Poder, resistencia y dominación en las Américas esclavistas: apostillas a Michel Foucault (paradojas y aporías)

En este artículo se explora uno de los equívocos más incidentales y, por ello mismo, menos estudiados en el pensamiento de Michel Foucault: su entendimiento de la esclavitud con relación a sus conceptualizaciones sobre el poder, la dominación, la resistencia y la libertad; y se considera el valor heurístico de estos equívocos para pensar los regímenes de las grandes plantaciones esclavistas de las Américas. ¿Nombra la esclavitud una relación de poder o un estado de dominación? ¿Qué distintas implicaciones analíticas y éticas tendría esta distinción al abordar la problemática de la libertad bajo la subyugación? A través de una exégesis cuidadosa de dos instancias tardías en la obra del pensador francés, “El sujeto y el poder” (1982) y “La ética del cuidado de uno mismo como práctica de la libertad” (1984), en este trabajo se identifican las ambigüedades conceptuales que acompañan sus fugaces observaciones en torno a la esclavitud y se las toma como punto de partida para destacar una serie de momentos en los que los juegos de poder bajo la dominación esclavista de las Américas muestran los límites intuidos pero no teorizados por Foucault, y que no son otros que la violencia extrema y la muerte. Ello es ejemplificado mediante la discusión de ciertas paradojas en los fenómenos del cimarronaje y de las aporías que se manifestaron en los usos de la pastoral cristiana como medio de sujeción en los inicios de las plantaciones esclavistas cubanas durante el siglo XVIII, y en diálogo con sus simbolizaciones en el arte.This article explores one of the most incidental equivocations, and thus, least studied of Michel Foucault’s work: his understanding of slavery in relation to his conceptualizations on power, domination, resistance and freedom. The article also considers the heuristic value of these equivocations for thinking about the regimes of the large slave plantations of the Americas. Does slavery describe a relation of power or a state of domination? What distinct analytical and ethical implications would this distinction have upon examining the problem of freedom under subjugation? Through a careful exegesis of two late examples in the work of the French thinker, “Subject and power” (1982) and “The ethics of care of the self as a practice of freedom” (1984), this article identifies the conceptual ambiguities that accompany his brief observations on slavery and takes them as a starting point for highlighting a series of moments in which games of power during the period of slavery in the Americas show the limits that were intuited, yet not theorized by Foucault, which are not different from extreme violence and death. This is exemplified through a discussion of certain paradoxes in the phenomena of the fugitive slaves and of the aporias, that were manifested through the roles of the Christian pastoral community as a means of subjection at the start of the Cuban slave plantations at the beginning and during the 18th century – and in dialogue with their representations in art.Neste artigo, explora-se um dos equívocos mais incidentais e, por isso mesmo, menos estudados no pensamento de Michel Foucault: seu entendimento da escravidão com relação a suas conceitualizações sobre o poder, a dominação, a resistência e a liberdade; considera-se o valor heurístico desses equívocos para pensar nos regimes das grandes plantações escravistas das Américas. A escravidão nomeia uma relação de poder ou um estado de dominação? Que diferentes implicações analíticas e éticas esta diferenciação teria ao abordar a problemática da liberdade sob a subjugação? Por meio de uma exegese cuidadosa de duas instâncias tardias na obra do pensador francês, “O sujeito e o poder” (1982) e “A ética do cuidado de si como prática da liberdade” (1984), neste trabalho, identificam-se as ambiguidades conceituais que acompanham suas fugazes observações sobre a escravidão para serem tomadas como ponto de partida para destacar uma série de momentos nos quais os jogos de poder sob a dominação escravista das Américas mostram os limites intuídos, mas não teorizados por Foucault, e que não são outros senão a violência extrema e a morte. Isso é exemplificado mediante a discussão de certos paradoxos nos fenômenos dos escravos fugitivos e das aporias que se manifestaram nos usos da pastoral cristã como meio de sujeição no início das plantações escravistas cubanas do século XVIII – no diálogo com suas simbolizações na arte

Poder, resistencia y dominación en las Américas esclavistas: apostillas a Michel Foucault (paradojas y aporías)

This article explores one of the most incidental, and thus least studied, equivocations in Michel Foucault's work: his understan-ding of slavery in relation to his conceptualizations of power, domination, resistance and freedom. The article also considers the heuristic value of these equivocations for thinking about the regimes of the large slave plantations of the Americas. Does slavery describe a relation of power or a state of domination? What distinct analytical and ethical implications would this distinction have upon examining the problem of freedom under subjugation? Through a careful exegesis of two late instances in the work of the French thinker, "Subject and power" (1982) and "The ethics of care of the self as a practice of freedom" (1984), this article identifies the conceptual ambiguities that accompany his brief observations on slavery, and takes them as a starting point for highlighting a series of moments in which games of power during the period of slavery in the Americas show the limits that were intuited, yet not theorized, by Foucault; limits which are no other than extreme violence and death. This is exemplified through a discussion of certain paradoxes in the phenomena of the fugitive slaves (cimarronaje) and of the aporias, that were manifested through the uses of the Christian pastoral as a means of subjection at the beginnings of the Cuban slave plantations during the 18th century - and in dialogue with their symbolization in art

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society