Ce sang qui n’est pas le mien : sens, liens et paradoxes de la transfusion sanguine : une étude anthropologique des familles en contexte clinique pédiatrique

This thesis provides an anthropological approach to blood transfusion, given that this treatment is considered a social practice that is infused with meanings and values that are inscribed within a cultural environment and the clinic itself. The principle objective of this research is to examine the lived experience of blood transfusions from the point of view of the receivers and the varied meanings they attach to this procedure. The guiding thread of the thesis is the multidimensional and polysemic signification of blood and blood transfusions. We also examine the social connections that are woven or constrained around the procedure in a context of sociocultural diversity. This project sheds a new light on blood transfusion, an essential element of care, and provides new data and innovative insights.  This research follows an ethnographic process inspired by medical anthropology, the sociology of health and the anthropology of kinship. The comparison of distinct social worlds is implicitly inscribed in the anthropological approach and consists of an analysis of each particular context chosen (the intensive care unit, the haematology clinic and the oncology centre at Sainte Justine mother and child university hospital center). These contexts are compared with each other in order to deconstruct their similarities and differences. Our research is qualitative and includes three pathways of data collection: 63 semi-structured interviews with patient and family members, 16 interviews with health professionals and ethnographic observations of blood transfusions and interactions between patients, their families and health care professionals. The research data was subjected to a descriptive content analysis.  We present the religious, cultural, scientific, moralistic and other connotations of blood and the act of receiving blood. We have examined different elements of families involved and have identified which ones most influence their manner of living with a blood transfusion; for example, the hospital setting, the particularities of the clinical case, socioeconomic status, religious or ethnic identity, the level of education and the relationship between the family and health care professional. We question the manner in how the practice impacts the construction of bioidentity, biosociality, and notions of how the body is constituted by the various actors. We discuss this procedure and its implications on the formation of human identity. At the same time, we analyse how economic and social conditions colour the meanings attached to this treatment and how it is perceived.  We show that not all of blood transfusions are experienced in the same way. Although, different elements come into play at this level, the hospital context where these practices take place and the quality of the family-health care professional relationships seem to exert the greatest influence. The families’ knowledge of the blood transfusion and the issues linked to informed consent are also discussed in the framework of divergences and convergences between expert knowledge and layperson knowledge. Finally, we explore attitudes toward anonymous donation, donation from a known donor and the system of collection and treatment of blood. The perspectives of participants are discussed in the framework of critical medical anthropology in relation to the pharmaceutical industry and the bioindustry of organic matter. We also discuss the social significance of these systems and their dehumanizing character.

Keyphrases: medical anthropology, anthropology of health, critical anthropology, blood transfusion, blood, paediatrics, families, intensive care, haematology, oncology, body, bioidentity, bio-sociality, kinship, communication health professional-patient, blood donation, anonymous donation, transfusion medicine