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Communicating Care at the End of Life


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 5. The Complexity of Death at Hospice


In both the ED and hospice, death is chaotic. This is an enduring tension for life and work at both locations. Through organizational routines and practices, providers, patients, and families are able to tame temporarily, and therefore deal with, the complexity and messiness of death, as well as their own humanity.

Aspects of this tension are experienced from the first moment people arrive at either the ED or the hospice through an un-stripping of humanity that takes place. This un-stripping will become more clear as workers describe their experience of caring for patients in their last and most vulnerable moments of life. This un-stripping also comes from seeing patients at some of their most vulnerable moments, when everything we believed to matter in life is suddenly taken from us.

The tension is especially pressing at hospice, where staff see and experience this un-stripping while promoting, if not promising, that death is indeed different. This means living every moment to the fullest until you die. Seeing this un-stripping from any perspective can be horrifying, but is even more so when your role is to somehow promise that death is different in hospice. This chapter will focus on the hospice and the next one will focus on the ED. ← 73 | 74 →

In many ways, I experienced this tension when my idea of death slammed into my experience of death in the ED and the hospice. I did not know how to make it less chaotic or...

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