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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.

Since before the Neolithic Revolution, when human civilisation first emerged, humans and canines have lived, and died, together. This Scottish study is conducted in the field of animal-human interaction and, using qualitative methods, applies established insights from the sociology of health (born of human-to-human interaction) to a human-animal relationship. Specifically, this thesis explores death and dying in relations between the companion canines, and the human members, of ten families. Nonhuman illness narratives are found in profusion in this study, and it was also found to be possible to apply biographical disruption to nonhumans, when conceptualised as biographical disruption-by-proxy. Unexpectedly, there emerged from the data support for a four-fold model of canine selfhood, as forged within the family. This is, as far as I am aware, the first modelling of a specific nonhuman consciousness, within the discipline. Suffering was found to exist in both physical and non-physical forms for the companions, and a mutual vulnerability to loneliness, and desire for companionship, appears to be a powerful point of connection between the humans and the canines. Being together emerged as both a practice, and as an ideal, that moulded the human-canine relations, and it was regarded as unfitting for a canine to die alone. Companion canine dying comes forth as a negotiated process, shaped by a divide between gradual and sudden death. This work encountered developed narratives of departure, that seem to structure the experience of losing a companion. In particular the role of the expert is a privileged voice in the negotiations of dying, and the biomedical view is treated as being definitive. The role of the expert is not simply submitted to however, but a range of stances to veterinary authority are displayed, being; acquiescence, resistance and invalidation of the veterinary voice. Ultimately, whilst interplays of wellbeing are present, they are less biophysically grounded, than they are rooted in the everyday routines of life, in the rituals of eating, sleeping, walking, and playing together, that compose the shared world of the human and companion canine.

This thesis examines attitudes and approaches towards death, as well as aesthetic representations of death, in Anglo-Saxon hagiography. The thesis contributes to the discussion of the historical and intellectual contexts of hagiography and considers how saintly death-scenes are represented to form commentaries on exemplary behaviour. A comprehensive survey of death-scenes in Anglo-Saxon hagiography has been undertaken, charting typical and atypical motifs used in literary manifestations of both martyrdom and non-violent death. The clusters of literary motifs found in these texts and what their use suggests about attitudes to exemplary death is analysed in an exploration of whether Anglo-Saxon hagiography presents a consistent aesthetic of death. The thesis also considers how modern scholarly fields such as thanatology can provide fresh discourses on the attitudes to and depictions of ‘good' and ‘bad' deaths. Moreover, the thesis addresses the intersection of the hagiographic inheritance with discernibly Anglo-Saxon attitudes towards death and dying, and investigates whether or not the deaths of native Anglo-Saxon saints are presented differently compared with the deaths of universal saints. The thesis explores continuities and discontinuities in the presentations of physical and spiritual death, and assesses whether or not differences exist in the depiction of death-scenes based on an author's personal agenda, choice of terminology, approaches towards the body–soul dichotomy, or the gender of his or her subject, for example. Furthermore, the thesis investigates how hagiographic representations of death compare with portrayals in other literature of the Anglo-Saxon period, and whether any non-hagiographic paradigms provide alternative exemplars of the ‘good death'. The thesis also assesses gendered portrayals of death, the portrayal of last words in saints' lives, and the various motifs relating to the soul at the moment of death. The thesis contains a Motif Index of saintly death-scenes as Appendix I.

Enjeux éthiques de la fin de vie dans la médecine moderne et traditionnelle : cas du Gabon. Si la médecine moderne héritée de la Colonisation, est parvenue à s'établir au Gabon, elle n'a néanmoins pas éclipsé totalement la médecine traditionnelle héritée des Ancêtres. Deux héritages cohabitent ainsi chaque jour à la faveur des personnes en quête de soin de plus en plus croissante. Quelle est leur efficace ? La médecine moderne et la médecine traditionnelle ont-elles les moyens suffisants de venir à bout de toutes les maladies, de toutes les souffrances qui rongent notre humanité ? Comment réagissent-elles quand elles ne peuvent plus pouvoir ? Comment construisent-elles la relation de soin ? Est-ce que le statut de celui qu'on appelle « mourant » ou malade en fin de vie signe la fin de l'humanité ou le commencement de celle-ci ? Y a-t-il une fatalité à la condition de mourant, ou, la fin de vie traduit-elle l'idée d'une fin inéluctable de toute vie ? Ce sont les questions que cette thèse traite de bout en bout à partir d'un seul angle d'attaque : l'éthique. Autrefois considérée comme étude des vertus, doctrine de la vertu ou encore comme une « métaphysique des mœurs » qui se réservait le droit de postuler les principes devant régir la vie de la communauté humaine au-delà des valeurs culturelles et des positions idéologiques, l'éthique sur la base de laquelle prend ancrage ce travail est une réflexion philosophique sur la condition humaine. Cette éthique répond à la question socratique « qu'est-ce que l'homme ? », et répond qu'il est tout être vivant devant le visage duquel nul ne peut se dérober, et qui, de surcroît, interdit le meurtre. Cette éthique à visage humain est celle de la fin de vie par quoi chacun est confronté au regard de l'Autre homme, qui se retrouve accablé par l'existence dans la situation de la maladie mortelle, de la souffrance qui atteint son être et de la douleur qui maltraite sa chair. Cette éthique est celle de la relation de deux êtres : l'un qui est en demande de soin et l'exprime au travers de l'Appel, et l'autre qui est en capacité d'offrir ce soin par son savoir et son savoir-faire, et qui Répond à cet Appel en disant : me voici ! Cette éthique à visage humain renvoie chacun à lui-même, à sa propre condition de mortel à partir de l'épreuve de l'Autre en tant que mourant. Dès lors, chacun est confronté à l'idée que la médiation instaurée par le visage du mourant n'est pas donnée, mais est à construire. Par quoi l'éthique de la fin de vie dégage l'horizon d'une philosophie de la réflexion où c'est Autrui qui me donne à être. / The stakes of ethics at the end of life in modern and traditional medicine : A case study of Gabon.Though the colonization inherited modern medicine has successfully been established in Gabon, it has, nonetheless, not completely eclipsed the traditional medicine derived from the ancestors .Therefore, two legacies coexist day by day in order to cater to an ever increasing number of people seeking health care. How effective are they? Does either type of medicine have substantial means to come to term with all the illnesses and sufferings that plague mankind? What happens when they could no longer provide treatment? How do they develop health care relation? Does the case of the so-called "dying person" or rather, terminally ill patient mark the end of humanity or does it represent the beginning of this one? Is the dying person doomed or does death means an inescapable end of any kind of life? These are the questions that this dissertation thoroughly addresses upon the basis of one point : Ethics. It was formerly known as the study of virtue, the doctrine of virtue, or best yet "metaphysics of morals". Ethics was entitled to postulate principles aimed to rule human community life beyond human values and ideological stances. Ethics from this thesis' perspective is based upon a philosophical theory concerned about human condition. It is an answer to a the following Socratic question :" What is Mankind?" The answer being that he's every human being in the face of whom no one can escape and who, moreover, forbids murder. It's ethics with a human face; when at the end of life each person will have to come face to face with the other when they are fatally ill, and experiencing sufferings and pain to the core of their being. This ethics epitomizes the relationship between two beings : One who is seeking treatment and expresses it through a call, while the other is able to provide that treatment through his awareness and expertise. He responds to that call by saying : Here I am. Ethics with a human face takes every one back to their true selves; to their own mortal condition thanks to the ordeal of the other as a dying person. As a result, everyone will have to grapple with the idea of mediation instilled in them by the face of the dying person is not given but built. Ethics of the end of life gives way to a wide array of philosophical thought where it is the other that gives me life.

6 ABSTRACT This thesis aims to provide information about the p rinciples of the care for the seriously ill, the dying, and the berieved in the context of the R oman-Catholic Church's pastoral activies. The theoretical section deals with the death from t he Bible's perspective, then with the death as well as the care for the berieved from the pasto ral point of view, and finally with the most suitable approach towards the individuals. In the p ractical part of the thesis, I assess the questionnaire that explores priests' and candidates ' for priesthood attitudes towards the matter of death and dying. The method is the literature an d primary sources analysis and questionnaires, which were used in my own research while collecting concrete experience Powered by TCPDF (www.tcpdf.org)

This thesis is devoted to the topic of palliative care in nursing, particularly for the elderly. The theoretical part deals with basic issues of palliative care for the elderly, defines palliative care and its organizational forms,dealing with the basic principles of palliative care topics of gerontologic care. The attention is paid to the competencies of the nursing team to perform palliative care for geriatric patients as well. The research deals with finding out the level of workers' skills in the field of palliative care, and then it defines the forms ofhealthcare professionals aid in how to approach the matter of dying, and how to cope with the cause of clients death.

Student Number : 7916069 - MA research report - School of Human and Community Development - Faculty of Humanities / This qualitative study set out to explore the idea of a good death through in-depth interviews with six terminally ill patients with cancer aged between thirty-seven and fifty-two, in other words in mid-life. Thematic content analysis was used to examine overt and covert themes revealed in semi-structured interviews that had been transcribed verbatim. Significant fear of dying was revealed and although respondents did not seem to have a conscious idea of a good death, they had a clear concept of good dying. Two key components of good dying were not being in pain or distress from physical symptoms, and wanting to drift off into a final “sleep” rather than being fully alert until the end. It was noticeable that, whether or not patients had religious convictions, relatively little attention appeared to be paid directly to what might or might not follow the moment of death itself, for example an afterlife. Preparation for good dying included completing a will, sorting out financial affairs and, for some patients, planning a funeral. At times this preparation also included trying to mend conflicted relationships and make plans for the ongoing care of family members. It is postulated that these preparations helped re-constitute a sense of order that had been shattered by the chaos of being declared terminally ill at a time of life when this was non-normative. Moreover, taking care of practical needs re-established a sense of agency, helped achieve some sense of closure and symbolised a measure of acceptance of their dying status. Respondents did not seem to experience external pressure from others to die in a certain way, although two people were particularly aware of their influence on how others in the family felt and thus tended to pretend to feel better than they did.

O presente estudo teve como objetivo analisar o conceito de cuidados paliativos expresso na literatura das áreas de Enfermagem, Medicina, Psicologia e Bioética. A busca das publicações foi feita por acesso a base de dados LILACS, BDENF, AdSaude, todos pertencentes aos sites da Biblioteca Virtual em Saúde do Centro de Documentação Latino Americano e do Caribe em Ciências da Saúde (BIREME); no Banco de Dados Bibliográficos da USP – DEDALUS e no Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES; busca manual em tese, livros e artigos publicados sobre o assunto, no período de 1991 a 2002. Utilizou-se a análise de conceito na perspectiva evolucionária de Rodgers (2000), destacando os atributos essenciais, eventos antecedentes, eventos conseqüentes, termos substitutos e a apresentação de um caso modelo, elementos que constituem o cerne do conceito a ser analisado. Como resultados obteve-se que: os cuidados paliativos são expressos pelas características de assistência integral do ser humano; controle da dor crônica oncológica; equipe interdisciplinar; morte como processo natural: preparo do paciente para a morte; autonomia e ortotanásia; alívio do sofrimento; cenários de atendimento: hospital e domicílio; comunicação franca e honesta, e visa o cuidado e não a cura. Dentre os eventos antecedentes foram descritos: o paciente terminal; o sofrimento psicológico, espiritual, social e físico; o câncer e outras doenças crônicas; despreparo profissional e barreira cultural. Os eventos conseqüentes foram relacionados a: qualidade de vida; morte digna; formação profissional e criação de serviços e núcleos em cuidados paliativos. Identificou-se como termos substitutos o “hospice" e a medicina paliativa. Concluiu-se que o conceito de cuidados paliativos é uma construção complexa de elementos, dentre os quais destaca-se a assistência integral do ser humano fora de possibilidade de cura (unidade de cuidado paciente–família); cujo paradigma é o cuidado e não a cura; que prioriza o alívio da dor crônica, controlada por equipe interdisciplinar capacitada, que preserva a autonomia do paciente e proporciona a ortotanásia, aliviando o sofrimento da unidade de cuidado, seja no domicílio ou hospital, por meio de uma comunicação franca e honesta entre paciente, família e equipe; no preparo do paciente e familiar para a morte digna, tendo-a como um processo natural, visando enfim, a qualidade de vida. / The aim of this study was to analyze the concept of palliative care on Nursing, Medicine, Psychology and Bioethics literature. The search for publications was done based on LILACS, BDENF and Adsaude data bases concerning the sites of the Health Virtual Library Documentation in Health Sciences of Latin America and Caribbean (BIREME); on DEDALUS – the University of São Paulo Bibliographic Data Base, and on CAPES – Superior Level Personnel Improvement Coordination Portal; on thesis, books and non-published articles about the theme from 1991 to 2002. The concept analysis was based on Rodgers (2000) evolutionary perspective, pointing out the basic attributes, previous events, consequential events, substitute terms and the presentation of a model case, which compose the core of the concept to be analyzed. As a result it was found out that the palliative care are expressed by characteristics such as the holistic care of human being; chronic pain control in oncology; interdisciplinary team; death as a natural process; patient and family preparation for death; suffering relief; autonomy and ortotanasia; care settings; hospital and home; honest and sincere communication; with the aim of caring and not cure. Among the previous events it was pointed out: terminal patient; the psychological, spiritual, social and physical suffering; cancer and other chronic diseases; unprepared professional and cultural barriers. The consequential events were related to life quality; peaceful death; professional education and the creation of palliative care services. Hospice and palliative medicine were identified as substitute terms for palliative care. Is was highlighted the holistic care for human being with no cure possibility (patient-family care unity); the paradigm is caring and not cure; the priority is chronic pain relief which is controlled by interdisciplinary trained team; patient autonomy is preserved, providing ortothanasia and relieving the care unity suffering either at home of in hospital by means of honest and sincere communication among patient, family and team; patient and family are prepared for a peaceful death, considering this a natural process and taking into account the quality of life.

Bakgrund: Vård i livets slut syftar till att förebygga och lindra lidande. Idag lever människor allt längre vilket resulterar i att behovet av palliativ vård och vård i livets slut ökar. Det kan upplevas som utmanande att vårda en döende patient eftersom denna vårdform fortfarande kan vara främmande för många sjuksköterskor. Syfte: Litteraturöversiktens syfte är att sammanställa forskningsbaserad kunskap om vad som kan påverka sjuksköterskans erfarenheter av vård i livets slut för patienten på en somatisk vårdavdelning.  Metod: Studien genomfördes som en litteraturöversikt som baserades på 15 vetenskapliga artiklar, varav tolv kvalitativa och tre kvantitativa. Artiklarna söktes fram via databaserna i PubMed och CINAHL. Resultat: Huvudresultatet som identifierades i studien var kompetens, utmaningar och vårdens resurser. Otillräcklig kompetens hos sjuksköterskor framkom, likaså att mer utbildning behövdes på grund av bristande kunskapen hos sjuksköterskor på somatiska vårdavdelningar när det gällde vård i livets slut. Sjuksköterskor som fått utbildning inom området upplevde det lättare och kände sig tryggare med att vårda döende patienter. Det framkom behov av att utveckla detta område i den grundläggande sjuksköterskeutbildningen. Kommunikation, som till exempel att bygga förtroende och sjuksköterskans förmåga att uttrycka sig, var viktiga faktorer. Sjuksköterskor tyckte att det var utmanande att få ett förtroende från patientens närstående.  Slutsats: Sjuksköterskans kunskap har i resultatet visats vara viktigt och behovet av utbildning och fortbildning har varit tydligt framträdande. Med den sjuksköterskebrist som råder behövs fler sjuksköterskor med rätt kunskap. Utbildning och praktiska erfarenheter kan bidra till att sjuksköterskor känner sig trygga i rollen att vårda döende patienter samt att kommunicera med dem och deras närstående. / Background: Palliative care and end-of-life care aims to prevent and relief suffering. Today people live longer which shows an increased care of dying patients. It can be expressed as challenging to care for a dying patient since this form of care still can be foreign to many nurses. Aim: The purpose of this literature review was to compile research-based knowledge of things that can affect the nurse's experiences of care in the end of life for the patient in a somatic hospital setting. Method: The study was conducted as a literature review which was based on twelve qualitative and three quantitative studies. The results were based on scientific articles that were found in databases such as PubMed and Cinahl.  Results: The main result that was identified in the study was competence, challenges and resources of care. Nurses had a lack of knowledge when caring for dying patients in a somatic hospital setting. The competence was inadequate and it appeared that there was a need of more education and the basic nursing education needs to be further developed in end of life care. Nurses who received education in end of life care were more safe caring for dying patients. Communication, for example building trust and the nurse’s ability to express themselves, were important factors. Nurses thought it was challenging to earn trust from the patient's relatives. Conclusion: The results have shown that the nurse's knowledge is important and the need for education and training has been clearly prominent. Today there is a lack of nurses and there is a need for more nurses with the right knowledge. Education and practical experience can help the nurses feeling safer in the role of caring for dying patients and communicating with them and their relatives.