And a Time to Die
How American Hospitals Shape the End of Life
9780226426853
And a Time to Die
How American Hospitals Shape the End of Life
Over the past thirty years, the way Americans experience death has been dramatically altered. The advent of medical technology capable of sustaining life without restoring health has changed where, when, and how we die. In this revelatory study, medical anthropologist Sharon R. Kaufman examines the powerful center of those changes: the hospital, where most Americans die today. She deftly links the experiences of patients and families, the work of hospital staff, and the ramifications of institutional bureaucracy to show the invisible power of the hospital system in shaping death and our individual experience of it. In doing so, Kaufman also speaks to the ways we understand what it means to be human and to be alive.
“An act of courage and a public service.”—San Francisco Chronicle
“This beautifully synthesized and disquieting account of how hospital patients die melds disciplined description with acute analysis, incorporating the voices of doctors, nurses, social workers, and patients in a provocative analysis of the modern American quest for a ‘good death.’”—Publishers Weekly
“Kaufman exposes the bureaucratic and ethical quandaries that hover over the modern deathbed.”—Psychology Today
“Kaufman’s analysis illuminates the complexity of the care of critically ill and dying patients [and] the ambiguity of slogans such as ‘death with dignity,’ ‘quality of life,’ and ‘stopping life support.’ . . . Thought-provoking reading for everyone contemplating the fate of us all.”—New England Journal of Medicine
“An act of courage and a public service.”—San Francisco Chronicle
“This beautifully synthesized and disquieting account of how hospital patients die melds disciplined description with acute analysis, incorporating the voices of doctors, nurses, social workers, and patients in a provocative analysis of the modern American quest for a ‘good death.’”—Publishers Weekly
“Kaufman exposes the bureaucratic and ethical quandaries that hover over the modern deathbed.”—Psychology Today
“Kaufman’s analysis illuminates the complexity of the care of critically ill and dying patients [and] the ambiguity of slogans such as ‘death with dignity,’ ‘quality of life,’ and ‘stopping life support.’ . . . Thought-provoking reading for everyone contemplating the fate of us all.”—New England Journal of Medicine
Reviews
Table of Contents
Introduction 1
PART I
THE PREDICAMENT: DEATH BECOMES A NEW KIND OF PROBLEM 21
1. Death and Hospital Culture
2. Death in Life: The "Person" and the Experience of Dying
PART II
THE HOSPITAL SYSTEM: TIME AND THE POWER OF THE PATHWAY 85
3. Transforming Time: From Deathwatch to Billable Treatments 89
4. Moving Things Along 95
I. The Heroic Intervention Pathway 104
II. The Paradox of Resuscitation: Approach/Avoidance on the Heroic Pathway 116
III. The Revolving Door Pathway 131
5. Waiting 147
I. Obstructing the Order of Things 152
II. "Let’s Wait and See": The Indeterminate Condition of Old Age 177
III. Agreement and Anticipation: Watchful Waiting 190
PART III
THE POLITICS AND RHETORIC OF THE PATIENT’S CONDITION: "SUFFERING," "DIGNITY," AND "THE QUALITY OF LIFE" 203
6. Death by Design 207
7. Life Support 236
8. Hidden Places: The Zone of Indistinction as a Way of Life 273
I. The Specialized Unit: Routines Without Pathways, Life with No End 275
II. The Shadow Side of "Death with Dignity"
9. Culture in the Making
Appendix A. About the Research
Appendix B. A Note on Diversity
Notes
Bibliography
Acknowledgements
Credits
Index
PART I
THE PREDICAMENT: DEATH BECOMES A NEW KIND OF PROBLEM 21
1. Death and Hospital Culture
2. Death in Life: The "Person" and the Experience of Dying
PART II
THE HOSPITAL SYSTEM: TIME AND THE POWER OF THE PATHWAY 85
3. Transforming Time: From Deathwatch to Billable Treatments 89
4. Moving Things Along 95
I. The Heroic Intervention Pathway 104
II. The Paradox of Resuscitation: Approach/Avoidance on the Heroic Pathway 116
III. The Revolving Door Pathway 131
5. Waiting 147
I. Obstructing the Order of Things 152
II. "Let’s Wait and See": The Indeterminate Condition of Old Age 177
III. Agreement and Anticipation: Watchful Waiting 190
PART III
THE POLITICS AND RHETORIC OF THE PATIENT’S CONDITION: "SUFFERING," "DIGNITY," AND "THE QUALITY OF LIFE" 203
6. Death by Design 207
7. Life Support 236
8. Hidden Places: The Zone of Indistinction as a Way of Life 273
I. The Specialized Unit: Routines Without Pathways, Life with No End 275
II. The Shadow Side of "Death with Dignity"
9. Culture in the Making
Appendix A. About the Research
Appendix B. A Note on Diversity
Notes
Bibliography
Acknowledgements
Credits
Index