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And a Time to Die: How American Hospitals Shape the End of Life, by Sharon 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
- Sales Rank: #526643 in Books
- Published on: 2006-09-15
- Released on: 2006-09-15
- Original language: English
- Number of items: 1
- Dimensions: 9.00" h x 1.00" w x 6.00" l, 1.22 pounds
- Binding: Paperback
- 412 pages
From Publishers Weekly
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."
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
From Booklist
Medical anthropologist Kaufman says that only within the last few hundred years has death become a medical concern. Previously, people looked upon death as a private, personal rite of passage that took place within the confines of the home and surrounded by one's loved ones: a spiritual journey. Enter the medical professional, who takes prolonging life--hence, delaying death--as a mission, and dying is transformed into a last gasp for hope, a medical failure. It gets worse. Only within the last half-century has the number of people who die in hospitals come to vastly outnumber that of those dying at home. Moreover, recent scientific research has only served to broaden and more often blur the definition of death and life. Death as a personal experience has pretty much been erased and instead has become an institutional nightmare, one contorted by hospital politics, "bureaucratic logic without logical purpose," and the law. Kaufman exposes, with all its complexities, the clash of dying patients and their families with the only institutional resources available to them. Donna Chavez
Copyright © American Library Association. All rights reserved
Review
“An act of courage and a public service.”
(San Francisco Chronicle)
“An outstanding, timely examination of how and why people die or are kept alive in U.S. society. . . . You finish the book with a sense that although the future remains unknown, you are at least better informed and perhaps better able to cope with the inevitable.”
(USA Today)
“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’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)
“This is ethnography at its best. . . . [The author's] quietly powerful book, which needs to be read by both family caregivers and medical professionals, belongs on the shelves of public, academic, and medical libraries.”
(Library Journal)
“Kaufman exposes the bureaucratic and ethical quandaries that hover over the modern deathbed.”
(Psychology Today)
"This is a book about slow dying in hospitals. . . . Through 27 case studies, Kaufman is able to describe and explore these intricacies thoroughly and with great success." (Allan Kellehear Aging & Society)
"[The] style of this book makes it accessible and enjoyable and takes the reader into the world of the modern US hospital that is the place where most Americans die. . . . Highly recommended for anyone interested in end of life care in institutional settings." (Jacqueline H. Watts Mortality)
"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." (Paul B. Bascomb JAMA)
Most helpful customer reviews
2 of 2 people found the following review helpful.
A book for anyone, we're all affected by death
By chey
I bought this book for a class I'm going to take (I'm a psych undergrad major/human services minor focusing in thanatology). This book is so revealing. Even if you aren't going to take a class on death and dying, thanatology, or something like it, buy this book. We are all are affected by the way hospitals shape the end of our lives, whether it be our own or one of our family members, and this book really sheds some light on it. I recommend this book to anyone. It's incredible.
3 of 3 people found the following review helpful.
Reality of healthcare & death
By DLin
I read this for my Medical Anthropology class in college, and I got lost in the topic. It is a very powerful book, and you find yourself asking questions about hospital/caretaker/hospice care and the ethics and politics of medicine. I really recommend this for college courses, but it's also a good read if you want to emerge yourself in this deep (and sometimes disturbing) reality of death. It made me think about my life (and of course death) planning and how I would want to leave this world and what responsibilities I would press onto my friends and family at the end of life.
2 of 2 people found the following review helpful.
A "should read" for everyone
By Erin
This was an assigned reading for my college medical anthropology class but I was glad I had to read it. Kaufman filled this book with real life situations she encountered during her research. You'll read about men and women (not always elderly) who are dying of one thing or another and see how the patients themselves, their families, and the medical staff deal with (or don't deal with) their situations.
Kaufman uses these true stories to show how patients need to make their wishes clear but how they often don't, and how families can choose to respect or not respect those wishes. She shows that the way the medical community operates is often not very "user friendly", but alternately how the choices people make for themselves and their loved ones basically "tie" the hands of doctors and can prevent them from doing what they think is best.
The chapters are basically set up that she briefly tells the reader what examples she will be using, spends the majority of the body of each chapter recounting conversations between patients, families and medical staff before she concludes the chapter with some analysis. She does say what she wants her readers to get out of each part but the majority of the impact I think readers will get from this book is from reading the individual examples.
My fellow students and I agreed that this book would be a useful read for just about everyone starting at perhaps late high school age depending on maturity levels. At some point in our lives we all will probably know/have direct interaction with someone who is at the end of life, and unless we experience a fatal accident, will likely have to make or plan our own end of life choices. This book will help readers understand the complexity involved and hopefully help make them more prepared forwhen it's their turn to make decisions(as much as anyone can actually be prepared for death....).
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