And A Time To Die: How American Hospitals Shape The End Of Life

Paperback | September 15, 2006

bySharon R. Kaufman

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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

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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...

Sharon R. Kaufman is professor of medical anthropology in the Department of Anthropology, History, and Social Medicine; at the Institute for Health & Aging; and in the Department of Social and Behavioral Sciences at the University of California, San Francisco. She is the author of The Ageless Self and The Healer’s Tale.

other books by Sharon R. Kaufman

Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line
Ordinary Medicine: Extraordinary Treatments, Longer Liv...

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Format:PaperbackDimensions:412 pages, 9 × 6 × 1 inPublished:September 15, 2006Publisher:University Of Chicago PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0226426858

ISBN - 13:9780226426853

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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

Editorial Reviews

"Through 27 compelling narratives, [the author] describes with uncanny accuracy and a gift for vivid detail the complex and often troubled dance that patients, families, physicians, nurses, and hospitals engage in as death nears. The book illuminates the central dilemma of dying in contemporary hospital culture."