the content of environmental decisions.

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