End of life and death: what are the implications for family relationships?
Directed by Diane Laflamme, Joseph Josy Lévy
Severe illness and death in the family context: the contributions of theoretical models and integrative approaches to the advancement of research
Diane Laflamme, Joseph Josy Lévy
There is much contemporary research concerning the theoretical, methodological and empirical aspects of the issues surrounding severe illness and death experienced in the family context. This text will offer an assessment of the oft-overlapping theoretical perspectives on these two topics, through a review of current literature. Theoretical models that are mainly sociological and psychosocial can be divided into the following categories: qualitative inductive approaches that lead to integrative models; hypothetical-deductive approaches that organize specific factors into models and verify them through quantitative measures and statistic procedures. Adding to these theoretical approaches, one finds systemic approaches concerning resilience, coping and meaning-making, as well as those that rest on integrative processes, such as the dual process model of coping. This overview of background theory, concepts and key assumptions will highlight the wealth of current research and its contribution to the understanding of family networks that are confronted to major crisis demanding a reorganization of relational configurations and the finding of adaptive resources to make it through hard times.
Families with Seriously Ill Children : The Psychologist’s Perspective
Claire Van Pevenage, Isabelle Lambotte
When children become seriously ill, the profound and painful effects are not limited to the sick children; they also extend to the families. These families find themselves thrust into acute emotional crises triggered by the threat of losing a child and by the child’s, and the rest of the family’s questioning of their sense of immortality. This situation results in various experiences and feelings (a search for meaning, sense of failure, anxiety, aggression, feelings of powerlessness and guilt, etc.) that inevitably have an impact on the children, their families, and their relationships with caregivers.
Our experience of over 15 years in acute-care pediatrics has shown us that while a child’s capacity to face serious illness varies according to personal factors (personality, age, temperament), it also depends on parental and familial factors such as adaptability, communication, cohesion, and development.
Based on transcriptions of several families’ stories, we examine a number of parental and familial reactions to seriously ill children, focusing in particular on certain complex situations (malformed infant, child of separated parents, parental needs of children in palliative care) and on approaches to providing support. We conclude by briefly broaching the subject of grief and follow-up care.
Cancer Among Us : Work and Family Dynamics Around a Seriously Ill Child
Marc-Antoine Berthod, Yannis Papadaniel, Nicole Brzak
When a child becomes severely ill, parents are forced to revisit how they balance their private and professional lives in order to best apportion tasks related to work, family, and care for the sick child. This article is based on an anthropological study conducted in Switzerland over a period of more than three years involving parents, other family members, colleagues, and superiors; its aim was to analyze the impacts of changes brought about by the child’s illness on the parents’ employment situation and on family dynamics. Using the example of Switzerland, where salaried employees are entitled to only three days’ paid leave to arrange for the care of a sick child, it highlights the discretionary powers that characterize negotiations between employees and employers in these situations and illustrates that, as a result, they are handled on a case-by-case basis. This finding, which is not limited to countries that lack legal support measures for such parents, points to significant failings in how today’s states, employers, and families make arrangements to care for sick children, in particular those who suffer from cancer; it is the parents of these children who fall through the cracks.
Families of Children Suffering from Serious Complex Chronic Conditions Transitioning to Adult Care: An Analysis of Logics of Action
Manon Champagne, Suzanne Mongeau, Sophie Côté
As modern medicine has advanced, a new phenomenon has begun to emerge: the survival beyond adolescence of children with complex, life-threatening chronic conditions. The broad objective of this study, whose results are reported here, is to better recognize and understand how these children and their families experience the transition from pediatric to adult care. Data were collected by way of semi-directed interviews with 10 parents and one youth from eight families in Québec. The analysis, based on certain concepts of the sociology of social experience (Dubet, 1994), underscores the fact that parents and youth experience significant losses – both tangible and symbolic – in the transition process, and that these losses threaten their identity and sense of belonging. Searching for suitable new services, programs, or environments is experienced as a struggle against numerous obstacles that forces them to resort to various strategies. For some, the solidarity experienced through projects designed to improve the living conditions of families in these situations helped them overcome a sense of alienation.
Relational Challenges of Alzheimer’s Disease: Orientations for Care and for Transforming Family Relationships
We examine the complex interconnections between, on one hand, filial and conjugal relationships and, on the other, the ways in which families deal with late-stage Alzheimer’s disease. We show that in certain situations, insofar as the disease disrupts how relationships are experienced, family relationships also orient and frame the manner in which support is provided and in which day-to-day decisions are made. To draw attention to this double dynamic, we selected three dilemmas that the loved ones of Alzheimer’s patients are regularly confronted with and that specifically address the experience of family relationships in illness and end-off-life situations: washing and personal hygiene, placement in extended care facilities, and intervention in the patient’s private affaires. These analyses, based on a qualitative assessment of some 20 monographs done as part of a doctoral thesis (Miceli, 2013), help shed light on the “relational work” undertaken by many partners, children, and loved ones of people suffering from Alzheimer’s or similar diseases.
Dying at Home, Surrounded by Loved Ones: The Effects of End-of-Life Care at Home?
Julien Biaudet, Tiphaine Godfroid
In France, hospitalization at home (HAH) is on the rise, even though statistically it remains an uncommon practice. Palliative and end-of-life situations account for a significant proportion of such cases. This article tries to demonstrate that these situations create new issues for the dying process. On one hand, the home is no longer considered by society as the place to die. On the other, the stakeholders involved, particularly the dying person’s loved ones, and those with whom they interact (the ill person and professional caregivers), must adapt to new roles. Thus, the analysis of death in HAH situations also deserves to be examined at the intersection of medical and familial logics.
The Other Widowhood: Common-law Partners and Death in France
This article examines widowhood in its broadest sense, i.e., the widowhood of married, unmarried, or remarried persons, who are not usually considered widows or widowers in the sense of civil status. In particular, it focuses on early widowhood.
A wider consideration of sociodemographic categories demonstrates the need to modernize the definition of “widowhood” to include annulment.
The article presents the results of two surveys carried out in France: the first, quantitative, survey shows that one-fifth of widows and widowers and one-third of young widows and widowers frequently do not appear in statistics. The second, qualitative, survey explores the reality of death among couples and the status of the widow and widower today.
Death and Mourning Among Migrants: Specifics, Networks, and Mutual Aid
Lilyane Rachédi, Catherine Montgomery, Béatrice Halsouet
Given the demographic changes in Québec society, the experience of mourning in immigrant communities and the adaptation of bereavement support programs to accommodate them have become unavoidable subjects. Yet research on the intersection of mourning and immigration is poorly developed in Québec (Rachédi et al., 2010). We are interested in documenting death and mourning among immigrant families not only in terms of their experiences, but also in terms of mutual aid and the participation of immigrants in various social networks, both local and transnational, that play a key role in events related to the cycle of life. Additionally, religious practices and knowledge, transmitted and adapted in these networks, provide a relevant avenue for better understanding death and mourning in their cultural context.
In this paper, we present some reflections on death and bereavement in the context of migration, drawing on both local and international literature, three qualitative research projects undertaken in Quebec, and the preliminary analysis of an interview conducted during an on-going research-action project that is currently in its initial phase of data collection.
Families and Communities Facing Local Youth Suicide Clusters: Two Examples in Québécois and Aboriginal populations
Based on interviews carried out in two Québec communities, including one First Nations community, affected by local clusters of youth suicide, this article examines the representations and repercussions of these events. Merely objectifying a series of suicides in a given time and place is not sufficient to describe the phenomenon, which also concerns a reality that is both physical and social and which is subject to a process of social construction. This may or may not contribute to transforming several individual and family tragedies into a broader issue that concerns and involves the entire community that has been affected. Beyond the suicides’ proximity in place and time, it is the fact that the phenomenon affects adolescents and young adults, sometimes in significant proportions, that deeply troubles these communities and forces adults to question why a portion of its youth, though the act of suicide, manifests a vulnerability so great that it shakes the foundations of social life and intergenerational transmission.
Le réseau familial de jeunes adultes hébergés en famille d’accueil jusqu’à leur majorité
Claudine Parent, Marie-Hélène Labonté, Marie-Christine Fortin, Marie-Christine Saint-Jacques, Françoise-Romaine Ouellette, Sylvie Drapeau, Caroline Paré-Lévesque
This study documents the family networks of 12 young adults who, over the course of their childhoods, have been placed in foster homes until they reach the age of majority. The goal was to describe the makeup of their family networks, understand the importance of birth- and foster-family connections, and identify factors that may have facilitated or hindered the maintenance of these connections. All participants underwent semi-structured interviews during which they were asked to construct two genograms: one representing their family while in foster care and the other their current family. The results suggest that family representations are diverse and specific to the experiences of each participant. While for a few, there is some complementarity between the foster-family and birth-family connections, the tendency is for the connections to be exclusive. Finally, while the quality of the connection is vital to ensuring positive placement, it does not guarantee that the connection will continue once foster care ends.
Constrained educational intervention: relationships between families and professionals who intervene in the home
Bernadette Tillard, Bernard Vallerie, Anna Rurka
Domestic educational interventions in France are, for the most part, judicially imposed on families. How do parents accept and perceive the professionals who intrude into their personal lives for the good of their children? We met with 15 families twice each at a one-year interval. The families all had in common that they were subjected to several simultaneous domestic interventions: from a specialized educator for an educational measure, and from a social and family intervention technician. The results show that families’ cooperation in this constrained context differed depending on the nature of the activity. This criterion was just one of a series of other known factors that were confirmed by the study.
A Boom of Boomers? Career Trajectories of French Women Born During the Baby Boom
Céline Clément, Catherine Bonvalet
In the normal scheme of things in the 1960s, life outside the family was reserved for men only, while women were considered “queens of the household.” Though raised according to this model, generations of women born post-war would nevertheless free themselves of it and gain more autonomy by developing new lifestyles both within their relationships and families but also outside of these private spheres. Once women were able to receive an education and take control of their fertility—choosing when and how many children to have—their life trajectories began to diversify, in particular in terms of their careers, as evidenced by their large-scale and permanent entrance into the job market starting in 1960. This was a major sociological change at the time and a radical transformation of employment status, with women moving from staying at home, to working some of the time, and leading to the model we have today, that of full-time employment and even holding multiple jobs (Maruani, 2000). Yet while the baby-boom generations are often viewed as the initiators of this latter model, a number of different employment models currently coexist.
The goal of this article is to describe, over the long term, these various employment models by way of 32 life histories of women from the first-generation of baby boomers (i.e., born between 1945 and 1954) taken in Paris and the surrounding region. These activity profiles constructed starting from childhood—in particular stemming from maternal imprinting (Battagliola, 1987), to modes of entry into adulthood, the root of social differentiation and female trajectories (Blöss et al., 1996), to the end of their working lives—can then be explored and used to establish a typology (knowing full well that such models are both highly changeable and permeable, since women may move from one model to another, especially if they separate). Such changes do not occur for everyone or at the same moment in life, which results in a heterogeneity of career paths but also in different visions women’s place in the family and in society, since these different models greatly influence how families are organized and represented, and they influence women’s trajectories, especially in terms of their conjugal relationships.