Debating end-of-life issues

September 16, 2009
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Thanks to a certain former governor from Alaska, “death panels” (and the attendant fear that the Obama administration will somehow decide when and how Americans die) have gained increasing currency in the health-care reform debate. Despite repeated assurances from the administration that the bill calls for no such thing (and evidence from fact-checking organizations that dispute Palin’s claim), a new poll shows that 41% of Americans believe that “senior citizens or seriously-ill patients would die because government panels would prevent them from getting the medical treatment they needed.”
This week, Newsweek magazine devoted its cover to an article (not-so-subtly) titled “The Case for Killing Granny.” The piece argues that “the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate” and that in order to rein in health care costs, we, as a nation, despite how uneasy it makes us, are going to need to confront this reality. As the article suggests, “Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.” With end-of-life issues at center stage in the health-care reform debate, it’s an apt time to look closely at modern death, especially in American hospitals. Medical anthropologist Sharon R. Kaufman does just that in the award-winning 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.
As Newsweek notes, “studies show that about 70 percent of people want to die at home—but that about half die in hospitals.” Hospitals will continue to be central to the American way of death, and how we die, and who decides when, will be forever linked to the health-care reform debate of 2009, no matter what gets passed into law. Kaufman’s book, which you can read an excerpt of here, shines light on the ethical quandaries at the heart of the issue.

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