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Communicating Care at the End of Life

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Carey Candrian

While health care at the end of life is changing, the language for talking about treatment options and patient preferences around the end of life is taking longer to change. This book carefully details the way language shapes decisions around end-of-life care. Using ethnographic research from two sites that offer emergency care and end-of-life care – a hospice and an emergency department – the author illustrates common themes around language use that serve as microcosms of the larger healthcare system in the United States. The sites have different purposes for providing care, yet the themes from both serve as guidance and reflection for other areas of caregiving.
The language used to talk about death holds consequences and opportunities for understanding and making decisions about care practices. This book uses personal stories and perspectives from patients, family members, and medical workers to paint a picture of some of the issues and tensions individuals and caregivers face. With an aging population – one that represents a major public health challenge in the twenty-first century – Carey Candrian argues that examining the care we provide for individuals, especially aging individuals, is fundamental to creating a developed, ethical, and engaged society.
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Chapter 3. The Many Ways We Use Language

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Discourses influence the way we understand life and death. For me, a particular discourse, like a particular model of care, orients us to the world a particular way. Even more, a discourse of care, like emergency medicine or hospice care, for instance, gives us a way of understanding and a way of feeling about death. A particular language influences what we value and what we take to be true, right, and worthy of pursuit. Therefore, to say that there are multiple or competing discourses of care is to say that there are competing ways of understanding life and death, arising with different vocabularies, different ways of interacting, and of making decisions. The more interesting thing is how each discourse and way of understanding life and death is produced, reproduced, and maintained.

By focusing on how discourses orient us to understand life and death in a particular way I have been most interested in language and the way we all use certain vocabularies to achieve certain ends and make distinctions over others. Therefore, I take language seriously and have gained insight from Watson (2003), who underscores that language is not just a tool we use to describe actions; rather, when we speak, we also act. Even more, we bring things into being in large part through the language that we use—and don’t use. And when we speak, our words put boundaries around meanings. For example, the ← 35 | 36 → words used to describe diagnosis, treatment, and remission have set...

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