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No / Purpose – The purpose of this paper is to understand the need and resources firefighters have to deal with death and dying (D&D) that they encounter whilst on duty and to present a curriculum to support D&D issues for firefighters. Design/methodology/approach – A qualitative methodology involving focus groups was conducted in two fire stations in Spain. The sample was 38 male participants with a mean age of 46 y/o (range: 30-59 years) and an average tenure of employment of 18 years (range: 6-35 years). Data were subjected to a thematic analysis. Dual coding of the transcripts in addition to member checking enhanced analysis. Findings – Nine themes emerged: witnessing D&D during rescue operations;memories about D&D and trauma; impact on firefighter’s families; decision-making process under stress; teamwork: protective and self-support; inadequate D&D preparation and training; adequate technical and physical training preparation; relationship between equipment, legal-moral obligation, and victims’ outcomes; communication issues: toward the victim and/or their relatives. These themes were subsequently framed into three basic domains: personal impact of D&D, team impact of D&D, and victim impact. Each domain, in its turn, is covered by three curriculum topics. The curriculum’s pedagogy is primarily based on experimental-reflective activities during 16 study-hours. Research limitations/implications – The absence of female participants. All fire stations were in cities with no more than 150,000 inhabitants. Practical implications – Individuals who take this curriculum will: increase their ability for self-care and resilience; improve teamwork, leadership skills, and to decrease burnout; provide more effective care for victims; provide skills to cope with compassion fatigue; reduced the levels of post-traumatic stress disorders. Originality/value – Understanding firefighters’ needs with relation to D&D, and assessing the resources available to mitigate these issues will provide a comprehensive approach to their education and promote health both personally and professionally. A comparable curriculum or proposal has not been previously identified.

In 2015, the Supreme Court of Canada ruled in the Carter decision that the prohibitions against physician-assisted dying, as outlined in section 241(b) of the Criminal Code of Canada, were unconstitutional as they violated an individual’s s.7 rights as outlined in the Canadian Charter of Rights and Freedoms. Though the jurisprudence of this landmark decision and subsequent amendments to Canadian law are interesting in and of themselves, what is particularly interesting about Carter is the framework within which physician-assisted dying is conceptualized. The Court shifts from a religiously informed framework for conceptualizing assisted suicide to a non-religious conceptualization of physician-assisted dying. Given that there remains much to be explored about nonreligion, this thesis asks: how is ‘nonreligion’ constructed by law in relation to physician-assisted dying in Canada? Since the Carter decision is not explicitly about religion or nonreligion the analysis in this thesis maps how the concepts life, death, and morality are reconceptualized. The analysis reveals that nonreligion is a phenomenon that is absent of the transcendent and is instead given positive content through a focus on autonomy. The conceptualization of nonreligion as presented in this thesis contributes to the literature that emphasizes that nonreligion is both positive and meaningful and not simply deficit terminology.

The contemporary juridico-political and bioethical debate over physician assisted dying has emerged as one of the most divisive of the late 20th and early 21st centuries. Commonly strained through Western conceptions of individual rights and near ubiquitous calls for the respect an abstractly defined human dignity, popular discourse on assisted dying tends to promote universal understandings of both human beings as well as ethical, legal, moral action. This thesis, however, holds these debates in abeyance preferring rather to explore the ways in which the possibility of an assisted death creates a more meaningful dying space for many Canadian advocates. And though I cannot answer for everyone, for many of the 24 individuals I spent months interviewing, “hanging out” with and generally following around to various meetings/training sessions, the assisted death is not some nihilistic response to the suffering of our materially bounded/feeling bodies, but a contemporary recurrence of a deeply spiritual, relational and artful dying.

This thesis explores the experiences of individuals living in a family where a member is dying or has a life-threatening illness. It focuses in particular upon how families are actively produced in the everyday `doing' of day-to-day family life (Morgan, 1996) in circumstances of severe ill-health and when facing death. Using an ethnographic approach combining informal, in-depth interviews with 9 families and participant observation on a hospice ward, the research provides insight into how families experience themselves as family in the `here-and-now' of their daily lives. It will be argued that in both popular culture and theoretical work there is a pervasive tendency to associate death with crisis and that the more ordinary, everyday and mundane aspects of dying experiences are less well understood. Therefore, the analysis of family lives presented here moves away from the more familiar model of emotional crisis and rupture in relation to severe ill-health and dying, to ask new questions about the `everydayness' of people's feelings and experiences during this time. A more nuanced picture of living with life-threatening illness and dying is provided as the data chapters explore the everyday and mundane in relation to families' experiences. Analysing empirical data about various aspects of dayto- day life - including eating practices, spatial dynamics and material objects - the thesis shows how ill-health and dying are not discrete ontological experiences existing outside and separate from everyday life. Rather, in paying attention to the `doing' of being a family day-to-day, this research brings more squarely into view, the everyday as a lived experience (Felski, 1999) within which families come to `know' their experiences of illness and dying.

Background: The End of Life Care Strategy stated that there should be a reduction of expected deaths in the acute setting. In order to achieve this goal, when it has been identified that where the patient's preferred place of care is home, clinicians need to be able to recognise when a patient is dying in order to achieve their preferred place of death. The aims of this study were to identify any factors that help or hinder a clinician when they are determining when irreversible dying begins and to seek consensus on which of these topics would be useful to include in an education programme. Method: A 3 stage mixed methods study was developed. Phase 1was a Systematic Review of current primary research in order to provide an evidence base for the study. Phase 2 involved unstructured interviews with clinicians in the acute setting utilising the Grounded Theory approach to the analysis identify potential factors. Phase 3 was a Delphi study used to identify which of these factors would be useful in an education programme. Conclusions: The Systematic Review identified four themes "Patient Observation", "Knowledge of the Patient", "Communication" and "Attitudes of the Clinician". These were confirmed by the interviews and a further theme "Experience" identified. The over-arching theme emerging from the findings of the interviews was that clinicians have a fear of getting the timing of the recognition of irreversible dying wrong because the decision making process is so complex and this is exacerbated by fear of missing the treatable. Many factors identified in the interviews were acknowledged as factors that could be included in an education package. It was also identified that there is the need for a culture shift in society regarding death and dying and a change in the philosophy of care for health care professionals.

Background: Nurses continuously meets and cares for dying patients, which can be perceived as both rewarding and stressful. To manage death and dying patients adequately, nurses need to reflect on what death means and her/his own perception of death and dying. Research showed that many nurses felt that they had a lack of knowledge and practical skills regarding end of life care. Objective: The purpose of this study was to illuminate nurses’ experiences of caring for patients in end-of-life care. Method: A literature-based study was used, based on analysis of qualitative data. Thirteen articles were analysed according to Friberg´s five-step model. The analysis resulted in four themes and eight subthemes. Results: Four main themes emerged from the analysis: 1) Deficient environment and organization 2) Deficient knowledge and practical skills 3) Support is an important factor 4) Response to end-of-life care. Conslusion: Education and training in end-of-life care was important. This should be implemented more, both in nursing education and in clinical practice. Support from management and colleagues was highly valued by nurses and should occur to a greater extent, as a way of preventing negative effects, such as burnout, and as a way of improving the care of dying patients and their relatives.

Esta dissertação de mestrado põe em questão o morrer, verbo tão elástico que confunde-se com a própria vida. Partindo do pressuposto que o morrer é um processo que cabe aos vivos e, por isso, é atravessado pelas relações do sujeito com a verdade, o seguinte trabalho pretende analisar, a partir do instante presente, como a sociedade moderna ocidental se organizou para dar conta dos infinitos mistérios que a morte desperta nos indivíduos em paralelo com o projeto de governo do Estado de gestão e controle da população, a partir das práticas biopolíticas e da legitimidade do saber médico que prescreve o que é uma vida, quais são os valores que a determinam e sob que códigos e condutas os seres devem se submeter para serem considerados existentes. Aliado ao filósofo Michel Foucault e Giorgio Agamben, propõe-se um percurso sinuoso da emergência do racismo biológico e do racismo de Estado para refletir sobre os grandes genocídios do século XX, sob a perspectiva de uma Tanatopolítica. Através do recurso do ensaio, este trabalho provocará a pergunta: como escrever sobre algo que não se fala O ensaio, mais do que um método, é um artesania capaz de costurar o tempo e a história em busca do passado de nossas verdades presentes e um convite ao leitor a um livre flanar pelos rastros de um conhecimento subsumido das cátedras acadêmicas, mas que clama por sua palavra e seu sepultamento. Ensaiar é permitir, também, que a ficção, a poesia e a literatura entrem pela porta da frente na obstinação do saber. Se a ciência moderna carece de evidências acerca do morrer e seus processos, o ensaio responde, sem ferir os mistérios do mundo, com mais questões que permitem criar outras realidades, fora das instituídas. Junto com Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart e outros filósofos, a dissertação problematiza a distância entre a pesquisa e a militância, flertando com o saber morrer e apostando no luto enquanto luta, ensaiando outras maneiras de dar sentido a ausência com a inventividade política dos movimentos de ocupação atuais para fazer frente ao projeto biopolítico. / This master's dissertation questions dying: a verb so elastic that it is confused with life itself. Based on the assumption that dying is a process that belongs to the living and is therefore crossed by the subject's relations with the truth, the following work intends to analyze, from the present moment, how modern Western society organized itself to address the infinite mysteries that death awakens in the individuals in parallel with the state governor's project of management and control of the population, from the biopolitical practices and the legitimacy of the medical knowledge that prescribes what a life is, what the values that determine it are and under what codes and behaviors living beings must undergo to be considered existing. Allied with the philosophers Michel Foucault and Giorgio Agamben, it is proposed a sinuous route of the emergence of the biological racism and the racism of State to reflect on the great genocides of century XX, from the perspective of Tanatopolitics. This work will provoke the question in the form of an essay: how do we write about something that is not spoken The essay, more than a method, is a craft capable of sewing time and history in search of the past of our present truths and an invitation to the reader to a free walk through the traces of a subsumed knowledge of academic chairs, but that claims by its word and its burial. Essaying is to allow, also, that fiction, poetry, and literature enter the front door in the obstinacy of knowledge. If modern science lacks evidence about dying and its processes, this essay responds, without hurting the mysteries of the world, with more questions that enable us to create other realities, other than those instituted. Along with Walter Benjamin, Jorge Larrosa, Peter Pal Pelbart, and other philosophers, this dissertation problematizes the distance between research and militancy, flirting with the acceptance of dying, and betting on mourning while fighting, essaying other ways to make sense of absence with the political inventiveness of the current occupation movements facing the biopolitical project.

yes / Professionals working with patients at end of life need to feel comfortable and confident discussing death, dying and bereavement (DDB), however this is not always the case.1 2 The Continuing Bonds Project sought to explore the impact of archaeology on the confidence and comfort for health and social care professionals and students in talking about DDB.

Of the 34,000 children who die annually, over 28,000 are four years old or younger. Nurses working in pediatric intensive care units (PICU) provide end of life (EOL) care before, during, and after death of these children. The purpose of this study was to determine thesuggestions PICU nurses have for improving EOL care for dying pediatric patients and their families. A sample of 1047 PICU nurses, who were members of the American Association of Critical-Care Nurses (AACN), were sent a 70-item questionnaire. One open ended item asked nurses to offer a suggestion for improving EOL care for dying PICU patients. Responses were received from 235 of the 474 (49.6%) nurses who returned the questionnaire. Eight themes were identified: (1) providing a better environment; (2) physician honesty about prognosis; (3) having a plan for dying; (4) ending futile care; (5) physicians on "same page;" (6)having more staff; (7) receiving more EOL education; and, (8) providing better pain control. Patient centered principles begin with creating an environment that allows the dying process to be centered on the family while fostering dignity. Fostering dignity includes providing an environment that is conducive to supporting quality EOL care. The importance of providing privacy and an appropriate place for the patient and family to feel more comfortable during the dying process was suggested. The need for better communication between providers and families, ending suffering, and having enough staff to support a "good death," were also high priorities. PICU nurses overwhelmingly suggested that the environment in which health care workers monitor, care for, and support patients and families during death is thegreatest area for improvement. Unit design teams need to assure that care areas for dying pediatric children are created to accommodate a dignified and peaceful passing to improve pediatric End-of-Life Care.