No Place For Dying: Hospitals and the Ideology of Rescue / Edition 1

by Helen Stanton Chapple

Overview

The U.S. hospital embodies society’s hope for itself—a technological bastion standing between us and death. What does the gold standard of rescue, as ideology and industry, mean for the dying patient in the hospital and for the status of dying in American culture? This book shows how dying is a management problem for hospitals, occupying space but few billable encounters and of little interest to medical practice or quality control. An anthropologist and bioethicist with two decades of professional nursing experience, Helen Chapple goes beyond current work on hospital care to present fine-grained accounts of the clinicians, patients, and families who navigate this uncharted, untidy, and unpredictable territory between the highly choreographed project of rescue and the clinical culmination of death. This book and its important social and policy implications make key contributions to the social science of medicine, nursing, hospital administration, and health care delivery fields.

Product Details

ISBN-13:	9781598744026
Publisher:	Taylor & Francis
Publication date:	04/14/2010
Pages:	324
Product dimensions:	6.00(w) x 9.10(h) x 1.00(d)

Table of Contents

Introduction 7

Chapter 1 Hospital Dying Situations 25

Chapter 2 Rescue, Stabilization, and Speed 53

Chapter 3 Configuring Dying and Death 79

Chapter 4 Death with as Little Dying as Possible 107

Chapter 5 "Every Medical Action Is a Transaction": Rescue as Industry 129

Chapter 6 How Rescue as Industry Minimizes Dying 155

Chapter 7 Order out of Chaos: The Ritual of Intensification 185

Chapter 8 Ritual Display, Palliative Care, and Trust 229

Chapter 9 Making a Place for Dying in the Hospital 257

Appendix 277

References 287

Index 309

About the Author 324

Editorial Reviews

"Helen Chapple provides a relentless look at the sequestration of dying in hospitals from ordinary human experiences and from the work that is valued in hospitals. She lets us in on the special language and codes that nurses and physicians use when discussing patientsand also the nuanced expressions that rank a dying patient's position down the ladder of importance at a hospital. It shakes our confidence that hospice and palliative care have changed society's perception of and response to dying markedly. We are let into a world with both explicit and tacit understandings that 'more time alive' is all that matters, and into a world where consequences unfold because dying is not a reimbursable code. Thanatologists may conclude that a new Cicely Saunders is needed to face down the hospital culture of avoiding death and of sequestering dying from all else human. From Chapple's book we know, however, that the typical hospital physicians, nurses, administrators, coders, and other staff members argue for the marginalization of dying and of death in order that the hospital may do the work of life prolonging medicine that makes possible more time alive."-David Balk, Brooklyn College, associate editor for Death Studies

"...Readers familiar with the inner workings of hospital care will instantly empathise with the ritual' described in all its guises in the text. Chapple's skill is in deploying such a description that raises awareness of the tacit cultural agendas that influence clinicians' practice. The stark point being made by Chapple is that dying patients often undergo rescue needlessly and that even if the ritual permits their re-labelling as dying' (considered, by the author, as a successful' outcome of the ritual), there follows a disappointing lack of co-ordinated clinical care to meet their and their loved one's particular needs at that crucial time. [Q]ualitative evidence of this sort must be welcomed. Given the equal-ninth ranking of the US and Canada on quality of death, according to the Economist Intelligence Unit [1], Chapple's analysis provides compelling evidence as to why this might be the case. Whilst the academic reader will welcome the amount of wider referencing and research that Chapple has used to develop her thesis, it is to her credit that a non-clinical, lay reader will also pick up this book and understand her points easily, thanks to the skilful and coherent organisation and presentation of the complex material she has chosen to study."...- Milind Arolker, Sociology of Health and Illness

"What makes an American hospital No Place for Dying? Helen Chapple offers a complex, multilayered reply that extends well beyond her ethnographic research methods to implicate bioethics, the wider American culture, and health care economics. She explains how rescue becomes a ritual that eventually entraps both patients and staff. The ritual begins by affirming the social value of the patient, but only at the cost of withdrawing recognition and affirmation as soon as the patient is relegated to the category 'dying.' She offers cogent observations on how the future hospital might continue the work of rescue where appropriate, while still affirming the full dignity and worth of those beyond rescue." --Howard Brody, MD, PhD, Director, Institute for the Medical Humanities, University of Texas Medical Branch-Galveston; author of The Healer's Power and The Future of Bioethics

From the Publisher