Book Report Info
Sharon Kaufman, a professor of medical anthropology at the University of California, San Francisco, used an ethnographic process to approach her subject. She spent two years studying three California hospitals by immersing herself in the hospital culture. She followed, observed, and interviewed nurses, physicians, therapists, patients, family members, social workers, and others while trying to understand the factors that led to the prevailing practices. She was particularly interested in how hospitals organized dying as a result of acculturated behavior that was regarded as normal and unproblematic by practitioners who did not understand the origins of the behavior. She discovered how hospitals shape medical practices, how shared medical rhetoric frames decision making about dying patients, and how cultural factors determine the way death occurs in the hospital and even which patients are considered to be dying by physicians and nurses.
Kaufman was particularly intrigued by patterns of social behavior. She observed that today death usually is orchestrated by professionals in hospitals and no longer is waited for, a transition that has markedly shortened the “waiting time” for dying. She found that hospital procedures and bureaucracy produced the imperative to “move things along,” mandating that health care professionals expedite decision making and produce the conditions for death. She identified “pathways” for moving things along, such as heroic intervention, and discussed how and why patients may stop moving along a pathway. Her ethnographic study features the detailed case histories of 27 patients culled from more than 100 dying patients she observed. In their clinical and social detail, multidisciplinary approach, and poignancy, many of the histories remind me of inpatient ethics consultations I have performed. Her analysis illuminates the