This project will pool anthropological, medical and philosophical skills that will be exercised on the basis of clinical and scientific knowledge provided by geriatric professionals. It will focus on the phenomenon of aging in its many dimensions as a physiological process, an experience lived in connection with specific contexts (example of study: aging among the Chibani population in the working-class neighborhoods of Marseille). The question of the loss of autonomy of the elderly subject will be explored in its articulation with various environmental factors (social isolation, unsuitable living environment, inactivity, loss of the family referent or the circle of friends, hospitalization). The relevance of the injunction to "respect the autonomy of the patient" poses an ethical problem with regard to the disorders from which the elderly patient sometimes suffers.
Led by Professors Patrick Villani and Anne-Laure Couderc, the issue of self-perception and social representations of old age is becoming central in the public arena, as evidenced by the magnitude of the controversies that have been mediated around the abuse of the elderly. Their research is intended to be part of an international debate insofar as aging and loss of functional independence also vary according to societies and cultures. While Western societies have a rather pejorative view of the elderly, African societies have a rather positive view and the younger generations are more willing to take care of the older members of the family unit. The researchers of this project will describe, measure and compare the autonomy of people aged 65 and over, living in Marseille, Nice and Senegal. The people studied will represent the heterogeneity of the elderly population in terms of aging mode and socio-cultural environment: robust or fragile elderly people, living at home or in an institution, isolated or with a caregiver and technical aids at home, from an immigrant background or living in Dakar. These populations will be interviewed about their perception of autonomy, their social and physical environment, and will be evaluated in terms of their autonomy. The researchers will work in partnership with the IRL ESS team in Senegal (E Macia) and the SESSTIM team for the methodology (MK Bendiane).
The members of this project also intend to contribute to the academic debate on the end of life and the conditions for "dying well
".
They start from the observation that in countries with a liberal tradition, during the last decades, the norms and practices of accompaniment at the end of life have undergone a slow and sporadic evolution in order to better take into account the wishes and preferences of patients. These changes are most noticeable in Western democracies where the value of the sacredness of life is weighed against other values such as quality of life or autonomy of will. The issue of active assistance in dying questions the relationship with the patient's body. A right to be helped to die can be seen as an extension of the principle of free self-determination, but also as the extension of a "biopower" (M. Foucault), with medicine being present from the beginning to the end of an individual's life.
In states that have decriminalized it, active assistance in dying is surrounded by a certain number of conditions, among which is almost always medical validation of the request. The doctor is thus confronted with a case of conscience that calls for a philosophical reflection to which the researchers of this project intend to contribute.
From a methodological point of view, end-of-life situations will be investigated on the basis of a conceptual, legal and philosophical framework, and thanks to the research fields made available to the doctoral students in the cancerology department (CHU La Timone). The researchers in ethics and health law intend to interact effectively, exploring the legislative resources available at the international level, but also taking advantage of the results of international surveys that will be conducted in the coming contract with the people concerned. A thesis funding from the Ecole Normale Supérieure d'Ulm has already led to the granting of a thesis to be started in September 2022 on "The end of life and patient autonomy: a comparative study of France, Belgium, and Switzerland", by a researcher in philosophy who will carry out surveys among the relatives of persons who have had recourse to active assistance in dying (euthanasia in Belgium, assisted suicide in Switzerland).