Sociologist Véronique Guienne plunges into the heart of the hospital experience to reflect on the moral dilemmas of health professionals in their daily confrontation with death. She succeeds in the bet to build death in the hospital as a corporate object.
Result of a two-year survey conducted in several hospital services with doctors, nurse, caregivers, psychologists, social workers, the book Save, let die, kill De Véronique Guienne delivers a reflection on the moral dilemmas of health professionals in their daily confrontation with death. Produced in two different services from Hoy (Hematology and obstetrics), in two different cities, Véronique Guienne’s investigation is based on a questionnaire, individual interviews and sessions in small collectives.
A dive into the heart of the hospital experience
The author succeeds in the bet to plunge the reader at the heart of the hospital experience: taking the side of detailing the case of patients who have posed problems (both medical and moral), Véronique Guienne studies medical files, liaison sheets Between caregivers and interviews afterwards about these patients. Result: a detailed description of the pathologies of patients, the decision -making process concerning their end of life. The very large extracts from the interviews present in the text undeniably constitute the great richness of this work. However, the interviews sometimes take precedence over the analysis, especially in chapter 4, where the author presents the cases of patients who divided the medical teams. If she gives to read the point of view of the different protagonists, she then lets the interviews speak alone, not intervening to point and analyze the discrepancies in the positions of the healthcare team. We may also regret that testimonies are not more socially rooted: weight of the professional trajectory, family situation, career in the establishment and service. But these are requests aroused by the quality of the interviews collected, which arouse the sociological curiosity of the reader and go beyond the purpose of the work which aims to be general. This 130 -page small opus is in the effective and precise imparted frame, while remaining accessible to all.
Leaving the word both to the different members of the healthcare teams, the author gives body to her work effectively: the confrontation of the words of the various actors, of doctors with nursing assistants, makes it possible to become aware of the differentiated ways of Think pathologies, care and death. The first introductory chapter “ The relationship to death »Updates different ways of speaking and living the death of patients: distance from doctors, empathy of nurses and nursing assistants … Age enters much in the ability to live more serenely the death of patients, especially When they are young: “ Having a bottle helps (P. 14) As a nurse points out. We regret, however, that within the same body (nurses, nursing assistants) intra-body variations are not more invested: if the experience due to age is a patent criterion of differentiation of ways of apprehending Situations, other criteria could have been highlighted. It will be noted in particular that the author questions doctors, nurses and nursing assistants without taking into account the gender variable. However, it certainly has a role in the greater or lesser empathy felt with regard to the deaths of patients.
The two chapters “ Therapeutic limitation ” And “ Medically assisted death Confront the reader with medically and morally difficult situations. The question of therapeutic limitation, often apprehended from the outside, on the confines of the denunciation of the therapeutic relentlessness or the criticism of unnecessary expenditure, is analyzed here from the inside. Véronique Guienne questions the difficult decision -making between nursing teams and care patients, when the curative project sometimes comes to alter the property of patients. Giving pride of place to the internal debates of caregivers in specific cases, the author raises the question of the way in which the patient takes into account his imminent death. The recurring sentence used by the medical staff “ He manages his small things »Reveals the case of patients who prepare their death consciously and moderately.
A return of the social question
Véronique Guienne reintroduces the social question in medical choices (“ What we don’t talk about »). Heading teams have an essentially “ biological and psychological patient “, But never social: the patient once hospitalized has no profession, living conditions, no insurance, mutual and often are questioned his projects concerning his lifestyle and death if not taken In account of social characteristics is experienced by hospital personnel as the means of guaranteeing equity in the treatment and care given to patients, the author recalls that in the question of therapeutic judgment, of therapeutic choice economic social patients are often of great weight: “ When the prevailing design, in terms of health offer, is only that of the best possible treatments, plus psychological aid for the patient to be voluntary in his treatment, we see the field of care a number of ‘Other questions (P.72). Véronique Guienne lifts here a “ hospital (P. 70). It pleads above all to take into account the choices of lifestyle and death of patients. Does the patient want to make a new chemo, knowing that the probabilities of failure are almost certain to earn two or three months of living or prefers to find an almost normal life away from the hospital for his Last months of life ?
If the caregivers are above all there to treat, to save lives, as they often repeat in the testimonies collected by the author, arises in a certain number of cases the question of “ kill Patients. In oncology, palliative or obstetric care services, the doctors interviewed testify to the violence felt to stop treatment or to let patients die. If doctors do not hear the requests to die made by patients (“ We are not there for that ), Nurses and caregivers feel relief when their end-of-life requests are taken into account. The author collects positive end of life stories. Moving the cursor of public debates (taken up in a developed manner in chapter 6) towards the medical experience of euthanasia, Véronique Guienne shows how much this act is the emanation of pushed discussions with the patient, his family, and the medical team . It raises the question of the freedom left to patients to choose their own death.
With his work Save, let die, kill Véronique Guienne builds death in the hospital as a corporate object, whose understanding involves the reconstruction of the senses given by the actors (patients, doctors) to the experience of illness and death, straddling the sociology of professions, the sociology of health and death.