Dying modern. A sociology of delegation

In France, as in other European and North American nations, there has been a slow and steady process of secularization of death-related practices since the early 19th century. Professionals, rather than families and religious communities, are now primarily responsible for caring for the dying and the dead. Far from having been accomplished peacefully, this delegation raised strong opposition from the outset: did it not open the way to objectification and anonymization, and hence to a dehumanization of the treatment of these individuals, as soon as they found themselves integrated into institutional arrangements designed to manage large-scale flows of the dying and the dead? Criticism of this delegation was particularly strong in the 1970s, when the "hospital-mortuary chain" was being massified. In response, they led to the institutionalization, among these same specialists, of practices for the subjectivation of patients, leading to greater consideration of their biographical dimension and their inclusion in social groups. How can the delegation of care to the dying and the dead be regulated by obligations to both objectify and subjectivate the dying and the dead?

It is to understand this practical difficulty that this thesis has set out. To do so, it first looks back at the emergence of "death workers" in the nineteenth century, before tracing the main moral crises affecting the development of delegated care for the dying and the dead throughout the twentieth century. This historical review highlights the fact that, while the process of delegating care to the dying and the dead was from the outset marked by a tension between the objectification of the body and the subjectification of the dying and the dead, the subjectification of the dying and the dead was mainly carried out outside professional structures. We then propose an ethnography of the care activity in the current context, where the duty of subjectivation has been instituted in the hospital. We follow the network of specialized professional interventions in a general oncology department, a palliative care unit and a hospital mortuary. In the end, this dual historical and ethnographic investigation shows that, while criticism of the activities of professionals involved in caring for the dying and the dead has not stopped the delegation movement, and a fortiori has failed to reverse it, it has nevertheless had profound and sometimes unexpected effects on the way in which these professionals resolve the tension between objectification of bodies and subjectification of individuals. She also shows how criticism of the de-subjectification of the dying and the dead is now joined by the symmetrical criticism of a possible lack of objectification of bodies. Finally, she shows how this interplay of cross-criticisms is maintained and renewed, by virtue of the fact that it makes explicit a tension whose origins lie in the most everyday practices of professionals.

Through these analyses, this thesis revives the Durkheimian perspective on two essential points. Firstly, it is intended as a contribution to thinking about what Durkheim called the "cult of the person", characteristic, according to him, of modern societies. It shows that, while the secularization of care and its rationalization are indeed typical of our societies, they do not lead to the reduction of the human being to his or her material dimension. On the contrary, our investigation tends to prove that a secular cult of the person can be observed in the daily practices of end-of-life and death professionals - although this does not exclude it being contained, defeated and subject to expectations of free adherence. Secondly, this thesis highlights how the possibility of treating the dying and the dead as "persons" - of "personalizing" them, we might say - depends first and foremost, in our societies, on a certain state of the division of labor, that is, on the existence of different specialists and an organic regulation of their activities.

In this respect, she suggests that it is not by abolishing the delegation of care to experts that the "cult of the person" is most likely to be honored in our societies. Rather, it is by regulating the moral life that emanates from this delegation, liable to produce excesses of objectification as well as excesses of subjectification, that new modes of regulation, respectful of this "cult of the person", can be developed.

Link to theses.fr: https://www.theses.fr/2020EHES0158