Статьи
Всего статей в данном разделе : 12
Опубликовано на портале: 22-03-2007
Cleave Seale, Julia Addington-Hall, Mark McCarthy
Social science and medicine.
1997.
Vol. 45.
No. 3.
P. 477-484.
Analysis of a subset of data from a survey of 3696 relatives, friends and others
who knew a sample of people dying in 1990 who lived in 20 areas of the United Kingdom
(the Regional Study of Care for the Dying) is reported. Using the typology of awareness
contexts developed by Glaser and Strauss [(1965) Awareness of Dying, Aldine, Chicago],
the prevalence of different awareness contexts is described and compared with an
earlier survey done in 1969. Open awareness of dying, where both the dying person
and the respondent knew that the person was dying, is the most prevalent awareness
context. This is particularly so in cancer and represents a change since 1969 when
closed awareness (where the respondent knows, but the dying person does not) was
more common. The characteristics of those dying in open and closed awareness contexts
are then compared, suggesting that having cancer, not being mentally confused, having
a respondent who knew for some time that the person was dying, and being of higher
social class are independently predictive of full open awareness, a condition marked
both by knowledge of dying, and a value commitment towards openness. Compared with
people in closed awareness, people dying in full awareness are more able to plan
their dying careers, so that they and their respondents are more satisfied with the
degree of choice over the place of death, they are less likely to die alone, and
are more likely to die in their own homes. Additionally, these individuals are more
likely to have spoken of their wishes for euthanasia, another indicator of their
desire to control the manner and timing of death. If dying from cancer, people in
full open awareness are more likely to have received hospice care. It is suggested
that underlying these patterns, and in contrast with some other cultures where awareness
of dying is seen as less desirable, people dying in Anglophone countries are particularly
concerned to maintain control over projects of self-identity. Their approach to death
is a reflection of this individualism.

Опубликовано на портале: 22-03-2007
Cleave Seale
Social science and Medicine.
1991.
Vol. 32.
No. 8.
P. 943-952.
The literature suggests that doctors' and nurses' openness about communicating with
the terminally ill and their families has increased in the past two or three decades,
partly influenced by the hospice movement. The present study reports the perceptions
of relatives, hospital doctors, general practitioners and nurses who knew a random
sample of 639 adults dying in England in 1987. The results from professionals suggest
a general preference for openness about illness and death, tempered by the consideration
that bad news needs to be broken slowly, in a context of support, while recognising
that not everyone wishes to know all. In practice people dying from cancer were more
likely to be reported as knowing what their illness was and that they would die than
were people dying from other conditions. This difference held when controlling for
the fact that death was more likely to be medically expected in cancer. Comparisons
with 1969 show that the increases were due largely to cancer patients being told
the truth more frequently by hospital doctors. This may be due to changed practices,
or to the increase in the number of hospital episodes in the last year of life. Nevertheless,
situations of 'closed awareness' where relatives were told and patients were not,
and situations where patients were left to guess the likely outcome for themselves,
were still quite common in 1987. Nurses and hospice practitioners were only marginally
involved in breaking bad news, this remaining the province of hospital doctors and
general practitioners. Relatives in general praised the manner in which they and
patients were told, although a small proportion reported insensitive practice. In
retrospect a high proportion of both relatives and professionals felt that the levels
of awareness were best as they were, although this preference may have been influenced
by a desire to see things in a good light. Most relatives reported adequate support
and information being given by professionals to them during the patient's illness.
On the whole, doctors provided information, and friends and family provided emotional
support to relatives. Again, hospital doctors played an increasingly important role
compared to 1969 in providing information, with general practitioners' role decreasing
in this area. Gaps in information included not being told enough about what was wrong
with the patient, not being told the reasons for decisions about treatment and, to
a lesser extent, not being given information about how to care for the patient.

Опубликовано на портале: 04-03-2007
Stefan Timmermans
Sociology of Health and Illness.
2005.
Vol. 27.
No. 7.
P. 993-1013.
Death brokering refers to the activities of medical authorities to render individual
deaths culturally meaningful. Social scientists and others agree that mortality provokes
existential ambiguity in modern life requiring cultural coping mechanisms. In contemporary
Western societies, medical professionals have sequestered the dying in institutions,
and have classified the causes of death to explain suspicious death. Over the last
decades, the institutionalisation of the dying process has been challenged by social
movements and the sudden onset of some deaths while forensic medicine has struggled
for professional legitimacy in the borderland between mainstream medicine and the
legal system. In this article it is argued that medical death brokering persists
in spite of challenges because medical experts offer increasingly flexible cultural
scripts to render the end-of-life socially meaningful while accentuating death's
existential ambiguity. Medical professionals help create the ambiguity they promise
to resolve, reinforcing the cultural need for more expert death brokering.

Опубликовано на портале: 04-03-2007
Robert E. Clark, Emily E. LaBeff
Journal of Health and Social Behavior.
1982.
Vol. 23.
No. 4.
P. 366-380.
This research focuses on the strategies used by various professionals in delivering
news of death. The lack of well defined, normative guidelines for such deliveries
adds to the problematic nature of the interaction. From in-depth interviews with
physicians, nurses, law enforcement officers, and clergy, a loose framework based
on common themes was generated providing a processual view of death telling. Five
distinct strategies of delivery developed within the framework. Discussion of each
strategy indicates the significance of situational and occupational factors in delivering
news of death. This study, though exploratory in nature, clarifies some of the processes
involved in the delivery of bad news, and identifies several important problems surrounding
death telling, such as lack of training and preparation among professionals for this
role and their dislike for this aspect of their work.


Опубликовано на портале: 22-03-2007
Stefan Timmermans
Sociology of Health and Illness.
1994.
Vol. 16.
No. 3.
P. 322-339.
In this paper, the author employs a grounded theory approach to extend an existing
theory. His starting point is the theory of awareness contexts, first formulated
in 1965 by Strauss and Glaser. Using introspective ethnography, he illustrates that
the way patients and relatives emotionally cope with terminal information defines
the kind of awareness context. He therefore suggests that the open awareness context
should be split into three different contexts. In the suspended open awareness context,
the patient or kin ignores or disbelieves the message communicated by the physician.
In the uncertain open awareness context, the patient or family member dismisses the
bad parts of the message and hopes for the best outcome. In the active open awareness
context, the patient or relative accepts the impending death and prepares for it.
This revision reclaims the emotional power of terminal illness from the viewpoint
of patients and relatives and adapts the theory to changed structural conditions.

Опубликовано на портале: 23-03-2007
Debra Parker-Oliver
OMEGA: The Journal of Death and Dying.
2000.
Vol. 40.
No. 4.
P. 493 - 512 .
The social construction of a dying role is emerging in response to terminal illness
for which the sick role is no longer functional. When people are in the process of
dying, in the absence of a dying role, they take on the rights and responsibilities
of the sick role to which they have been socialized. This is problematic for the
individual who will not get well no matter how hard the effort. Hospice, a professional
community with a central purpose of bringing the drama of dying to an appropriate
close, marks the transition from a sick role to a dying role. This article looks
at how the hospice community directs this transition and redefinition of self for
the dying and significant others. Utilizing the symbolic interactionist and phenomenlogical
perspective and the sick role theory of Talcott Parsons, this view of the drama is
demonstrated through stories of hospice patients.

Опубликовано на портале: 02-03-2005
Екатерина Александровна Кваша
Социологические исследования.
2003.
№ 6.
С. 47-55.
В ХХ веке в России уровень младенческой смертности снизился почти в 20 раз. Изменилась
и ее доля в общем уровне смертности. Но за этими положительными достижениями скрыты
тенденции, вызывающие серьезную озабоченность. Концу ХХ века уровень младенческой
смертности был в 2-5 раз выше, чем в развитых странах мира, то есть при абсолютном
уменьшении относительное отставание стало даже больше, чем было в начале ХХ века.
Более высокими, чем в России, показатели были только в Румынии и некоторых республиках
бывшего СССР. Автор считает, что необходим переход на другой уровень здравоохранения,
способный бороться не только с экзогенными, но и с эндогенными причинами смертности
новорожденных.


Опубликовано на портале: 05-12-2006
Галина Львовна Микиртичан, Римма Васильевна Суворова
Социологический журнал.
1996.
№ 1/2.
Авторы констатируют увеличение числа студентов-медиков,
одобряющих эвтаназию, и еще раз ставят вопрос о допустимости эвтаназии как социального
явления и как возможного выбора медика, работающего с безнадежно больными пациентами.
Выделяя пассивную (приостановление лечения) и активную (применение медицинских препаратов,
ведущее к летальному исходу) формы эвтаназии, Г.Л. Микиртичан и Р.В. Суворова говорят
о первой, как о вероятной в исключительных случаях, и о второй, как о несовместимой
с профессиональной этикой врача.


Проблема эвтаназии: "за" и "против" [статья]
Опубликовано на портале: 31-07-2005
Леонид Лазаревич Карп, Татьяна Борисовна Потапчук
Социологические исследования.
2004.
№ 2.
С. 136-137.
В статье приведены материалы изучения мнений врачей Казахстана об эвтаназии. Согласно
результатам исследования, отношение врачей к эвтаназии меняется с возрастом в пользу
противников последней. Анонимные опросы медицинских работников свидетельствуют о
том, что существует множество примеров применения эвтаназии в практической деятельности
медиков при отсутствии какого-либо наказания. Чаще всего эти факты остаются незамеченными
и не входят в официально зафиксированные случаи применения эвтаназии на практике.


Опубликовано на портале: 25-05-2005
Дмитрий Дмитриевич Богоявленский
Социологические исследования.
2002.
№ 5.
С. 76-80.
По данным Всемирной организации здравоохранения, в середине 1990-х годов Россия занимала
по самоубийствам второе место в мире после Литвы. Извлеченные
из архивов советского времени материалы показывают, что число и уровень самоубийств
в городах постоянно росли. Общее число завершенных, т.е. приведших к смерти, самоубийств
в России за последние 45 лет в сумме превысило 1 700 тыс. Мужчины в России избирают
добровольный уход из жизни намного чаще, чем женщины. Особенность российских самоубийств
– их очень высокая интенсивность у мужчин средних возрастов. Уровень самоубийств
тесно связан с полом, возрастом, семейным положением, но, при прочих равных условиях,
роковую роль играет алкоголизм.


Опубликовано на портале: 07-10-2005
Ирина Николаевна Лаврикова
Социологические исследования.
1999.
№ 5.
С. 95-98.
В статье сопоставляются данные двух опросов, проведенных среди врачей по поводу их
отношения к эвтаназии. Первый был проведен в Москве в 1991-1992 гг. Второй –
в Твери в 1997 г. Ответы классифицировались по полу, возрасту, должности и специальности
респондентов. По мнению автора, полученные данные демонстрируют стремительную динамику
отношения врачей к принятию эвтаназии. Автор считает обесценивание человеческой жизни
в сфере, организованной непосредственно для охраны здоровья и жизни людей, красноречивой
тенденцией в развитии нашего общества.


Опубликовано на портале: 25-05-2007
Александр Юрьевич Мягков
Социологические исследования.
2004.
№ 3.
С. 83-92.
Темпоральные характеристики самоубийств часто остаются за пределами специального
эмпирического анализа, а потому исследованы в значительно меньшей степени. Данная
ситуация вполне объяснима с учетом явного доминирования макросоциологической традиции
в современной суицидологии, но вряд ли продуктивна как с феноменологической точки
зрения, так и с позиций системного подхода к анализу и объяснению суицидов. Изучение
цикличности самоубийств и установление эмпирических закономерностей в этой сфере
могло бы способствовать более глубокому пониманию природы и источников суицидального
поведения.

