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Why & How to Investigate Death and Dying. Lessons of 30 years. Reflecting on the significance of endings. ENDINGS FORCE REVIEWS.
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Why & How to Investigate Death and Dying Lessons of 30 years
ENDINGS FORCE REVIEWS Only in conclusions are the connections between means and ends realized, the "clash of interests and impulses resolved" (Duncan, p. 82), and when "we contemplate, and abide, and rest in our presentations" (Mead, p. 385).
THE PHENOMENOLOGY OF ENDINGS • Friday time • End of academic terms • End of academic and career/work conclusions • Dessert logic
DEATH AS CENTRAL CULTURAL METAPHOR FOR UNDERSTANDING ENDINGS
last hurrah (last hoo-rah) noun. A final appearance or effort, especially at the end of a career. [After The Last Hurrah, a novel by American writer Edwin O'Connor (1918-1968).]
Garrison finish (GAR-i-suhn FIN-ish) noun The finish of a contest in which the winner rallies at the last moment to score the victory. [After Edward "Snapper" Garrison (1868-1930), a jockey known for hanging back during most of the race and finishing at top speed to achieve a thrilling victory.]
Across the United States in 2009, coroners and medical examiners reported spikes in the number of unclaimed bodies and indigent burials, with states, counties and private funeral homes having to foot the bill when families cannot. A Kentucky funeral director wiping off a small marker after a recent burial.
Obama’s Health Insurance Initiatives Quickly Turned to Matters of Death
Researchers at the Dana-Farber Cancer Institute in Boston interviewed 603 patients with advanced cancer. They asked the patients, who had about six months left to live, whether their doctors had discussed their wishes for end-of-life care. The majority — 69 percent — said those conversations had not taken place. And in their last weeks of life, those patients who had talked with their doctors wound up with medical bills that were on average 36 percent lower — $1,876 compared to $2,917 — than those of patients who did not have end-of-life conversations with their doctors. • --Maggie Jones. “At the end of life, denial comes at a price.” New York Times (April 3, 2009)
MEDICINE TAKES CONTROL • Reflecting on the successes of the 20th century • Medicine inherits from religion the cultural responsibility to oversee final passage • Death prevention as the primary goal of medicine • Death-as-disease, death-as-the-enemy, death as result of medical failure Franz Glaubacker, “The Physician” (1923)
Now that fewer people, especially those in the Western, believe that life is a transitional phase leading to immortality, they are left with nothing after death to believe in. So their faith is placed in technology and physicians who, ironically, have become decreasingly equipped to deal with patients as humans.
Add to this equation that health care in the United States is based on capitalist principles. There people get medical treatment according to how much money they have. Those without money thus die prematurely.
However, public expectations about medicine’s success in its war against death are continuously fueled.
APRIL 12, 2005 55 years ago the Salk vaccine was released for general use in the United States.
Big gun against cancer | Vanadium Corp. of America, 1960 | Jo Kotula (1910-98)
The biotechnology company Tengion has since 1999 been selling new bladders made out of the customer’s own cells. From biopsy to surgery, the process takes six to eight weeks.
In June 2008 the newswires carried comments of David Sinclair, the Harvard Medical School professor who found that mice given large doses of resveratrol "live longer, they're almost immune to the effects of obesity. They don't get diabetes, cancer, Alzheimer's as frequently. We delay the diseases of aging."
Part of the contract between the modern nation-state and its citizenry is the former’s responsibility to kill what kills us—especially lethal microbes.
Who is more likely to die in hospitals? • Minorities are more likely than whites • Men are more likely than women (64% v. 55%) • Uninsured patients more than Medicare recipients (70% v. 55%)
Americans increasingly die when they no longer can afford to pay • Amount by which the number of U.S. deaths in 2000 from lack of medical insurance exceeded those from AIDS: 967 • --Source: Centers for Disease Control and Prevention (Atlanta)/Institute of Medicine (Washington)
FROM MORAL TO TECHNOLOGICAL RITE-OF-PASSAGE • More than half of attending physicians & 70% of attending physicians say they often violate their own personal beliefs and ignore requests from patients to withhold life support in cases of terminal illness(Am J. of Public Health, Jan. 1993, n=1400 from 5 major hospitals nationwide) • According to Dr. Nicholas Christakis (U. Chicago), 40-70% of patients die in pain (first phase study of Dying in America)
FROM MORAL TO TECHNOLOGICAL RITE-OF-PASSAGE--ii • In 1990, it was estimated by the American Hospital Association that seven out of ten deaths in the U.S. were somehow timed or negotiated • Dying has become a game of information control, with patients uninformed of their fate. • Recently, results of an eight-year clinical study of dying in America, (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) found little relationship between what patients wanted and what, in fact, physicians did. Living wills made little difference. • More than one-third of families lose all or most of their life savings in the course of caring for a dying member
In 2008, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education. --CBS “60 Minutes.” “Cost of Dying” (Nov. 22, 2009)
A study of nursing home patients, by Dr. Susan Mitchell of Harvard and the Hebrew Rehabilitation Home for the Aged, found that those with end-stage Alzheimer's received more aggressive medical treatment — including feeding tubes, intravenous fluids and antibiotics and hospitalizations — than cancer patients at the end of their lives. • --Gina Kolata. “When Alzheimer’s Steals the Mind, How Aggressively to Treat the Body?” New York Times (May 18, 2004)
About one-third of total Medicare spending is incurred by decedents Andrew J. Rettenmaier & Zijun Wang, “Explaining the Growth of Medicare II” Natl. Center for Health Policy Analysis (Aug. 6, 2002)
