Peace And War Moacyr Scliar Pdf
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- The Ballad of the False Messiah Moacyr Scliar
- The Miniaturization of the World in Moacyr Scliar’s A Guerra no Bom Fim
- Shofar: An Interdisciplinary Journal of Jewish Studies
What whimsy- what fancy- what caprice- what imaginative power- what sheer delight. Otaviano writes his short-stories on the walls of public toilets- Pascoal threw parties and recorded his guests and used their dialogues as short-stories. His friends are not amused- Ciao produces a short-story every two hours, thinking a percentage of what he writes must be good- 8 year old Miguel writes stories of nymphomaniacs- Misael intends to write brief short-stories in smoke up in the sky, using a squadron of airplanes for the purpose- Ernesto mimeographs his stories and hands them out at soccer games- Fischer writes in a trance-like condition, dictating his stories to his secretary. He was taken to an empty house and for a week he was forced to write two short stories a day.
The Ballad of the False Messiah Moacyr Scliar
This article seeks to address some ethical issues experienced on the borders of life and death in Intensive Care Units ICUs.
These are special places in hospitals, where there is the mandatory presence of cutting-edge medical technology and support for the preservation of life of a patient in a critical condition or risk. It is in this complex context that difficult ethical issues emerge: there are no objective criteria for admissions to the ICU, ICUs can be overcrowded with patients without diagnosis and there are difficulties in limiting treatment, which results in medical procedures that only prolong the dying process of the patient.
I am immediately transported to the ICU. And then, I had an experience that was, to say the least, unusual. In ICU life is on hold.
Time stands still — in fact, there are no clocks on the walls. The light never goes off: it is not day; it is not night; a flat, unchangeable, glare reigns. But movement is continuous; doctors, nurses, nurse assistants circulate non-stop, examining and manipulating patients, who are always in a serious condition.
In ICU life is on hold , Moacyr Scliar, a doctor and famous writer from the south of Brazil, defines in the epigraph that frames the introduction of our ethical reflection on the use of ICUs, after his experience of spending some time in one of them, while recovering from a health problem. ICUs are now hospitals units that care for human life in critical situations that present great complexity and drama.
On the other hand, the fact that we may be required to undergo a prolonged, painful and useless process of death is disturbing and scary! ANVISA also defines ICU as a critical area for the hospitalization of critically ill patients who continuously require specialized professional attention, as well as specific materials and technologies necessary for diagnosis, monitoring and therapy.
The document classifies the ICUs into several categories:. Adult ICU: for the care of patients aged 18 or over, and may admit patients of years, if that is specified in the rules of the institution. Specialized ICU: for the care of patients selected by type of disease or intervention, such as cardiac, neurological, surgical, among others. Paediatric ICU: for the care of patients aged 29 days to 14 or 18 years, a limit defined according to the routines of the institution.
The ethical issues that present themselves today in ICUs are numerous and complex: therapeutic decisions to invest or not in the treatment of a patient; definitions as to whether a state is reversible or not; administration of nutrition and hydration; communication of bad news; family participation in the decision process related to the patient; professional interaction of the care team working in the ICU with patients and their families humanization ; judicial decisions for admission of patients in ICU, among many others.
Each one of these topics can be discussed in depth in a separate chapter, which we have done in various other works of public knowledge 4 - 8 , although in this text we will focus only on the question of the dignity of life and death in the ICU , to highlight the point we aim to discuss in depth. Despite medical advances in critical care or scientific medicine, the ICU still remains as the unit where many patients die.
Among patients with chronic diseases who die in the hospital, approximately half are cared for in the ICU in the three days before their death and a third pass at least 10 days in the ICU during the final period of their hospitalisation.
Studies in the US, Canada and Europe have shown that most deaths in ICUs involves difficult decisions regarding the use of life-sustaining treatments for critically ill patients who no longer respond to critical care therapies. An important goal is to provide a death without pain and suffering for these patients and a compassionate care to their families 9. Death never ceases to be current and provoke us in terms of life. It always has an unplanned meeting with us, visiting us in a silent, gentle and surprising way, forcing us to reflect on our own finite life through the loss of loved ones, or, through unusual and unexpected situations that frighten us The question is so disturbing and poignant that art, literature and media, frequently discuss it.
In the social sphere, the first public policies also begin to emerge. An example of this is the legalization of euthanasia in in the Netherlands and Belgium In the latter, the extension of the practice of euthanasia for minors was approved in , reigniting the international debate on medical decisions concerning the end of life in children In March and April , the case of Terri Schiavo expanded beyond the limits of American discussions and reached the international public forum.
After 16 years in a persistent vegetative state, Terri died of starvation, at the age of 43, on the 31 st March , 14 days after the removal of the feeding tube Almost concurrently, on the 2 nd April, Pope John Paul II said farewell to mankind after exposing his excruciating agony and suffering, which has drawn criticism and caused discomfort for many.
In the end, wisely, the Pope refuses to return to the hospital, choosing to spend his final moments in his own chambers While these isolated events caused worldwide commotion, several wars, rebellions and conflicts killed thousands of people around the world: Kashmir, Darfur, Colombia, Afghanistan, Somalia and Uganda are some of the countries where armed conflicts have lasted decades. The contrasts and contradictions of the situation are exemplify with the position made public by then US President George W.
At the end of , the world witnessed another American case that had a great impact, which happened in the state of Oregon, where the practice of assisted suicide is legally allowed It refers to young Britney Maynard, who, in January , found out she was suffering from a fatal disease that condemned her to have only a few months of life left.
Fearing for an excruciating and painful death, Britney decided, in accordance with her young husband, her family and her doctor, to go through an assisted suicide, which was carried out on the 2 nd November of the same year Another ethical and human aspect that has a great impact on relationships and human and professional interactions, which has just been mentioned before, is considering the patient and family as a unit of care. Assistance to families is one of the most important aspects of the overall care of ICU patients, and one of the pillars of humanised care.
The care provided to the family still deserves the necessary respect, both regarding caring and regarding the training process of professionals. Improvement in communication, prevention of conflicts related to values and choices, and spiritual support, are some of these strategies, to name a few 7 , Despite the existence of these studies, the production of new works on this topic is very welcome, as it is important to continue to deepen the studies on ICU visitation policies, seeking to reconcile the procedures and routines with a greater flexibility regarding the presence of family members.
Patient and family must be at the centre of the attention and care 23 , Pain and suffering are companions of humankind since time immemorial. Today, pain control and relief constitute fundamental skills and ethical responsibilities of health professionals.
Pain is a symptom and one of the most frequent causes of demand for health services. In many health institutions that are now at the forefront of holistic care of human beings that have been made vulnerable by some serious illness, and, therefore were forced to face excruciating pain. This pain experience is recognized as the fifth vital sign integrated into clinical practice. If pain were treated with the same zeal that other vital signs temperature, blood pressure, breathing and heart rate , there would be, without doubt, much less suffering.
The purpose of assessing pain is to identify its cause and understand the sensory, emotional, behavioural and cognitive experience it represents for the person, with a view to promoting its relief and care.
Today it is recognized that pain is a disease. According to the WHO definition, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity It is clear that the painful conditions constitute a state of infirmity; therefore, a human being suffering from pain is not healthy, and it can be said - legitimately - that there is a violation of their inalienable right to health.
Article 25 of the Universal Declaration of Human Rights recognizes as one of the rights of human beings a standard of living adequate for the health and well-being Unfortunately, health and well-being are not always a possible choice, as in many situations, many people, because of old age or disease, feel pain and suffer a great deal at the end of life. The difference between pain and suffering has great significance, especially when dealing with terminal patients.
Dealing with pain requires the use of analgesic medication, while suffering calls for compassion to strengthen the spirit and the notions of significance and meaning of life, because unexplained pain often turns into suffering.
And suffering is a deeply complex human experience, which involves the identity and subjectivity of the person, as well as their socio-cultural and religious values.
One of the main dangers in neglecting the distinction between pain and suffering is the tendency of treatments to focus only on symptoms and physical pain, as if these were the only source of anguish and suffering for the patient.
There is a tendency to reduce suffering into a simple physical phenomenon, which can be more easily identified, controlled and dominated through technical means.
Moreover, this relationship enables us to continue aggressively with futile treatment, believing that if treatment protects patients from physical pain, it will also protect them from all other aspects, including their existential angst.
Suffering has to be seen and cared for in four key dimensions 29 , explained below. At a physical level, pain works as clear marker, warning that something is not functioning normally in the body. It emerges into consciousness when one must face the inevitability of death; when dreams and hopes vanish and there is an urgent need to redefine the world that one is about to leave. It is the pain of isolation that arises when the person who is dying realizes that they will no longer live, but the world as they know will continue to exist.
It is the suffering of feeling inexorably touched by a destiny one does not want to experience, and the loneliness for knowing that it is impossible to fully share this reality that requires redefining relationships and communication needs;.
It arises from the loss of meaning, purpose of life and hope. Everyone needs a horizon of meaning — a reason to live and a reason to die. Recent research in the US shows that 30 , 31 advice on spiritual matters is among the three needs most requested by terminally ill patients and their families.
The concept of spirituality is found in all cultures and societies. All of these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another Health actions are now increasingly marked by the healing paradigm, characterized by critical and intensive care in high-tech medicine.
The massive presence of technology is indeed a necessary and legitimate fact in contemporary medicine. But the healing paradigm can easily become a prisoner of technology because, when facing the pulse of life, it is not hard to forget that medicine is a means, not an end. The healing paradigm induces the adoption of an ethic of uncritical problem solving - if something can be done, then, it should be done - and to forget that not everything that is scientifically possible to perform is ethically permissible.
It also calls on the idolisation of physical life and feeds the desire to prolong life, even when the quality of life deteriorates and living is restricted to truthfully unacceptable conditions.
This vitalism takes shape in the belief that the inability to cure or to prevent death is a failure of medicine Opposing this emphasis on healing, another line of interpretation and understanding begins to gain strength among scholars and health professionals: the caring paradigm.
Based on understanding and caring for terminally ill patients and their families, this new concept has attracted growing public interest, motivating discussions on euthanasia and assisted suicide. The process of determining the reversibility or not of a clinical condition is critical in the ICU, as Doctor Vitor Oliveira stated:. The judgment of the technical inevitability of death is one of the most sensitive procedures among those that can be made in an ICU, as it is an opinion that has a high impact on a human life, on a person who has a long and rich history, who has dreams and desires, who loves other people and who has family and friends that love them back.
It is imperative to admit that this is the life of a person who, unless they clearly expressed otherwise, wants to continue living and counts on our professional work for it. Because it is this way, both so delicate and with universal, ethical and moral impact, that the judgment of the technical inevitability of death and also its previous corresponding dilemma, the technical inevitability of clinical worsening of the patient, which is so necessary in an ICU, that the judgement must be submitted to broad and critical scrutiny, in the search for errors, before being minimally accepted.
There will be nothing more valuable to a human life in ICU and to their family members than discovering errors in our judgment regarding the impossibility of treatment and of saving that life Unfortunately, today ICUs have, in practice, turned into spaces for the technical management of life and death. However, the challenging ethical perspective is to recover its original role, that is, their reason for being, which is to apply all the medical science known to promote the improvement of the health of the person hospitalized.
In our community, care and palliative actions in the intensive care unit is also advocated The truth is that medicine cannot stave off death indefinitely. Death finally ends up arriving and winning. The key question is not whether we will die, but when and how we will have to face this reality. When medical therapy cannot achieve the goals of preserving health or alleviating suffering, treating to cure becomes a futility or burden and, rather than prolonging life, extends the agony.
What follows is the ethical imperative to stop what is useless and futile, stepping up efforts to provide quality, rather than quantity, of life in the face of death Starting from the perspective that death is a dimension of our human existence, as we are finite and mortal, and have the right to live with dignity, and the right to die with dignity, without suffering or artificial prolonging of the dying process dysthanasia is implicit.
However, this does not give us the right to shorten life, which would be the practice of euthanasia. The judiciary, in this case the judge who embargoed the resolution in Brasilia, needs more ethical and bioethics culture to distinguish the concepts of euthanasia and orthothanasia because one can clearly see that the arguments presented have been shuffled.
The understanding of orthothanasia is that if the person is dying, we will not shorten their life by practicing euthanasia in their last moments, much less prolong their agonizing process, which would be a futile practice that should also be avoided.
The resolution is in full force. Here we need ethical wisdom to realize that, in certain situations, we are facing a human being whose life is coming to an end, and ignoring this reality would simply be a disaster.
The Miniaturization of the World in Moacyr Scliar’s A Guerra no Bom Fim
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PEACE AND WAR MOACYR SCLIAR PDF. By Stéphane Gerson Patrick Boucheron with her son cœur, Democide, baixadas e ama-los The New York.
Shofar: An Interdisciplinary Journal of Jewish Studies
Meenakshi Bharat. Madhu Grover. Hardbound — Available Buy now. The essays collected here re-assess this tendency, not least by focusing on the kinds of intellectual tourism and dilettantism to which it has given rise.
Most of his writing centers on issues of Jewish identity in the Diaspora and particularly on being Jewish in Brazil. Scliar is best known outside Brazil for his novel Max and the Cats Max e os Felinos , the story of a young German  man who flees Berlin after he comes to the attention of the Nazis for having had an affair with a married woman. En route to Brazil, his ship sinks, and he finds himself alone in a dinghy with a jaguar who had been travelling in the hold. He graduated in medicine in , majoring in public health.
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