The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ. For this study, data were collected using semi-structured, in-depth interviews with an open interview guide. These interviews were conducted in a two-tiered format. Tier 1 included ten leading experts in various areas of end-of-life healthcare and aging in Tennessee. Tier 2 included nine legislators who were members of the health committees of either the Tennessee House of Representatives or the Tennessee Senate. Qualitative data were organized into numerous categories, and an initial phase of open coding was completed. From this phase of coding, emergent themes and focuses were discovered. This was followed by focused coding on all nineteen interviews using coding software to organize subtleties. Findings of the Tier 1 interviews indicated that there are many areas of end-of-life healthcare that need improvement including increased funding, expanded caregiver support, improved doctor-patient communication, and increased use of advance directives. Emergent themes included the influence of money, having difficult conversations, the stigma of death and dying, and supporting the caregiver. Tier 2 findings highlighted the motivations behind voting decisions and the level of awareness legislators have in areas of end-of-life healthcare policy. Both tiers also explored the support and opposition of physician-assisted death. The findings of this dissertation are intended to inform health professionals and state legislators. The data gathered through this exploratory research and the knowledge gained will lead to a greater understanding of end-of-life healthcare in Tennessee, and what needs to be done to improve its quality. This will allow individuals and families faced with end-of-life decisions to navigate the process with expanded options, access, and support.

With the widespread use of the Internet, grief has been extended in its representation. Specifically, social networking sites, like MySpace, have turned grief presentation from private expressions into public displays of mourning. This study utilizes the theoretical foundations of the grief presentation process of Kübler-Ross' (1969) five categories of bereavement (denial, anger, bargaining, depression and acceptance) to determine whether the grief presentation process is present in an online setting. In this study, the researcher conducted an empirical investigation of 4,931 comments, resulting in 22,263 bereavement themes outlined by Kübler-Ross, which were condensed into 2,288 time-point comparisons posted to 140 MySpace profiles of users who have passed-on. Results revealed noteworthy practices surrounding grief presentation on the MySpace profiles of the deceased. Specifically, bereaved commenters post a significantly greater number of bereavement narratives in the first three months post-mortem as opposed to months four through six. Additionally, race and sex of the deceased, as well as sex of the bereaved, did not prove to be mitigating factors in online grief presentation. Moreover, across observed races and sexes, the bereavement category of acceptance was found most often, followed by depression, denial, anger, and bargaining. Findings suggest that post-mortem commenting behavior blends current memorializing practices while also extending the space for communication and grief presentation. Additional implications for understanding grief communication on MySpace and future directions for research conclude this study.

Seit einigen Jahre fällt eine Fülle an verschiedenen multimedialen Veröffentlichungen zum Thema Sterben auf, die einen Zusammenhang von Sterben und Erzählen offensichtlich machen, den ich in dieser Arbeit näher erforscht habe. Das Erzählen als eine kulturelle Praktik übernimmt in den von mir untersuchten Veröffentlichungen die Funktion einer ästhetisch-ethischen Sorge und kann als Form zeitgenössischer Sterbekunst betrachtet werden. Es eröffnet einen Raum für ethisches Handeln, um die eigene Haltung zum Sterbeprozess zu eruieren, um diesen selbstbestimmt zu gestalten und abschließend ästhetisch als ein ‚gutes Sterben‘ zu formulieren. Die Fülle der verschiedenen Veröffentlichungen zum Thema Sterben – von diaristischen Selbstreflexionen über fiktionale Sterbenarrative hin zu populärwissenschaftlichen Publikationen von Palliativmediziner*innen – drückt sich sowohl in der Wahl verschiedener Medien als auch in den unterschiedlichen Perspektiven auf den Sterbeprozess aus. Ich spreche demzufolge von einer Polyphonie, die sowohl Sterbende als auch diejenigen zu Wort kommen lässt, die Sterbende begleiten. Die Polyphonie hebt im Bachtin’schen Sinne nicht nur die Bedeutung der ‚Anderen‘ hervor, sondern bringt auch ‚fremde Stimmen‘ zu Gehör. So werden Uneindeutigkeiten, Asymmetrien oder auch Sehnsüchte formulierbar, die Sterbeprozesse heute maßgeblich bestimmen und nicht zuletzt in den ethischen Debatten zu Sterbebegleitung/-hilfe evident werden. Die Polyphonie öffnet dabei im besonderen Maße den Blick auf die Pflege, die so eine neue Sichtbarkeit erfährt. Die Veröffentlichungen artikulieren nämlich verschiedene Formen der Sorge, die nicht nur die konkreten Maßnahmen von Sterbebegleitung und/oder Sterbehilfe meinen. Vielmehr wird auch eine im Foucault‘schen Sinne Idee der Selbstsorge formuliert. Das polyphone Erzählen artikuliert demnach einen Raum der Sorge selbst, in dem Sterben als Form der Gemeinschaftung und Solidarität zwischen Sterblichen erscheint. / Recent years have seen an abundance of varied publications about dying, manifesting the relationship between dying and narration. In my work I argue that in these publications, narrating as a cultural practice articulates an aesthetic-ethical concern to communicate the process of dying not only from a dying person’s perspective but also from that of those accompanying death. Thus, these narratives of dying can be seen as a contemporary form of an “art of dying.” The act of narrating opens up a space for ethical transactions in which one’s own position toward the process of dying can be plumbed; in turn, one is able to determine one’s own process of dying and, finally, aesthetically formulate the process as a “good death.” Today’s plethora of publications on dying – from diaristic self-reflections to fictional narratives to popular scientific publications by doctors in the field of palliative medicine – not only manifest the many types of media in which the narratives are formulated but also convey the many perspectives on the process of dying itself. I therefore speak of a polyphony, which raises the voices of those dying and of those accompanying a dying person. This polyphony accentuates the importance of the “other” and elevates “outsider voices.” The narratives articulate the ambiguities and asymmetries, but also desires, that largely shape dying today and that become evident in the ethical debates about euthanasia and assisted suicide. Contemporary narratives of dying show that the idea of care is of great importance today. Care, however, is articulated not only in questions of how the dying can be cared for — in the sense of palliative care or assisted suicide — but also in the Foucauldian sense of “care for the self,” meaning self-awareness and concern about oneself. To this extent, these polyphonic narratives articulate a space of concern and care, in which the process of dying requires and builds community and becomes a form of solidarity between mortals.

No description available.

The modern hospice movement emerged in the 1960s as a grassroots social movement that attempted to restore an holistic and contextualised approach to the care of people at the end of life. This approach embraced the lived experience of the dying person at the centre of care across physical, emotional, social and spiritual domains of life. To achieve this, the care of dying people was largely removed from mainstream health care systems to promote more holistic and socially contextualised dying. In recent decades, the evolution of palliative care demonstrates the gradual return of palliative care services to the mainstream. It has been asserted that, in this process, palliative care services have progressively abandoned the social context of dying people, increasing instead an emphasis on "physical care [while] simultaneously de-emphasizing psychological, social and spiritual care" (Kellehear, 1999a, p.76). Kellehear and others have proposed that the repositioning of palliative care within mainstream health care systems has increased a focus upon illness and disease at the expense of health and wellbeing. Subsequently, conventional palliative care services have been criticised for not adequately locating end of life care within the social contexts in which death and dying take place. In an attempt to address this problem, Australian sociologist Allan Kellehear proposed an approach to end of life care that brought together the core concerns of palliative care with the principles and practices of health promotion (Kellehear, 1999b). Whilst their congruence is not immediately apparent, these two fields have been increasingly examined for their potential benefits in the provision of end of life care. In the current policy climate in Australia, there is an imperative to consider how end of life support services might be improved through adopting a health promoting palliative care approach. The aim of this study has been to investigate the integration of health promotion principles and practice by a selected palliative care service by examining the qualitative impact of this change on the organisation. Specifically, it endeavoured to identify the factors that advanced or impeded this integration by examining how the structures and processes of, and outcomes for, the organisation reflected a health promoting approach. To meet these aims, this study undertook an in-depth examination of the implementation of a health promoting palliative care model by a community based palliative care organisation. Based in a constructionist-interpretivist paradigm, a mixed-method (QUAL+quant), instrumental case study research design was utilised to capture multiple perspectives of the implementation process. Data collection comprised examination of 127 organisational documents, 32 in-depth interviews with staff, volunteers and consumers, 5 focus groups with staff and volunteers, and 25 carer questionnaires. Qualitative data were subject to thematic analysis, with supplementary quantitative data analysed to generate descriptive statistics. The findings demonstrated a large number of complex and interrelated enabling and impeding factors to the implementation in the case study site. These factors have been grouped into four key themes which have been examined in light of the aims of this study and the issues identified in a comprehensive review of the literature. This study found that: ◦ Conceptual congruence between health promotion and palliative care was a fundamental starting point in the implementation of a health promoting palliative care model. ◦ Where conceptual congruence was clear, activities associated with the model that were regarded as beyond conventional approaches to palliative care core business were viewed favourably by stakeholders and were less likely to encounter resistance within the organisation. ◦ When systematic approaches to organisational change, such as quality improvement systems, were rigorously applied, the impact of the transition upon stakeholders was qualitatively less. ◦ Where this transition had been effectively made, consumers, staff, volunteers and members of the wider community were seen to benefit. This study adds to the current discourse regarding the intersection between end of life support and health promotion, and provides insight into how palliative care organisations might undertake the transition from conventional models to a health promoting palliative care approach.

The dissertation aims at showing the differences in dealing with the death issue in characteristic works of art of both Czech and world literature. Above all, it pursues the comparison of two novels Život střídá smrt ("Life Becomes Death") by Petr Prouza and Nebe nemá dno ("Heaven is Bottomless") by Hana Andronikova. Both unique books belong to key Czech novels with the topic of death. Moreover, both of them deal with death from the point of personal experience, which means they are strongly autobiographical. The dissertation concentrates on creative processes and topical aspects, grasps autobiographical elements of both novels and all the identities and differences in the approach to the same topic. Therefore, the dissertation is devoted to listing the works of art dealing with death, further on to the analyses, interpretation and comparison of the novels Život střídá smrt ("Life Becomes Death") and Nebe nemá dno ("Heaven is Bottomless") together with the reflexion of reader's experience.

This diploma thesis focuses on the topic of posthumous user data management concerning social media platforms. This topic is rarely discussed from the viewpoint of new media studies in academic literature. My thesis endeavours to unveil, contextualize, and critically assess the development of the posthumous data policies in order to uncover the level of control users and survivors have over the deceased users' data. Thus, three case studies of chronological posthumous policy development of major social media (Facebook, Twitter, and LinkedIn) were conducted and results were compared. The analysis has shown that platforms are rather reluctant to change their posthumous policies. One of the primary triggers for change comes from the users' feedback. Across all three cases every platform provided limited or no information about these policies in their terms of use or privacy policies. The case studies demonstrated that users have very limited choices regarding their data after death directly on the examined social media platforms. Individuals who were close to the deceased account users have the ability to request account deletion or have limited access to the account granted by the platform. The level of data preservation demanded by platforms seems dependent on a given social media's communication specificity...

This diploma thesis focuses on the topic of posthumous user data management concerning social media platforms. This topic is rarely discussed from the viewpoint of new media studies in academic literature. My thesis endeavours to unveil, contextualize, and critically assess the development of the posthumous data policies in order to uncover the level of control users and survivors have over the deceased users' data. Thus, three case studies of chronological posthumous policy development of major social media (Facebook, Twitter, and LinkedIn) were conducted and results were compared. The analysis has shown that platforms are rather reluctant to change their posthumous policies. One of the primary triggers for change comes from the users' feedback. Across all three cases every platform provided limited or no information about these policies in their terms of use or privacy policies. The case studies demonstrated that users have very limited choices regarding their data after death directly on the examined social media platforms. Individuals who were close to the deceased account users have the ability to request account deletion or have limited access to the account granted by the platform. The level of data preservation demanded by platforms seems dependent on a given social media's communication specificity...