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Para avaliar os aspectos necrológicos do envelhecimento, este estudo investigou as características relacionadas às mortes de moradores da cidade de São Paulo os quais foram submetidos à necropsia no Serviço de Verificação de Óbitos da Capital (SVOCSP) no período de Junho de 2004 a Novembro de 2005. A casuística foi constituída por 402 indivíduos com idade igual ou superior a 50 anos, divididos em dois grupos quanto à causa mortis: por causa encefálica (CE) e por outras causa (OC), que foram estudados quanto ao gênero, idade, cor, altura, peso, estado civil, presença de benefício social, presença de vícios (tabagismo e/ou alcoolismo), causa mortis e causas associadas ao óbito. Dentre os que apresentaram causas encefálicas (CE) de óbitos, foram mais prevalentes o enfarto cerebral isquêmico (50,7%) e as causas hemorrágicas centrais (32,3%) com predomínio dos óbitos no sexo feminino, enquanto que dentre os falecimentos por outras causas (OC) o enfarto agudo do miocárdio (27,9%), as demais cardiopatias (23,9%) e as neoplasias (11,9%) foram às causas mais freqüentes, com predomínio no sexo masculino cuja idade, ao morrer, foi inferior às mulheres. Em ambos os grupos, as evidências de aterosclerose disseminada foram muito prevalentes. O processo do envelhecimento em moradores da cidade de São Paulo é caracterizado pelo predomínio e prevalência das mortes por doenças cardiovasculares no sexo masculino e das cerebrovasculares no sexo feminino / For evaluating the obituary aspects of aging, this study investigated the characteristics related to deaths in residents of São Paulo who underwent autopsy in the Department of autopsies in the Capital (SVOC-SP) in the period from June 2004 to November 2005. The sample was consisted of 402 individuals aged over 50 years, divided into two groups as the cause of death: encephalic causes (EC) and other causes (OC), that were studied in relation to gender, age, color, height, weight, marital status, presence of social benefit, the presence of addictions (smoking and / or alcoholism), causa mortis and causes associated to death. Among those who died by encephalic causes (EC) were the most prevalent the ischemic cerebral infarction (50.7%) and central hemorrhagic causes (32.3%) with predominance of deaths in females, while among the deaths by other causes (OC) to acute myocardial infarction (27.9%), other heart diseases (23.9%) and neoplasm (11.9%) were the most frequent causes, with predominance in males, whose age was lower than women. In both groups, the evidence of widespread atherosclerosis was very prevalent. The aging process in residents of São Paulo is characterized by the dominance and prevalence of cardiovascular deaths in males and strokes in women

Para avaliar os aspectos necrológicos do envelhecimento, este estudo investigou as características relacionadas às mortes de moradores da cidade de São Paulo os quais foram submetidos à necropsia no Serviço de Verificação de Óbitos da Capital (SVOCSP) no período de Junho de 2004 a Novembro de 2005. A casuística foi constituída por 402 indivíduos com idade igual ou superior a 50 anos, divididos em dois grupos quanto à causa mortis: por causa encefálica (CE) e por outras causa (OC), que foram estudados quanto ao gênero, idade, cor, altura, peso, estado civil, presença de benefício social, presença de vícios (tabagismo e/ou alcoolismo), causa mortis e causas associadas ao óbito. Dentre os que apresentaram causas encefálicas (CE) de óbitos, foram mais prevalentes o enfarto cerebral isquêmico (50,7%) e as causas hemorrágicas centrais (32,3%) com predomínio dos óbitos no sexo feminino, enquanto que dentre os falecimentos por outras causas (OC) o enfarto agudo do miocárdio (27,9%), as demais cardiopatias (23,9%) e as neoplasias (11,9%) foram às causas mais freqüentes, com predomínio no sexo masculino cuja idade, ao morrer, foi inferior às mulheres. Em ambos os grupos, as evidências de aterosclerose disseminada foram muito prevalentes. O processo do envelhecimento em moradores da cidade de São Paulo é caracterizado pelo predomínio e prevalência das mortes por doenças cardiovasculares no sexo masculino e das cerebrovasculares no sexo feminino / For evaluating the obituary aspects of aging, this study investigated the characteristics related to deaths in residents of São Paulo who underwent autopsy in the Department of autopsies in the Capital (SVOC-SP) in the period from June 2004 to November 2005. The sample was consisted of 402 individuals aged over 50 years, divided into two groups as the cause of death: encephalic causes (EC) and other causes (OC), that were studied in relation to gender, age, color, height, weight, marital status, presence of social benefit, the presence of addictions (smoking and / or alcoholism), causa mortis and causes associated to death. Among those who died by encephalic causes (EC) were the most prevalent the ischemic cerebral infarction (50.7%) and central hemorrhagic causes (32.3%) with predominance of deaths in females, while among the deaths by other causes (OC) to acute myocardial infarction (27.9%), other heart diseases (23.9%) and neoplasm (11.9%) were the most frequent causes, with predominance in males, whose age was lower than women. In both groups, the evidence of widespread atherosclerosis was very prevalent. The aging process in residents of São Paulo is characterized by the dominance and prevalence of cardiovascular deaths in males and strokes in women

Die Arbeit befaßt sich mit den Formen des nicht natürlichen Todes und weiteren rechtsmedizinischen Sachverhalten wie Leichenerscheinungen, Scheintod, Identifizierung von Personen und Leichen, Selbstverstümmelungen und Spuren von Tätern und Opfern in den deutschen Volksmärchen. Rechtsmedizinische Zusammenhänge von Ursache und Wirkung werden nach ihrer Gültigkeit im Märchen hinterfragt. Wie werden beispielsweise Gewaltwirkungen auf äußere Erscheinungsbilder betroffener Märchenfiguren, Tötungsgeschehen und Tatwerkzeuge dargestellt? Inwiefern entsprechen Schilderungen der Tatbestände und ihre Bewertung im Märchen auch historischem Rechtsverständnis? Was unterliegt den epischen Gesetzen des Märchens? Für die rechtsmedizinische Fragestellung nach den Verletzungsspuren am Getöteten, dem Tötungsgeschehen und den Tatwerkzeugen sind die Märchen als Quelle des Volkswissens nur begrenzt verwertbar. Zum Beispiel sind keine Wunden, innere Blutungen oder kleinere Verletzungen nach Gewalteinwirkung beschrieben. Es wurden nahezu alle klassischen Todesarten wie Ertrinken, Vergiften, Verbrennen, Verhungern, Erhängen, Erfrieren, Selbsttötung und Tod durch scharfe und stumpfe Gewalt im Märchen vorgefunden und betreffende Textstellen unter Benutzung der "historisch-geographischen Methode" regional verglichen. Zusammenhänge von Ursache und Wirkung konnten jedoch nicht im Sinne einer rechtsmedizinischen Rekonstruktion des zum Tode führenden Geschehens nach heutigen Maßstäben aufgestellt werden. Das Märchen als Volksüberlieferung kennt keinen historisch konkreten Zeitbezug. Mit der zeitlich und regional variierenden Wiedergabe des Erzählstoffes fließen neue Motive und anderes Wissen mit ein. Daraus ergab sich für die Arbeit eine zurückhaltende Aufstellung von Vergleichen des rechtshistorischen Alltags und der geschilderten Märchenwirklichkeit. Der nicht natürliche Tod konnte bei der rechtsmedizinischen Untersuchung nicht unabhängig von seinem Zusammenhang im Märchen betrachtet werden. Er ist im Märchen oft ein Mittel, entsprechend den Moralvorstellungen Gerechtigkeit herzustellen, aber auch die Protagonisten von ihrem positiven Weg abzubringen. Seine sozialisierende Funktion in der Märchengesellschaft kann nicht übersehen werden. / This thesis reports about the types of the non-natural death and further issues of legal medicine in the German folk tales such as the sure signs of dead bodies, appearently dead people, identification of persons and corpses, mutilation of its own and traces of perpetrators and victims. Do forensic correlations between cause and effect appear in the fairy tales? How do fairy tales describe the violent effects to the concerned figures? outward appearance, the killing event and the tools of crime? How does the facts of the cases? description and their valuation in the fairy tales correspond to the historical comprehension of the rights? The folk tales are only of restricted use as a source of general knowledge for the forensic issue of the injury traces on a dead body, of the killing event or of the tools of crime. For example, there are not described any wounds, internal bleedings or smaller injuries after violence. Nearly all classical causes of non-natural death are found in the fairy tales: drowning, freezing to death, hanging, burning to death, poisoning, dying of starvation, suicid and death by sharp and blunt force. There could not be shown any correlations between cause and effect in the sense of a killing event?s forensic reconstruction after today's standards. The folk tales as an oral tradition are not exactly related to a certain historical period. With each new performance a story was influenced by new motivs or knowledge. For that reason the comparison between fairy tales and historical reality of everyday life is very restrained. The non-natural death as a forensic fact can only be interpretated in ist function in the folk tales. By means of the non-natural death the fairy tales? characters are doing justice corresponding to their moral ideas, but positive figures can also be pushed away from their good ways. The non-natural death? socializing function in the fairy tales? society is evident.

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / La mort assistée ou aide médicale à mourir étant débattue et légalisée dans de plus en plus de pays et régions, notamment au Québec, le contexte du mourir en Occident semble en mouvance. Puisque la légalisation de cette pratique introduit un nouveau soin de fin de vie, de nombreuses personnes doivent désormais faire le choix entre mourir « naturellement » ou par aide médicale à mourir; un choix important susceptible de teinter le deuil des proches du défunt. La présente thèse porte un regard sur ces expériences de deuil en contexte d’aide médicale à mourir ou de mort naturelle accompagnée de soins palliatifs, et ce afin de déterminer les similitudes et différences dans le vécu des endeuillés, ainsi que le rôle des influences interpersonnelles (des relations avec autrui) dans ce même vécu. Dans le premier article de la thèse, les expériences de deuil sont directement comparées par l’entremise d’une recherche à devis mixte. L’échantillon se compose de 60 endeuillés ayant rempli des questionnaires mesurant des symptômes de deuil (25 endeuillés en contexte d’aide médicale à mourir et 35 en contexte de mort naturelle), desquels 16 ont pris part à des entrevues de recherche individuelles. Les résultats quantitatifs mettent en lumière l’absence de différences statistiquement significatives entre les deux populations. Les conséquences des deux contextes de fin de vie sur l’intensité du deuil s’avèreraient donc similaires. De plus, les scores ne suggèrent pas de complications du deuil, ce qui peut sous-entendre que l’aide médicale à mourir et la mort naturelle ne contribuent pas de prime abord à rendre l’expérience du deuil davantage éprouvante. Les résultats qualitatifs sont nuancés : des « empreintes » négatives et positives (concernant la distance temporelle et le symbole du héros) peuvent colorer l’expérience dans les deux contextes. Bien que les morts naturelles et médicalement assistées semblent généralement toutes deux ne pas avoir un impact foncièrement négatif sur le processus de deuil, il demeure qu’elles peuvent produire des vécus plus difficiles lorsqu’en interaction avec d’autres facteurs de risques. Dans le deuxième article, le concept du paysage relationnel est utilisé afin d’informer des conclusions à l’égard des facteurs interpersonnels à l’œuvre dans le deuil. Les résultats présentés sont basés sur les 16 entrevues individuelles conduites auprès d’endeuillés et prennent la forme d’un modèle interprétatif permettant de décrire cinq types d’acteurs dans l’environnement de l’endeuillé (le défunt, les co-endeuillés, les aidants, les antagonistes et les personnages secondaires) et leurs manières « d’être avec » et de « laisser seul ». Le modèle comprend également quatre paysages vécus décrivant la manière dont le deuil se vit en lien avec l’environnement social (se sentir entouré, se sentir seul et loin, se sentir assiégé et se sentir investi d’un message). Le modèle interprétatif du paysage relationnel permet de s’attarder aux similitudes entre les défis relationnels du deuil par aide médicale à mourir et du deuil par mort naturelle, ainsi qu’au rôle d’autrui. L’intégration des différents résultats nourrit des réflexions sur la création de sens, la compréhension de la souffrance en fin de vie, la temporalité, la culture, de même qu’à l’égard du poids relatif des circonstances d’une mort anticipée dans l’expérience du deuil des proches. L’accompagnement de la mort et du deuil en Occident à l’ère de la mort assistée est abordé sur la base des différents constats issus de la thèse. Ces réflexions permettent de songer à de futures avenues de recherche et de penser la clinique du deuil. / With assisted dying being debated and legalized in more countries and regions, including Quebec, the context of death in the Western world seems to be in flux. Since the legalization of this practice introduces a new type of end-of-life care, many individuals must now choose between dying “naturally” or with medical assistance in dying, an important choice that may affect the grief of the deceased’s loved ones. This thesis examines grief experiences in the context of medical assistance in dying or natural death with palliative care to determine the similarities and differences in the experiences of the bereaved persons and the role of interpersonal influences (relationships with others) on bereavement. In the thesis’ first article, grief experiences are directly compared through a mixed design research study. The sample consists of 60 bereaved persons who completed questionnaires measuring grief symptoms (25 bereaved individuals in the context of medical assistance in dying and 35 in the context of natural death), of whom 16 participated in individual research interviews. The quantitative results show no statistically significant differences between the two populations. The consequences of the two end-of-life contexts on grief intensity would therefore appear to be similar. Furthermore, the scores do not suggest grief complications, which may imply that medical assistance in dying and natural death do not prima facie contribute to a more distressing grief experience. Qualitative findings are nuanced: negative and positive “imprints” (regarding temporal distance and the hero symbol) may colour the grief experience in both contexts. Although both natural and medically assisted deaths generally appear not to have an inherently negative impact on the grieving process, they can still produce more difficult experiences when interacting with other risk factors. In the second article, the relational landscape concept is used to inform conclusions regarding the influence of interpersonal factors at work during bereavement. The results presented are based on the 16 individual interviews conducted with bereaved persons and take the form of an interpretive model describing five types of actors in the bereaved individuals’ environment (the deceased, co-bereaved, caregivers, antagonists, and secondary characters) and their ways of “being with” and “leaving alone”. The model also includes four lived landscapes describing how grief is experienced relative to the social environment (to feel open and visited, to feel alone and far away, to feel besieged, and to feel invested with a message). The relational landscape interpretive model allows us to focus on the similarities between the relational challenges of bereavement after a medical assistance in dying and after a natural death. It also sheds light on the role of others on one’s grief experience. The different results are integrated to provide insights into meaning-making, the understanding of suffering at the end of life, temporality, culture, and the relative weight of an anticipated death’s circumstances on the grief experience. End-of-life and grief support within Western societies in the era of assisted dying is also discussed based on the thesis’ various findings. These reflections allow us to consider future research avenues and to elaborate on grief intervention.