En clave intercultural: Intervenciones en el final de la vida con fundamento en las “diferencias culturales” / Through an intercultural lens: Grounding end of life interventions in “cultural difference” approaches

El artículo indaga en los modos en que el personal sanitario en contextos institucionales de atención en el final de vida se apropia de los discursos sobre las “diferencias culturales” de las poblaciones que atienden para basar sus intervenciones, interpretando qué es lo que los pacientes y sus familias necesitan. Sostiene que la apelación a discursos en clave culturalista aparece cuando los pacientes pertenecen a minorías étnicas, atravesando la comunicación de la enfermedad; la gestión de la atención y el cuidado y la espiritualidad, la religiosidad y los sistemas de creencias. Se trata de un análisis secundario basado en datos propios recabados en investigaciones realizadas en Servicios de Cuidados Paliativos, Oncología y Hospices de Argentina. Este fundamento “culturalista” de las intervenciones es atravesado por estereotipos y prenociones sobre las identidades culturales de poblaciones que ya tienen una alta carga de estigmatización en la sociedad y reproduce actitudes paternalistas y condescendientes. Concluye que negar o ignorar otras cosmovisiones es tan nocivo como reificarlas. / The purpose of this article is to explore the ways in which healthcare professionals who provide care to patients during end of life use discourses based on arguments of “cultural differences” to justify their interventions and interpretations of patients’ and their families’ needs. The article argues that this reliance on cultural discourses appears when patients belong to ethnic minorities. These discourses shape the communication of the disease as well as the delivery of care and spiritual services. The article is based on the secondary analysis of data collected in palliative care, oncology and hospice services in Argentina. A conclusion of this study is that the “culturalist” nature of these interventions leads to stereotypes and preconceptions of the cultural identity of patient populations and reproduces paternalistic and condescending attitudes. Furthermore, these cultural discourses led to the reification and decontextualization of patients’ cosmovisions, producing harmful effects on populations who are already suffering from social stigma and confronting the end of life

Analgo-Sedation of Patients with Burns Outside the Operating Room

none11noneGregoretti C; Decaroli D; Piacevoli Q; Mistretta A; Barzaghi N; Luxardo N; Tosetti I; Tedeschi L; Burbi L; Navalesi P; Azzeri FGregoretti, C; Decaroli, D; Piacevoli, Q; Mistretta, A; Barzaghi, N; Luxardo, N; Tosetti, I; Tedeschi, L; Burbi, L; Navalesi, P; Azzeri,

La stigmatisation de la maladie physique: Le cas du cancer

The literature shows ample evidence of stigmatization of mental illness and infectious diseases. Although cancer does not fall under any of the above categories, it has been stigmatized because of the deleterious consequences of its course and treatment. In fact, in the 21st century, cancer remains a dreaded disease associated with social representations of death, impairment, disfigurement, suffering, and pain. The objectives of this paper are twofold: first, to review theoretical elements that can help understand the stigma associated with physical illness, by defining the concept of stigma, presenting the different theoretical models of stigmatization of physical illness, and describing the psychosocial functions of stigma for both the stigmatized and stigmatizing individuals. Second, to focus on the specificity of cancer-related stigma, with particular reference to the cultural aspects of coping strategies used by oncological patients to address illness and the related stigma, through practices based on popular medicine. As part of the conclusion, it is suggested that cancer-related stigma has undergone several changes during history, from being a fatal disease to being a chronic disease. However, its initially silent course, alarming epidemic behaviour (still uncontrollable despite scientific advances), and treatment characteristics favour negative social representations of cancer (as conviction, sentence of death, suffering, deterioration, pain, affliction, and guilt), which act as iatrogenic factors in the health–disease process, interfering especially in the decision making regarding effective treatments and leading patients to prefer alternative methods based on popular medicine, even if those methods imply risks for their health and quality of life. © Springer-Verlag France 2012