Introduction : L’entrée en vigueur de l’aide médicale à mourir (AMM) au Québec et au Canada pose la question de l’élargissement de cette prestation, notamment à des mineurs. La présence accrue des infirmières au chevet du patient les amène à recevoir des demandes liées à l’AMM. C’est pourquoi il appert pertinent de s’interroger sur leurs perceptions de ce soin pour des adolescents en fin de vie afin de mieux connaître leur opinion, de leur offrir plus d’outils et ainsi, de répondre plus adéquatement aux besoins du patient. Objectif : Le but de cette étude est d’explorer les perceptions d’infirmières œuvrant en service d’oncologie pédiatrique au regard de l’élargissement de la possibilité, pour des adolescents de plus de 14 ans, de demander l’AMM. Méthodologie : Un devis qualitatif exploratoire a été utilisé. Six infirmières œuvrant en soins oncologiques (n=3) ou palliatifs pédiatriques (n=1) ou étant en contact direct avec des adolescents en fin de vie dans le cadre de leur travail d’infirmières (n=2) ont participé à une entrevue individuelle semi-dirigée. La collecte de données et l’analyse ont été réalisées de manière simultanée en se basant sur l’analyse thématique. Résultats : Les résultats de cette recherche mettent en exergue que : 1) les infirmières reconnaissent leur rôle de soutien et leur implication dans les soins du patients en fin de vie, 2) la plupart ont une opinion professionnelle positive de l’AMM pour les adultes et distingue celle-ci de leur opinion personnelle, 3) elles apprécient les discussions autour de l’AMM pour des adolescents bien qu’elles soient préoccupées par les balises qui entoureraient ce soin, et 4) une longue expérience engageait plus de préoccupations sur l’élargissement mais aussi plus de confort à fournir des informations à ce sujet. Discussion et conclusion : Cette étude montre que les discussions autour de l’élargissement de l’AMM s’alimentent de plus en plus en soins pédiatriques de fin de vie. Cependant, des infirmières avec peu d’expérience dans ce milieu reflètent un inconfort vis-à-vis de l’AMM. Ainsi, les établissements universitaires et de santé pédiatrique doivent évaluer et répondre au besoin de formation des infirmières sur l’AMM afin de les outiller davantage face à de telles situations et ainsi, mieux répondre aux besoins de leurs patients. Mots clés : Perceptions, infirmières, soins palliatifs pédiatriques, oncologie, aide médicale à mourir, adolescents. / Introduction: With the recent introduction of medical assistance in dying (MAID) in Quebec and Canada, the extension of this health benefit, particularly to minors, is becoming increasingly important. The role and position of nurses close to patients puts them in the forefront of requests for MAID. This is why it seems relevant to examine their perceptions of this benefit for adolescents at the end of life: in order to better understand their opinions, and so to offer them more tools and thus to respond more adequately to patients' needs. Objective: The purpose of this study is to explore the perceptions of nurses working in pediatric oncology wards regarding medical aid in dying for adolescents at the end of life, in the event MAID comes into effect for this population. Methodology: An exploratory qualitative approach was chosen for this study. The sample consisted of seven nurses working in pediatric oncology (n=3) or palliative care (n=1) or who are in contact with this population in the course of their nursing work (n=2). Data collection and analysis were conducted concurrently, using thematic analysis. Results: The results of this research highlight that: 1) nurses recognize their supportive role and involvement in the care of patients at the end of life, 2) most have a positive professional opinion of MAID for adults and distinguish that from their personal, private opinion, 3) they appreciate discussions about MAID for adolescents although they are concerned about the markers that would surround this care, 4) more experienced nurses were more concerned about expanding MAID but at the same time more comfortable in providing information about it. Discussion and conclusion: This study shows that discussions about extending MAID are increasing in pediatric palliative units. However, nurses with little experience in these units reflect discomfort with MAID. Academic and pediatric health care institutions must assess the training needs of nurses regarding requests regarding MAID in order to better equip them to deal with such situations and thus better meet the needs of their patients. Key words: Perception, nurses, palliative pediatric cares, oncology, medical aid in dying, adolescents.

This thesis examines welfare provision in rural Oxfordshire after the 1834 Poor Law Amendment Act. The county had little industrial development, remained largely agricultural in nature, and the region had been perceived as a backwater of friendly society development. This thesis rectifies that view and places Oxfordshire as an important component of the movement with its independent nature and early rejection of affiliated order branches that emanated from urbanized and industrialized areas. There is no evidence of impetus given to friendly society formation after the implementation of the new poor law with the general increase in societies continuing. However, the relationship with poor law administration changed. A case study of Stonesfield demonstrates how the friendly society became the heart of village life and was integral to self help and support for the poor. A wider view is taken of welfare provision, with detailed assessment of a range of welfare instruments, such as coal and clothing clubs, soup kitchens, and medical clubs, together with an appraisal of their geographical spread. The range of welfare instruments available is compared to Maslow’s Hierarchy of Need, a model of human motivation. The case study of Whitchurch provides an in-depth assessment of one parish welfare system where after 1834 at least nine stands of welfare were available at all times to the poor who held a degree of selection in what was an increasingly a consumer market. The thesis is underpinned throughout by the use of extensive primary source material.

Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment / Psychology / M.A. Psychology

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In the post-World War II period, the population of poor and working-class Chinese New Yorkers––most of whom lived in Manhattan’s Chinatown––drastically increased in size and so too did the range of health problems they faced. This dissertation is the first in-depth historical study of Chinese Americans/New Yorkers’ postwar experiences with health education and activism. It documents the work of Chinese American grassroots activists and medical professionals to establish access to healthcare for Chinatown residents. By analyzing the transnational and cross-class dynamics of this movement, the dissertation challenges the long-standing assumption that the more well-to-do individuals of Chinese ancestry—especially recent professional immigrants from Taiwan and Hong Kong—had little interest in the wellbeing of their poorer counterparts. It also places Chinese New Yorker history alongside the better-known community control movements and health activism in Black and Latinx communities. The dissertation draws from research at 14 archives across the U.S., rare personal papers in Chinese and English, and interviews with over twenty Chinese American doctors and Chinatown activists. Before the mid-twentieth century, Chinese New Yorkers faced inequities in medical education and healthcare due to racially discriminatory policies and practices. From the 1940s to the 1960s, the end of Chinese exclusion and U.S. Cold War geopolitical interests in Asia allowed a select group of Chinese and Chinese American doctors and nurses to enter academic medicine and public health in the city. Chinese American public health nurses attracted public and private funding for much-needed social and health services in Chinatown by leveraging their transnational backgrounds and popular beliefs in the assimilation and integration of nonwhites. Meanwhile, the New York City-based American Bureau for Medical Aid to China and other American groups launched medical aid programs to help train medical personnel for the Nationalist Party and sustain its troops in their fight against the Chinese Communist Party. A subset of Chinese medical graduates from these programs drew from their hybrid credentials, contacts, and linguistic skills to obtain competitive jobs at hospitals and academic medical centers in New York and other American cities. Many of the transplanted Chinese medical graduates had intended to return to China after a short stint of advanced study in the U.S. But they decided to stay as a pragmatic response to political and social upheavals and constraints. Starting in the late 1960s, Chinatown’s rapidly expanding population, as well as the “maximum feasible participation” doctrine of President Lyndon Johnson’s War on Poverty initiative, made it strategic for the community watchdog agency, the Lower East Side Health Council-South, to court and include Chinatown residents in the fight for a better and new public hospital—Gouverneur Hospital. Inspired by the Civil Rights movement, workers’ struggles, and health radicalism in Black and Latinx communities, the Chinese American and Afro-Puerto Rican Health Council workers, Thomas Tam and Paul Ramos, implemented community programs and organized highly publicized and disruptive events, including a summer street health fair in Chinatown. Chinese New Yorkers of diverse migratory, class, age, and political backgrounds, including Chinese medical graduates who had the credentials and resources to serve their compatriots, played an integral role in these activities. In 1971, the cross-ethnic, cross-class coalition successfully demanded the opening and hiring of more bilingual personnel at the new Gouverneur. By the late 1970s, efforts led by Thomas Tam and Paul Ramos to bring the medical exam room into the Lower East Side became institutionalized in the form of the Chinatown and Betances Health Clinics. The clinics offered low-cost, comprehensive, and multilingual services, and encouraged professionals and youths of color to serve the community.

No description available.

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.