And a Time to Die: How American Hospitals Shape the End of Life - Hardcover

Starred Review. 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." In a series of case studies, Kaufman (The Ageless Self: Sources of Meaning in Life), a professor of medical anthropology at UC–San Francisco, shows how hospitals, by focusing on life-saving treatments, can indefinitely prolong the life of the critically ill patient, who may drift into an indeterminate zone, suspended between life and death. "[D]ying has become a technical endeavor, a negotiated decision and a murky matter biologically," she notes. Writing with penetrating clarity and detached compassion, and with respect for hospital staff and families alike, Kaufman reveals the dilemmas of hospital death in America today: the shift to patients' control of decision making despite the doctors' greater knowledge; the ethics and practical effects of resuscitation versus pain relief; the complexities of assessing "quality of life" while guessing at the desires of an unconscious patient. Kaufman's unwavering account reveals a culture of clinical practice that seems to have trouble acknowledging the inevitability of death, and that moves awkwardly from curative to palliative treatment. This deeply probing study lays bare the cultural and institutional assumptions and rhetoric that frame our search for "a good death."
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