Bakgrund: Döendet är en normal process som ingen kan undkomma. Centralt i den palliativa omvårdnaden är respekten för patientens autonomi och självbestämmande. Upplevelserna av livskvalitet är starkt förenat med existentiellt välbefinnande. Det går inte lindra allt lidande endast det väsentliga i omvårdnaden går att lindra. För att främja en god kommunikation vid livet slut bör den vara hoppingivande och stödjande. Syfte: Syftet var att beskriva patienters upplevelser av sin sista tid i livet. Metod: En kvalitativ studie med narrativ ansats valdes som metod, datamaterialet baserades på sju självbiografier. Resultat: Ur analysen framträdde fyra kategorier: Ett annat synsätt på livet, Det svåra i att vara sjuk, Som patient få utöva egen vilja, Önskan att bevara livskvalitet med elva underkategorier. Konklusion: Ett annat synsätt på livet fås vid det ofattbara beskedet. Det svåra med att vara obotligt sjuk var fysiska symtom och skuldkänslor. Att bli sedd och den egna viljan prioriterades och önskan att bevara livskvalitet fanns. / Background: Death is a normal process from which there are no exceptions. Central aspects of palliative care is to respect the patients autonomy and right to make own decisions. How patients experience their quality of life is strongly associated to their existential wellbeing. It is not possible to ease all suffering, only those parts that are connected to the treatment. To be able to promote a good communication at the end of life is it necessary that it’s encouraging and supportive. Aim: The purpose of this thesis was to describe patients reported experiences as their life came to an end. Methods: A qualitative study with narrative approach was chosen as method, seven self-biographies were included. Results: Four categories emerged: Another perspective on life, The difficulties of being ill, As patient exercise own will, and The desire to retain life-quality with eleven subcategories. Conclusions: Another approach to life is obtained when the unimaginable news is notified. The difficultness about being terminally ill was physical symptoms and feelings of guilt. To be seen and their own will was a priority and the desire to preserve the quality of life.

Bakgrund: Människor som lever med obotlig sjukdom i livets slutskede kan leva med en hotad existens. I dessa fall kan palliativ vård vara en lämplig form av vård. Livskvalitet är ett sätt att mäta individers välbefinnande och påverkas av stöd. Stöd uppfattas som positivt när det sker motgångar i livet. Den subjektiva levda kroppen är där existensen lever genom och kan förändras på grund av sjukdom, då kan även existensen hotas. Sjuksköterskor behöver både stöd och kunskap inom den palliativa vården för att de ska känna trygghet i sitt arbete. Syfte: Beskriva patienters upplevelser av att leva med en obotlig sjukdom i livets slutskede. Metod: En kvalitativ innebördsanalys med sex stycken självbiografier användes för att svara på syftet. Resultat: Fyra teman framkom dessa var; Stöd kan underlätta sorgen, Att välja livskvalitet trots sjukdom, När kroppen inte är som förr och Förändrad syn på livet och döden. Diskussion: Stöd är inte endast en viktig aspekt för personer som lever med en obotlig sjukdom i livets slutskede, det är också viktigt för anhöriga och närstående. Sjuksköterskor behöver känna stöd från sina kollegor för att kunna utföra en så god vård som möjligt. Slutsats: Personer som lever med oboltig sjukdom kan få en förändrad livssyn då livet prioteras på ett sätt som det tidigare inte gjorts. / Background: People, who are living with incurable diseases, can be living with threatening existence. In these cases, palliative care can be an appropriate form of care. Quality of life is a way to measure individual’s well-being, and is affected by received support. Support is perceived as a positive influencer when people are faced with setbacks in life. The subjective lived body is where the existence lives through and may change due to illness, and then even existence is threatened. Nurses need both support and knowledge in the field of palliative care to feel confident in their work. Purpose: The purpose of this thesis is to investigate the patients’ experiences of living with an incurable disease in end life care. Method: In this thesis a qualitative meaning analysis is used. Six autobiographies are used to answer the purpose. Result: Four different themes were identified. They are; support can overcome the grief; Too choose life quality over sickness; When the body is not like it used to be; and lastly, a changed perception on life and death. Discussion: Support is not only important for the patient living with an incurable disease, but also for relatives and friends. Nurses need support from their colleagues so they can give the best care possible. Implication: People living with an incurable diseases can have a changed sight of life, when life portieres different than before.

Este estudo teve como objetivos conhecer a percepção dos enfermeiros a respeito das competências inerentes à sua função quanto assistir as famílias de pacientes fora de possibilidades terapêuticas; identificar como os enfermeiros assistem as famílias de pacientes fora de possibilidades terapêuticas; identificar como esses enfermeiros têm desenvolvido suas habilidades para assistir as famílias diante do processo de perda iminente. A pesquisa foi realizada, utilizando a abordagem qualitativa, a técnica empregada foi o Discurso do Sujeito Coletivo que, segundo Lefèvre e Lefèvre (2003), possibilita a identificação e a construção de sujeitos e discursos coletivos distintos, por meio da análise de material individual e da extração das ideias centrais, compondo-se, com o conteúdo das ideias centrais semelhantes, discursos-síntese que expressam as representações sociais de uma coletividade (Silva, 2006). Os dados foram coletados por intermédio de entrevistas semiestruturadas, realizadas de março a maio de 2008, com 18 enfermeiros com experiência mínima de dois anos de atuação em Unidade de Terapia Intensiva (UTI) e atendimento a familiares de pacientes fora de possibilidades terapêuticas. O cenário do estudo foi um hospital privado de médio porte, localizado no Município de São Paulo. Da análise, foram apreendidos sete discursos; e as categorias foram qualificadas em função das competências que o enfermeiro deve adquirir para assistir as famílias de pacientes fora de possibilidades terapêuticas. Competências atitudinais relacionadas à preocupação com o cuidar da família: 1.Vínculo de confiança entre enfermeiro e família; 2. Sensibilidade para cuidar da família do paciente com prognóstico fechado; 3. Dor emocional da família. Competências atitudinais relacionadas a valores pessoais, éticos e religiosos: 1. Condutas do agir ético-profissional; 2. Apoio em sua espiritualidade ou religião. Competências atitudinais relacionadas ao desenvolvimento pessoal e profissional para cuidar da família: 1. Maturidade científica, emocional e espiritual; 2. Preparo profissional do enfermeiro para assistir a família. Os resultados demonstraram que os enfermeiros sentem dificuldades em assistir as famílias dos pacientes fora de possibilidades terapêuticas em sua dor e sofrimento. Estas dificuldades advêm desde a formação acadêmica, perpassando pelo acúmulo de atividades no cotidiano das Instituições de Saúde e reforçadas pela pouca discussão em relação às competências do enfermeiro em assistir essas famílias. Os profissionais mostraram-se abertos ao atendimento das demandas de cuidado dessas famílias e ressaltaram aspectos importantes para a construção e definição das competências em relação a esse cuidado / This study aimed to know the perception of nurses regarding competencies inherent to their function in the delivery of care to families of patients beyond cure; identify how nurses deliver care to these families; and how nurses have developed their abilities to care for these families in face of imminent death. This is a qualitative research and the Collective Subjective Discourse was the technique used. According to Lefèvre and Lefèvre this technique yields the identification and the construction of distinct subjects and collective discourses through the analysis of individual material and extraction of main ideas, which are composed with the content of similar main ideas, discourses-synthesis that express social representations of a group. Data were collected through semi-structured interviews carried out between March and May 2008 with 18 nurses with minimum experience of two years working in Intensive Care Units (ICU) and delivering care to families of incurable patients. The study setting was a medium size private hospital in Sao Paulo, SP, Brazil. Seven discourses emerged from the analysis. The categories were based on competences nurses should acquire to care for families of patients who are beyond cure. Attitudinal competences related to the responsibility of caring for the family: 1. Ties of trust between nurses and families; 2. Sensibility to care for families of incurable patients; 3. Families emotional pain. Attitudinal competence related to personal, ethical and religious values: 1. Ethical-professional conduct; 2. Support families spirituality and religion. Attitudinal competences related to personal and professional development to care for families: 1. Scientific, emotional and spiritual maturity; 2. Nurses professional experience to care for families. Results showed that nurses have difficulties in helping families of patients who are beyond cure to cope with their pain and suffering. These difficulties derive from their academic education, overload of activities in the routine of health institutions, and are reinforced by the lack of discussion on nurses competences necessary to care for these families. Professional are open to meet the care demands of these families and highlight important points for the construction and definition of competences related to this care

Este estudo teve como objetivos conhecer a percepção dos enfermeiros a respeito das competências inerentes à sua função quanto assistir as famílias de pacientes fora de possibilidades terapêuticas; identificar como os enfermeiros assistem as famílias de pacientes fora de possibilidades terapêuticas; identificar como esses enfermeiros têm desenvolvido suas habilidades para assistir as famílias diante do processo de perda iminente. A pesquisa foi realizada, utilizando a abordagem qualitativa, a técnica empregada foi o Discurso do Sujeito Coletivo que, segundo Lefèvre e Lefèvre (2003), possibilita a identificação e a construção de sujeitos e discursos coletivos distintos, por meio da análise de material individual e da extração das ideias centrais, compondo-se, com o conteúdo das ideias centrais semelhantes, discursos-síntese que expressam as representações sociais de uma coletividade (Silva, 2006). Os dados foram coletados por intermédio de entrevistas semiestruturadas, realizadas de março a maio de 2008, com 18 enfermeiros com experiência mínima de dois anos de atuação em Unidade de Terapia Intensiva (UTI) e atendimento a familiares de pacientes fora de possibilidades terapêuticas. O cenário do estudo foi um hospital privado de médio porte, localizado no Município de São Paulo. Da análise, foram apreendidos sete discursos; e as categorias foram qualificadas em função das competências que o enfermeiro deve adquirir para assistir as famílias de pacientes fora de possibilidades terapêuticas. Competências atitudinais relacionadas à preocupação com o cuidar da família: 1.Vínculo de confiança entre enfermeiro e família; 2. Sensibilidade para cuidar da família do paciente com prognóstico fechado; 3. Dor emocional da família. Competências atitudinais relacionadas a valores pessoais, éticos e religiosos: 1. Condutas do agir ético-profissional; 2. Apoio em sua espiritualidade ou religião. Competências atitudinais relacionadas ao desenvolvimento pessoal e profissional para cuidar da família: 1. Maturidade científica, emocional e espiritual; 2. Preparo profissional do enfermeiro para assistir a família. Os resultados demonstraram que os enfermeiros sentem dificuldades em assistir as famílias dos pacientes fora de possibilidades terapêuticas em sua dor e sofrimento. Estas dificuldades advêm desde a formação acadêmica, perpassando pelo acúmulo de atividades no cotidiano das Instituições de Saúde e reforçadas pela pouca discussão em relação às competências do enfermeiro em assistir essas famílias. Os profissionais mostraram-se abertos ao atendimento das demandas de cuidado dessas famílias e ressaltaram aspectos importantes para a construção e definição das competências em relação a esse cuidado / This study aimed to know the perception of nurses regarding competencies inherent to their function in the delivery of care to families of patients beyond cure; identify how nurses deliver care to these families; and how nurses have developed their abilities to care for these families in face of imminent death. This is a qualitative research and the Collective Subjective Discourse was the technique used. According to Lefèvre and Lefèvre this technique yields the identification and the construction of distinct subjects and collective discourses through the analysis of individual material and extraction of main ideas, which are composed with the content of similar main ideas, discourses-synthesis that express social representations of a group. Data were collected through semi-structured interviews carried out between March and May 2008 with 18 nurses with minimum experience of two years working in Intensive Care Units (ICU) and delivering care to families of incurable patients. The study setting was a medium size private hospital in Sao Paulo, SP, Brazil. Seven discourses emerged from the analysis. The categories were based on competences nurses should acquire to care for families of patients who are beyond cure. Attitudinal competences related to the responsibility of caring for the family: 1. Ties of trust between nurses and families; 2. Sensibility to care for families of incurable patients; 3. Families emotional pain. Attitudinal competence related to personal, ethical and religious values: 1. Ethical-professional conduct; 2. Support families spirituality and religion. Attitudinal competences related to personal and professional development to care for families: 1. Scientific, emotional and spiritual maturity; 2. Nurses professional experience to care for families. Results showed that nurses have difficulties in helping families of patients who are beyond cure to cope with their pain and suffering. These difficulties derive from their academic education, overload of activities in the routine of health institutions, and are reinforced by the lack of discussion on nurses competences necessary to care for these families. Professional are open to meet the care demands of these families and highlight important points for the construction and definition of competences related to this care

Introduktion: Den palliativa behandlingsfasen vid obotlig cancersjukdom har blivit längre. Cancerpatienters upplevelser och hantering av att leva med en obotlig sjukdom är relativt väl undersökt men för den som lever med en obotlig sjukdom och får palliativ cytostatika- behandlingen behöver upplevelsen av livssituationen belysas mer.  Syfte: Att beskriva patienters upplevelse av sin livssituation under palliativ cytostatika-behandling.   Metod: Detta är en systematisk litteraturöversikt av kvalitativa forskningsresultat som utgick ifrån intervjuer. De delar av studiernas resultat som mötte syftet analyserades med tematisk analys där både det latenta och manifesta innehållet tolkades.   Resultat: Sammanlagt analyserades 13 artiklar. I dessa deltog 213 personer, åldern 28-86 år med 20 olika cancerdiagnoser och relativt jämn könsfördelning. Resultatet inordnades under fyra teman: den fysiska, psykiska, sociala och existentiella/andliga dimensionen. Palliativ cytostatikabehandling, trots de problem den medförde, stod för hopp liksom förlängd överlevnad och kunde kontrasteras mot palliativ vård som förknippades med döden. Livet  omorganiserades, omvärderades och deltagarna fokuserade på att leva det liv som fanns kvar och befinna sig i nuet.   Slutsats:  Litteraturöversikten ger en inblick i hur patienter upplever och hanterar sin livssituation; betydelsen som cytostatikabehandlingen har, hur förloppet påverkar patienten liksom dennes starka fokusering på livet och nuet, vilket också inkluderar ett undvikande av att tänka eller samtala om döden eller att anslutas till palliativ vård. Resultatet kan ge stöd i samtalet med patienten och i kontakten med dennes livsvärld, då en förutsättning för god  patientcentrerad vård är att utgå ifrån patientens förutsättningar och prioriteringar. / Introduction: The palliative treatment phase for incurable cancer has become longer. Cancer patients' experiences and ways of living with incurable cancer are relatively well studied, but for those living with an incurable disease and receiving palliative chemotherapy treatment, their own experience of their life situation needs to be elucidated more. Aim: To describe patients' experience of their life situation during palliative chemotherapy. Method: This is a systematic literature review of qualitative research results that were based on interviews. A thematic analysis were used, both the latent and manifest content were interpreted. Result: A total of 13 articles were analyzed. These included 213 persons, aged 28-86 with 20 different types of cancer, men and women were fairly evenly represented. The result was organized into four themes: the physical, psychological, social and existential/spiritual dimension. Palliative chemotherapy, despite the problems it caused, stands for hope as well as extended survival in comparison with palliative care that they associated with death. Life was reorganized, re-evaluated and they focused on appreciating life. Conclusions: The literature review provides an insight into how these patients experience and manage their life; the importance of chemotherapy, how the current situation affects the patient, as well as their focus on life and the present, which also includes the avoidance of thinking or talking about death or being connected to a palliative care unit. The result can provide support in the conversation with the patient and in contact with his or her lifeworld.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente dissertação analisa a possibilidade da prática da eutanásia ativa e voluntária em pacientes com doenças incuráveis à luz da bioética e do direito. O trabalho é de natureza teórica e foi realizado através de pesquisa bibliográfica, que levantou publicações, nacionais e internacionais, inclusive na imprensa, sobre os temas tratados na dissertação, a saber: eutanásia, morte, vida, dignidade, autonomia, princípios bioéticos, liberdade. O levantamento bibliográfico compreendeu, preferencialmente, obras sobre filosofia, ética, bioética, medicina e direito, que permitiram a análise das questões teóricas envolvidas diretamente no estudo. Aborda-se o conceito de morte e suas transformações ao longo dos anos e as distinções necessárias entre os conceitos do fim da vida, que apesar de muito próximos tem suas especificidades. Apresenta-se os princípios bioéticos da não maleficência e da beneficência, com a finalidade de discutir os limites da intervenção médica sobre o paciente, bem como o princípio da autonomia na visão da bioética e do direito, com o intuito de demonstrar que o doente incurável é um ser autônomo, com vontades e desejos que devem ser respeitados. Examinam-se os direitos à vida e a liberdade para fins de ponderação em face do princípio da dignidade da pessoa humana. Diferenciam-se os princípios da sacralidade da vida e da qualidade da vida, na busca de uma integração entre eles e faz-se uma análise do Código de Ética Médica e da Resolução CFM n 1.805 de 2006, que autoriza a ortotanásia, para confrontar os limites da prática médica e da autonomia do paciente. Pontua-se o estado atual da criminalização da eutanásia no ordenamento jurídico brasileiro apontando-se o quão perversa pode se tornar essa criminalização para aquele que sofre e, que através da compaixão laica e da solidariedade deve-se buscar meios hábeis para se permitir a eutanásia, sem deixar de proteger os vulnerados de eventuais abusos. Utilizam-se os casos de Ramón Sampedro e Vincent Humbert, pessoas que por causa de um acidente ficaram tetraplégicas e solicitaram na justiça uma morte digna, para exemplificar os diversos conceitos utilizados nesse trabalho. Por fim, apresentam-se os requisitos pessoais e formais mínimos para que a declaração de vontade de um paciente incurável, que pede uma morte digna, seja respeitada, quando essa vontade é expressa de forma inequívoca por ele, tendo como exemplo, a legislação da Bélgica e da Holanda, onde a eutanásia é permitida observando-se determinados requisitos. / In the light of Bioethics and Law, this dissertation analyzes euthanasia, in its active and voluntary form, as a possibility to patients suffering from incurable diseases. Through a theoretical approach, this dissertation is based on a review of the current Brazilian and foreign literature, and also of what has been published in the media, in issues such as euthanasia, death, life, dignity, autonomy, Bioethics principles, freedom. A bibliography focused mainly on Philosophy, Ethics, Bioethics, Medicine and Law has contributed to better analyze the theoretical matters of this dissertation. Death, the transformations of its concepts along the years, the necessary differences among the concepts of end of life though their closeness and have their own specificities, are here approached. In order to discuss the limits of medical intervention to the patient, as well as the principle of autonomy in the light of Bioethics and of Law, principles such as non-maleficence and beneficence are here presented. We aim to demonstrate that, for the sake of autonomy, even the wishes of an incurable patient must be respected. The rights to life and to freedom are here examined, in order to consider the principle of the human dignity. Principles such as the sacredness of life and quality of life are, at first, differentiated, and are later reunited. The Code of Medical Ethics and the Resolution nr. 1805/2006, of the Brazilian Federal Council of Medicine which authorizes orthotanasia -, are analyzed in order to compare the limits to medical practice and the autonomy of the patient. Highlighting the current criminalization of euthanasia in Brazilian Law, we aim to demonstrate how perverse it is that criminalization to the suffering one. Through solidarity and the secular approach to compassion, we might also find the right means to legalize euthanasia, thus protecting the vulnerados from eventual abuses. The stories of Ramón Sampedro and Vincent Humbert persons that, suffering from tetraplegia due to an accident, have petitioned to superior Courts for their right to die with dignity - are examples of the different concepts here employed. Finally, having Belgium and the Netherlands as examples of States where euthanasia, under the compliance of some requirements, is authorized, we present the personal and minimal formal requirements to fully respect the unequivocal declaration of will made by an incurable patient.

No description available.

The theoretical part has six chapters: End of life and dying, Palliate care, Home hospice multidisciplinary team, Specific of care about a terminally ill patient in home background, Family and caregivers, Specifics of care about dying people in the CR. The second, practical part is based on qualitative-quantitative research with three goals. The first goal was to define the needs of family members caring about a terminally ill person in domestic background. The second goal was to define the skills of nurses necessary for saturation of the needs of family members caring about a terminally ill person in domestic background, and the last goal was to specify the present drawbacks of the care upon the research results. The following research questions were set in the qualitative part of the research: 1. What factors lead to decision of a family to participate in the care about a terminally ill person in domestic background? 2. What factors prevent families from integration into the care about a terminally ill person in domestic background? 3. What skills are necessary for a nurse in the process of family integration into the care about a terminally ill client in home background? The research sample of the qualitative research consisted of six respondents having experience with care about a dying patient in domestic background. A semi structured interview consisting of six questions was the research method of this part of the thesis. The questions focused on the care about a dying family member in home background. The following hypotheses may be deduced from the research: 1. Giving information to lay caregivers before releasing a terminally ill client to domestic treatment within education contributes to their active involvement in the care. 2. Participation of a mobile hospice team in the care about a terminally ill client in home background contributes to saturation of the needs of certainty and safety of the caregivers. The following hypotheses were set at the beginning of the quantitative research: 1. Respondent?s feeling of inability to participate in the care is an obstacle to the decision to start caring about a terminally ill person in home background. 2. Fear of economic risk is an obstacle to the decision to start caring about a terminally ill person in home background. 3. Utilization of professional services in the care about a terminally ill person in home background depends on awareness of their existence and the extent of services being provided. The research sample consisted of 198 persons from the wide public. The data were collected by means of a questionnaire. The questionnaires examined the readiness of the respondents to decide to start caring about a terminally ill person in home background and their awareness of the existence of institutions providing palliative care in home background. The first two hypotheses were confirmed by the results of the questionnaire research, the third one was not confirmed. A manual for general nurses ?Care about a dying client in home background? and an ?Informational leaflet for laics? deciding on caring about someone close in home background, which form a part hereof, were elaborated upon the results of the research.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A presente dissertação analisa a possibilidade da prática da eutanásia ativa e voluntária em pacientes com doenças incuráveis à luz da bioética e do direito. O trabalho é de natureza teórica e foi realizado através de pesquisa bibliográfica, que levantou publicações, nacionais e internacionais, inclusive na imprensa, sobre os temas tratados na dissertação, a saber: eutanásia, morte, vida, dignidade, autonomia, princípios bioéticos, liberdade. O levantamento bibliográfico compreendeu, preferencialmente, obras sobre filosofia, ética, bioética, medicina e direito, que permitiram a análise das questões teóricas envolvidas diretamente no estudo. Aborda-se o conceito de morte e suas transformações ao longo dos anos e as distinções necessárias entre os conceitos do fim da vida, que apesar de muito próximos tem suas especificidades. Apresenta-se os princípios bioéticos da não maleficência e da beneficência, com a finalidade de discutir os limites da intervenção médica sobre o paciente, bem como o princípio da autonomia na visão da bioética e do direito, com o intuito de demonstrar que o doente incurável é um ser autônomo, com vontades e desejos que devem ser respeitados. Examinam-se os direitos à vida e a liberdade para fins de ponderação em face do princípio da dignidade da pessoa humana. Diferenciam-se os princípios da sacralidade da vida e da qualidade da vida, na busca de uma integração entre eles e faz-se uma análise do Código de Ética Médica e da Resolução CFM n 1.805 de 2006, que autoriza a ortotanásia, para confrontar os limites da prática médica e da autonomia do paciente. Pontua-se o estado atual da criminalização da eutanásia no ordenamento jurídico brasileiro apontando-se o quão perversa pode se tornar essa criminalização para aquele que sofre e, que através da compaixão laica e da solidariedade deve-se buscar meios hábeis para se permitir a eutanásia, sem deixar de proteger os vulnerados de eventuais abusos. Utilizam-se os casos de Ramón Sampedro e Vincent Humbert, pessoas que por causa de um acidente ficaram tetraplégicas e solicitaram na justiça uma morte digna, para exemplificar os diversos conceitos utilizados nesse trabalho. Por fim, apresentam-se os requisitos pessoais e formais mínimos para que a declaração de vontade de um paciente incurável, que pede uma morte digna, seja respeitada, quando essa vontade é expressa de forma inequívoca por ele, tendo como exemplo, a legislação da Bélgica e da Holanda, onde a eutanásia é permitida observando-se determinados requisitos. / In the light of Bioethics and Law, this dissertation analyzes euthanasia, in its active and voluntary form, as a possibility to patients suffering from incurable diseases. Through a theoretical approach, this dissertation is based on a review of the current Brazilian and foreign literature, and also of what has been published in the media, in issues such as euthanasia, death, life, dignity, autonomy, Bioethics principles, freedom. A bibliography focused mainly on Philosophy, Ethics, Bioethics, Medicine and Law has contributed to better analyze the theoretical matters of this dissertation. Death, the transformations of its concepts along the years, the necessary differences among the concepts of end of life though their closeness and have their own specificities, are here approached. In order to discuss the limits of medical intervention to the patient, as well as the principle of autonomy in the light of Bioethics and of Law, principles such as non-maleficence and beneficence are here presented. We aim to demonstrate that, for the sake of autonomy, even the wishes of an incurable patient must be respected. The rights to life and to freedom are here examined, in order to consider the principle of the human dignity. Principles such as the sacredness of life and quality of life are, at first, differentiated, and are later reunited. The Code of Medical Ethics and the Resolution nr. 1805/2006, of the Brazilian Federal Council of Medicine which authorizes orthotanasia -, are analyzed in order to compare the limits to medical practice and the autonomy of the patient. Highlighting the current criminalization of euthanasia in Brazilian Law, we aim to demonstrate how perverse it is that criminalization to the suffering one. Through solidarity and the secular approach to compassion, we might also find the right means to legalize euthanasia, thus protecting the vulnerados from eventual abuses. The stories of Ramón Sampedro and Vincent Humbert persons that, suffering from tetraplegia due to an accident, have petitioned to superior Courts for their right to die with dignity - are examples of the different concepts here employed. Finally, having Belgium and the Netherlands as examples of States where euthanasia, under the compliance of some requirements, is authorized, we present the personal and minimal formal requirements to fully respect the unequivocal declaration of will made by an incurable patient.

In the theoretical part the terms hospice, home hospice care and palliative care are defined. History, principles, objectives and the concept of hospice care in the Czech Republic are mentioned. The phases of psychological responses to a serious illness undergone by a patient and the patients´ reaction to impending death are described. The traditional model of dying in the Czech Republic in the home environment, the gradual institutionalization and the taboos surrounding death, and the new inception of humane methods in the care for the dying after the year 1989 are particularized. The current types of hospice care in the Czech Republic and especially home hospice care are described in detail, and also the needs of the dying and those of their loved ones, which is the main topic of my thesis. The aim of this work is to survey the availability of palliative home care services in the Vysočina region, to compare the range of offered services, to map the users´ experience and to identify the risk factors in providing this care. In the realized qualitative research the availability of these services was surveyed through the content analysis of data by the technique of official documents and virtual data analysis. In order to map the users´ experience, managers of two agencies providing home hospice care in the town of Třebíč were addressed, as well as the users or their families to whom these agencies provide their services. The interview method, the technique of a semi-structured interview was used. There are eight providers of home hospice care in the Vysočina region. The Vysočina region supports not only home hospice care, but also supported the establishment of residential hospice services in the Long-Term Care Hospitals in three towns in the Vysočina region and the Palliative Care Department in the Jihlava hospital. These facilities have partially substituted a non-existent hospice in the Vysočina region. Hospice care in the Vysočina region is relatively new. It is necessary to get some experience and discover possible shortcomings. The complexity of the care for the seriously ill can be extended, which may enable the seriously ill patients to stay at home with their relatives as long as possible. Although home hospice care has its limits in terms of pain alleviation and complications resulting from a disease, the users´ experience is satisfactory and meets their expectations. The contribution of the thesis lies in uncovering deficiencies in home hospice care and the provision of identified information to the care providers and other health care workers, thus enhancing the awareness of this care among health professionals and family members of seriously ill patients.