This thesis explores the access of care for the terminally ill in hospitals from 1945 until present. Issue include humane access to medics and nurses for terminally ill patients, and focus on the changes in care over time. The focus of exploration is palliative care in hospitals, awareness of palliative care, and the education of medics and nurses in this domain. Studies of postwar information is an integral part of this thesis's empirical research. This thesis deals with death as a taboo of modern society, and aspects of experiences of the terminally ill in last phase of life. The postwar period has emphasized spirituality, but the quality of care in the hospitals has worsened over time. After 1948, in the period of real socialism, there has been a measured deficit of psychological and spiritual support, less involvement from sanitary personnel, but a measured increase from the support of families. The present has put emphases on expertise, but there is less family cohesion and space for family care. The growing bureaucracy of sanitary care, and in general, more serious cases, has led to the work becoming harder.

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 diploma thesis deals with practical ethical issues in specialized mobile palliative care. First of all the terms necessary for understanding the context are explained. Than brief introduction to the legal order and the principles of palliative care in the Czech Republic follows. Diploma thesis summarizes the phases of coping with the disease and the loss of a close person. This is both from adult's and a child's point of view. Next section deals with spiritual and pastoral care of dying, four principles of medical ethics and informed consent. Based on an interview with MUDr. Irena Závadová, supported by specialized literature, the ethical issues and theire possible solutions are mentioned too. This thesis deals with ethical issues as follows: awareness of diagnosis education system in palliative care development of palliative care in hospital facilities opiatophobia antibiotics in palliative and hospice care proxy decision making in a patient with dementia alternative forms of nutrition palliative sedation transfusion in palliative/hospice care Keywords Home hospic, dying, death, specialized mobile palliative care, ethical dilemmas.

This diploma thesis deals with practical ethical issues in specialized mobile palliative care. First of all the terms necessary for understanding the context are explained. History of palliative care. Than introduction to the legal order and the principles of palliative care in the Czech Republic follows. Diploma thesis summarizes the phases of coping with the disease and the loss of a close person. This is both from adult's and a child's point of view. Next section deals with spiritual and pastoral care of dying, four principles of medical ethics and informed consent. Based on an interview with MUDr. Irena Závadová, supported by specialized literature, the ethical issues and theire possible solutions are mentioned too. This thesis deals with ethical issues as follows: education system in palliative care controversial interpretation of the law n. 372/2011 opiatophobia antibiotics in palliative and hospice care nutrition in palliative care palliative sedation transfusion in palliative/hospice care autonomy patient with dementia Keywords Home hospic, dying, death, specialized mobile palliative care, ethical dilemmas.

Bakgrund: Det finns ett uttalat behov av att samtala om döden vid livets slut, hos både patienter och anhöriga. Behovet varierar i omfattning och kan innehålla så väl existentiella frågor, som praktiska göromål kring begravningen. Genom att prata om döden kan patienternas oro minskas och vården i livets slut kan bli mer personcentrerad. Sjuksköterskans uppgift är inte enbart att vårda patienten fysiskt, utan även se till patientens psykiska tillstånd, vilket kan ske exempelvis med samtal. Ur ett omvårdnadsperspektiv är det intressant att veta hur vårdpersonalen upplever dessa samtal, om de präglas av vårdpersonalens egna inställningar till döden, eller om de fokuserar på patientens behov och den personcentrerade vården. Syfte: Syftet med litteraturstudien var att undersöka hur vårdpersonalupplever samtal om döden med patienter nära livets slut. Metod: Arbetet genomfördes som en kvalitativ litteraturstudie baserad på 12 vetenskapliga studier. Resultat: Vårdpersonals upplevelser av samtal om döden fördelades på tre huvudteman; Vårdpersonalen undviker samtal om döden med patienter, Vårdpersonalen vill säga sanningen till patienterna, Samtal om döden kräver balans och timing. Konklusion: Vårdpersonal upplever samtal om döden som svåra, på grund av tids- och kompetensbrist och undviker dem ofta. De upplever att undvika samtal om döden kortsiktigt kan skydda patienten från stress och oro, men för att ge personcentrerad vård måste vårdpersonal involvera patienten. Efterhand samlar vårdpersonalen erfarenhet i yrket, men utbildning i ämnet krävs för att även nyutexaminerade sjuksköterskor ska känna sig trygga i samtal omdöden med patienter och hitta balans i när dessa bör ske. / Background: Patients and relatives express a need to talk about death at the end of life. This includes both existential issues and practical tasks like funeral arrangements. Allowed talking about death, patients' worries can be reduced and end of life care more person-centred. The nurse's task is to take care of the patient including the patient's mental state, as through conversations. From a nursing perspective, it is interesting to learn how health personnel experience these conversations, if they are characterized by staff attitudes towards death, or focused on patient needs and person-centred care. Aim: To investigate how health personnel experience conversations about death, with patients near the end of life. Method: A qualitative literature study based on 12 scientific studies. Results: Health personnel’s experiences of conversations about death were divided into three main themes; The health personnel avoid conversations about death with patients, The health personnel want to tell the truth to the patients, Conversations about death require balance and timing. Conclusion: Health personnel experience conversations about death as difficult, due to lack of time and skills and prefer to avoid them. They experience avoiding conversations about death can protect the patient in the short term from stress and anxiety, but toprovide person-centered care, health personnel must involve the patient. Gradually, the health personnel gathers experience in the profession, but training in the subject is required so that even newly graduated nurses can feel safe in conversations about death with patients, and find balance in when these should take place.

This thesis describes the life of a family with a dying child. The objective of the thesis is to describe the experience of its members after the diagnosis has been decided, during treatment and after the child's decease. It discusses the phases of going through the disease and death of one's own child for the parents and other close persons and how such a critical event in a family's life changes its values and attitudes. The theoretical part of this thesis deals with experiencing of all stages of the child's disease by their closest persons and with the psychology of the ill child. In this context, it briefly describes the history and idea of care of the incurably ill and the possibility of family support provided by non- governmental organizations. The practical part of the thesis contains the findings of the qualitative research conducted using the phenomenology approach on how the parents supported the child in the terminal stage of their disease, what they went through during this difficult time of life and how they remember that time after certain time has elapsed. Respondents include the parents or closest persons of children aged over one year that deceased as a result of a malignant disease.

Dilemmas in thanatology in the 21st century In the thesis "Dilemmas in thanatology in the 21st century" I focused on the definition of the contradictory questions about the end of human life. I found that most of the respondents of different age groups, who were involved in the care process and responded to the questionnaire, are acquainted with the issue of thanatology. They assess this issue as emotionally challenging, difficult and professionally untreated. In addition, I investigated the needs of helping professions in the issue of communication barriers in the topic of death and dying. I came to the conclusion that communication on this subject is displaced, missing training and there is a lack of the literature on this topic. Due to the unrepresentativeness of the survey I assess the result obtained only as the orientation indicator according to the issue under the investigation. This result rather opens up further contradictory questions in the thanatology.

This audio documentary explores the contemporary landscape of death and dying with specific focus on caregiving, the process of cultivating personal death value systems, and the importance of intergenerational exchange for fostering inquiry and acceptance of the aging process. The audio thesis is fluidly presented in three parts, with an accompanying annotation to be read after listening. For the sake of textual clarity, the annotation is separated into chapters. Chapter I explores hospice care and the complexities of the dying process, leading the listener to consider what it is like to work professionally in the field of end-of-life care. Chapter II explores implications of highly technological medical care and advancements in health sciences. Finally, Chapter III implicitly suggests through personal narrative that embodied experiences of caregiving and intergenerational exchange create spaces that subvert cultural and temporal fears of aging and the dying process.

This audio documentary explores the contemporary landscape of death and dying with specific focus on caregiving, the process of cultivating personal death value systems, and the importance of intergenerational exchange for fostering inquiry and acceptance of the aging process. The audio thesis is fluidly presented in three parts, with an accompanying annotation to be read after listening. For the sake of textual clarity, the annotation is separated into chapters. Chapter I explores hospice care and the complexities of the dying process, leading the listener to consider what it is like to work professionally in the field of end-of-life care. Chapter II explores implications of highly technological medical care and advancements in health sciences. Finally, Chapter III implicitly suggests through personal narrative that embodied experiences of caregiving and intergenerational exchange create spaces that subvert cultural and temporal fears of aging and the dying process.

The thesis is dealing with ethical aspects of the end of human existence. The first part of this work is focused on the issues of dying and death, especially in the understanding and development of death at the time. The process of dying, along with changes in the history of death brings with it certain ethical and moral issues that are further specified. Subsequently the thesis covers palliative care and its ethical principles. The final section presents an ethical problem and dilemmatic situations that workers in hospice facility may confront. It focuses on ethical decisions and actions of workers.