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Background Current Canadian Medical Assistance in Dying (MAiD) legislation requires individuals to have the mental capacity to consent at the time of the procedure. Advance requests for MAiD (ARs for MAiD) could allow individuals to document conditions where MAiD would be desired in the setting of progressive dementia. Methods Greater Vancouver area dementia care clinicians from family practice, geriatric medicine, geriatric psychiatry, and palliative care were approached to participate in an online survey to as­sess attitudes around the appropriateness of ARs for MAiD. Quantitative analysis of survey questions and qualitative analysis of open-ended response questions were performed. Results Of 630 clinicians approached, 80 were included in the data analysis. 64% of respondents supported legislation allowing ARs for MAiD in dementia. 96% of respondents articulated barriers and concerns, including determination of capacity, protecting the interests of the future individual, navigating conflict among stakeholders, and identifying coercion. 78% of respondents agreed with a mandatory capacity assessment to create an AR, and 59% agreed that consensus between clinicians and substitute decision-makers was required to enact an AR. Conclusion The majority of Vancouver dementia care clinicians participat­ing in this study support legislation allowing ARs for MAiD in dementia, while also articulating ethical and logistical concerns with its application.

A modified Delphi study that aims to find consensus- criteria for irremediable psychiatric suffering in the context of PAD.

Among the many remarkable aspects of the June 2016 introduction of legislation to permit medical assistance in dying (MAiD) in Canada, is the central and even dominant role that women have played in moving this legislation forward, and their ongoing influence as the law continues to be reviewed and revised. The index medical cases on which the higher courts have deliberated concern women patients, and the legal decisions in the various courts have been presided over by women justices. Since the legislation has become law in Canada, women have been among the most vocal and enthusiastic proponents for expanding the criteria to ensure MAiD is more accessible to more Canadians. In this paper, I discuss how the voice of women in this debate is not the ‘different voice’ of second wave feminism first articulated by Carol Gilligan and then adapted and expanded in the ethics of care and relational ethics literature. Instead it is the very familiar voice of the ethics of personal autonomy, individual rights and justice which feminist critics have long decried as inadequate to the task of articulating a comprehensive social morality. I argue for the need to reassert the different voice of relational ethics and the ethics of care into our ongoing discussion of MAiD., Parmi les nombreux aspects remarquables de l’introduction, en juin 2016, d’une législation permettant l’aide médicale à mourir (AMM) au Canada, on peut citer le rôle central et même dominant que les femmes ont joué pour faire avancer cette législation, et leur influence permanente alors que la loi continue d’être examinée et révisée. Les cas médicaux indexés sur lesquels les tribunaux supérieurs ont délibéré concernent des patientes, et les décisions juridiques des différents tribunaux ont été présidées par des femmes juges. Depuis que la loi est entrée en vigueur au Canada, les femmes ont été parmi les plus virulentes et les plus enthousiastes partisanes de l’élargissement des critères afin de garantir que l’AMM soit plus accessible à un plus grand nombre de Canadiens. Dans cet article, j’explique comment la voix des femmes dans ce débat n’est pas la « voix différente » du féminisme de la deuxième vague, d’abord exprimée par Carol Gilligan, puis adaptée et développée dans la littérature à l’éthique des soins et l’éthique relationnelle, mais plutôt la voix très familière de l’éthique de l’autonomie personnelle, des droits individuels et de la justice, que les critiques féministes ont longtemps décrié comme inadéquate pour articuler une morale sociale globale. Je plaide pour la nécessité de réaffirmer la voix différente de l’éthique relationnelle et de l’éthique des soins dans notre discussion actuelle sur l’AMM.

In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient characteristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid. We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March&ndash, June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis. The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slightly more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at the end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.

Background: In 2019, cancer patients comprised over 65% of all individuals who requested and received Medical Assistance in Dying (MAID) in Canada. This descriptive study sought to understand the self-reported symptom burden and complexity of cancer patients in the 12 months prior to receiving MAID in Alberta. Methods: Between July 2017 and January 2019, 337 cancer patients received MAID in Alberta. Patient characteristics were descriptively analyzed. As such, 193 patients (57.3%) completed at least one routine symptom-reporting questionnaire in their last year of life. Mixed effects models and generalized estimating equations were utilized to examine the trajectories of individual symptoms and overall symptom complexity within the cohort over this time. Results: The results revealed that all nine self-reported symptoms, and the overall symptom complexity of the cohort, increased as patients’ MAID provision date approached, particularly in the last 3 months of life. While less than 20% of patients experienced high symptom complexity 12 months prior to MAID, this increased to 60% in the month of MAID provision. Conclusions: Cancer patients in this cohort experienced increased symptom burden and complexity leading up to their death. These findings could serve as a flag to clinicians to closely monitor advanced cancer patients’ symptoms, and provide appropriate support and interventions as needed.

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders (the three Abrahamic religions) suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L (1949) Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. (1967) A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 (1968) https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F (2013) After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J (1975) Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html

Most of us would agree with the almost trite saying that “life is a journey”. Of course it is, unless it ends tragically at birth, and even then it is a very short journey. All of us can describe how we got from one stage in life to another, whether personal, family, education or career. Many journeys seem to be in an almost straight line while others meander from one place to another, changing direction and alternating goals, sometimes zigging back and forth. I have had many wonderful journeys in my life; the choice to change career aspirations from engineering to medicine, the choice the study in medicine in Scotland, the choice to focus on geriatrics and then the choice to branch out into medical ethics to add more depth to clinical medicine. The early undergraduate study of philosophy planted the seed that eventually grew into my completing a Master’s in Medical Ethics; and then expanding my teaching and practice to include palliative care and end of life-decision-making, to most recently participating in the assessment of those requesting medical assistance in dying (MAID in Canada)., La plupart d’entre nous sont d’accord avec l’adage presque banal selon lequel «la vie est un voyage». Bien sûr, c’est le cas, à moins qu’elle ne s’achève tragiquement à la naissance, et même dans ce cas, le voyage est très court. Nous pouvons tous décrire comment nous sommes passés d’une étape à l’autre de notre vie, qu’il s’agisse de notre vie personnelle, familiale, scolaire ou professionnelle. De nombreux voyages semblent se dérouler en ligne presque droite, tandis que d’autres serpentent d’un endroit à l’autre, en changeant de direction et en alternant les objectifs, parfois en faisant des zig-zig. J’ai connu de nombreux voyages merveilleux dans ma vie : le choix de changer d’orientation professionnelle pour passer de l’ingénierie à la médecine, le choix d’étudier la médecine en Écosse, le choix de me concentrer sur la gériatrie, puis le choix de m’orienter vers l’éthique médicale pour donner plus de profondeur à la médecine clinique. L’étude de la philosophie au début du premier cycle a planté la graine qui m’a permis d’obtenir une maîtrise en éthique médicale, puis d’étendre mon enseignement et ma pratique aux soins palliatifs et à la prise de décision en fin de vie, et plus récemment de participer à l’évaluation des personnes demandant une aide médicale à mourir (AMM au Canada).

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD., Une personne compétente peut-elle refuser des soins afin de rendre son décès naturel raisonnablement prévisible pour être admissible à l’aide médicale à mourir (AMM)? Prenons l’exemple d’un patient compétent atteint d’une paralysie du côté gauche à la suite d’un accident vasculaire cérébral droit qui ne devrait pas mourir avant de nombreuses années ; normalement, la cause de son décès ne serait pas prévisible. Cependant, il refuse de se retourner régulièrement, de sorte que son médecin peut prédire que des plaies de pression se développeront, entraînant une infection pour laquelle il refusera le traitement et mourra par conséquent. Est-il maintenant admissible à l’AMM? Prenons l’exemple d’un patient compétent atteint d’une sténose spinale (affection non mortelle) qui refuse de manger (mais pas de boire pour ne pas perdre sa capacité à cause de la déshydratation). Par conséquent, son médecin peut prédire la mort par famine. Est-elle maintenant admissible à l’AMM? Pour répondre à ces questions, nous devons répondre à trois sous-questions: 1) les patients compétents ont-ils le droit de refuser des soins; 2) les prestataires de soins de santé ont-ils l’obligation de respecter ces refus; et 3) les décès résultant de refus de soins sont-ils naturels aux fins de déterminer si un patient est admissible à l’AMM? Si un patient compétent a le droit de refuser certains soins particuliers et que les prestataires de soins de santé ont l’obligation de respecter ce refus, et si le décès qui résulterait du refus de ces soins est naturel, alors ce refus de soins est une voie légale vers le AMM. Toutefois, si le patient compétent n’a pas le droit de refuser certains soins particuliers, ou si les prestataires de soins de santé n’ont pas l’obligation de respecter ce refus, ou si le décès qui résulterait du refus de ces soins n’est pas naturel, alors ce refus de soins ne constitue pas une voie légale vers le AMM. Dans cet article, nous explorons ce terrain juridique complexe avec les implications éthiques les plus profondes : l’accès à l’AMM.

Since the legalization of Medical Assistance in Dying (MAID) in Canada in 2016, there have been discussions regarding the extension of this service to patients who lose decision-making capacity but have made a prior advance request for physician-assisted suicide. Both caregivers and physicians have shown some support for allowing patients to make advance requests for MAID. The proposed changes to the legislation would remove the mandatory 10 day waiting period and include a waiver of final consent for those who loose decision-making capacity following their MAID request.

This article examines the media coverage of food in the context of community-based end of life rituals and death meals that are increasingly being observed by those undergoing a medically assisted death (medical assistance in dying: MAID). I employ a reconstituted form of media analysis that aims to identify and unpack the socio-cultural themes, values, and assumptions that underpin these food events. These include the central frame of plenty, community/family, personality, comfort, and gender. My objective is to provoke a discussion about how media coverage acts as a site from which to understand the significance of food in the context of death, when death is desired, and how new avenues of research can be pursed therein.

Background: Legally practiced assisted dying is an ethically complex area in need of empirical and conceptual work. International research suggests that providing assisted dying may be experienced as rewarding and meaningful but also emotionally and psychologically taxing, associated with feelings of loss and loneliness. Yet little research has been published to date, which attends to the long-term effects of providing assisted dying. In this article, I contribute to filling this gap in the literature using the Canadian province Quebec as an illustrative case. Medical aid in dying (MAiD) in the form of physician provided euthanasia has been a lawful end of life healthcare option in Quebec since December 2015 and significant research is currently emerging from this jurisdiction. Methods: In this article, I draw on nine in-depth interviews with Quebec physicians, all of whom engaged with end of life care in different ways. Results: Four of the interviewed physicians provided medical aid in dying (MAiD) and five did not. The major themes of MAiD in relation to aggressive treatment, conscientious objection and uneven distribution of work emerge, and it appeared clearly that MAiD was experienced and thought of as qualitatively different to other end of life procedures. Conclusions: Our findings expose a complexity and contentiousness within the practice, which remains under researched and underreported and indicate avenues where more research is needed.

According to the Canadian law legalizing physicians to provide medical assistance in dying (MAID) under certain circumstances, the patients alone determine if their suffering cannot be relieved under conditions "that they consider acceptable." This contrasts with the laws on MAID in the Netherlands, which require that physicians only grant access to MAID if they concur with the patient that there are no other potential means of alleviating the suffering. In the Netherlands, when a doctor believes that other means to reduce the suffering exist, they must be tried before having access to MAID. This criterion is often applied and is considered an essential precaution to ensure that lives are not ended prematurely when other viable interventions exist. The Canadian emphasis on the patient's right to decide whether to try potential alternatives a physician may suggest, such as palliative care, instead of dying by MAID, gives patients the liberty to make informed decisions, even when they may not seem to be in their best interest. This contrasts with the belief in the Netherlands that the state has an obligation to protect citizens from making decisions that are not in their best interest, such as choosing to die when the "intolerable suffering" can be diminished sufficiently for the person to abandon the desire to end the suffering by dying. The Canadian parliament, when they consider expanding access to MAID, should incorporate the Dutch due care safeguards to ensure that death is not the solution when other ways of reducing suffering exist.

Nurses play a central role in Medical Assistance in Dying (MAiD) in Canada. However, we know little about nurses’ experiences with this new end-of-life option. The purpose of this study was to explore how nurses construct good nursing practice in the context of MAiD. This was a qualitative interview study using Interpretive Description. Fifty-nine nurses participated in semi-structured telephone interviews. Data were analyzed inductively. The findings illustrated the ways in which nurses constructed artful practice to humanize what was otherwise a medicalized event. Registered nurses and nurse practitioners described creating a person-centered MAiD process that included establishing relationship, planning meticulously, orchestrating the MAiD death, and supporting the family. Nurses in this study illustrated how a nursing gaze focused on relationality crosses the moral divides that characterize MAiD. These findings provide an in-depth look at what constitutes good nursing practice in MAiD that can support the development of best practices.

Este artículo pretende analizar las representaciones de la criada presentes en pliegos de cordel publicados entre mediados del siglo XVIII y comienzos del xix. Teniendo en cuenta la capacidad de difusión de estos impresos, y por tanto la influencia cultural de sus contenidos, se relacionan las imágenes de la criada con los modelos sociales que la literatura de cordel divulgaba entre su público, This article aims to analyze the maid’s representations found in chapbooks published from the mid-eighteenth century to the beginning of nineteenth century. Considering the capacity of dissemination of this kind of printings, and thus their cultural influence, the maid’s images are linked to the social patterns that cordel literature spread among its publics.

En la literatura popular de España en los siglos xviii y xix llama la atención por su ausencia la figura de la criada. Con la excepción de obras de teatro publicadas en sueltos, y que tienen su origen en el teatro del Siglo de Oro, se limita la presencia de la criada en la literatura popular de este período a una serie de ejemplos de mal comportamiento que aparecen, mayoritariamente, en las últimas décadas del siglo xix, y que ofrecen una visión positivista del destino de la criada buena y de la mala. A diferencia de estas historias de ejemplaridad, que anulan la posibilidad de ejercer el libre albedrío, una historia famosa circula en forma de suelto a partir del xviii, y que pone en tela de juicio el papel de la criada, de forma que en él entran en juego cuestiones de género y de clase. Al interpretar esta historia según el modelo de Bronfen, en el que la literatura ofrece como consolación para el lector masculino el mal comportamiento y castigo de las mujeres, se revela cómo éstas sirven de chivo expiatorio de los males de la sociedad., In Spanish popular literature of the 18th and 19th centuries, the figure of the maid is remarkable for her absence. With the exception of plays published in chapbook form, and whose origin is in Golden Age drama, the presence of the maid in popular literature of this period is limited to a number of examples of bad behaviour, most of which occur in the last decades of the 19th century, offering a positivist vision of the destiny of the good maid and the bad one. Contrasting with these exemplary tales which show no room for the exercise of free will, a famous story circulates in suelto form from the mid-18th century that exposes issues of gender and class. If we interpret this tale on the model of «Over her dead body» as articulated by Bronfen, we can perceive the maid here not only bearing the blame of wrongdoing and its punishment, but can see her also as a scapegoat for the society she is in.

This thesis offers a spatial analysis of the representation of female servitude and rebellion in contemporary French cinema through the archetype of the 19th century rebellious maid figure. The rebellious maid figure is an historical, social and cultural construct upon which a series of spatialised iconographic features were grafted during the nineteenth century and that continue to be employed in contemporary cinematic mise en scène. This thesis uncovers dual spatial translation processes. The first process under study is the translation of the maid’s ‘space syntax’ (a spatial and architectural iconography) into the cinematic medium. Film, by way of its spatial diegesis and mise-en-scène, manifests in a particular manner the archetypal maid’s narrative of servitude and rebellion. This will be demonstrated through the study of Chabrol’s La Cérémonie (1995) and Dercourt’s La Tourneuse de pages (2006), two films that represent, in a typological ma nner, the domestic architectural setting associated with the 19th century bonne à tout faire and her syntax of space. The second process that I refer to is that of the translation of the maid’s space syntax onto updated, contemporary social contexts and spatial settings of female servitude and rebellion in cinema that are divorced from the original domestic environment of the traditional maid figure. Achache’s Le Hérisson (2009), Klapisch’s Ma part du gâteau (2011), Charef’s Marie-Line (2000), and Mennegun’s Louise Wimmer (2012) will be analysed in that context. By examining how the maid figure is translated across time, space and medium, this thesis demonstrates the power of social and cultural constructions of space to endure radical temporal and environmental changes. In effect, this thesis will argue, the archetypal 19th century maid figure and her attendant space syntax survive as a latent construct that filmmakers draw upon in order to stage narrati ves of servitude and rebellion. The findings of this underta! king seek to inform critical understandings of the politics and poetics of the representation of rebellion in films that present narratives of female servitude.

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