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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 8. Conclusions, Implications, and Reflections


This book explained how discourses influence and provide particular rhythms for understanding life and death. Even more, it described how competing discourses orient us to the world in a particular way and in so doing, put into play a way of feeling, thinking, and talking about death. Further, this book scrutinized how language organizes meaning and also naturalizes meaning around care, health, and death. Beyond organizing and naturalizing, however, this study illustrated how these discourses are decorated to be unique and different but are inherently chaotic, wild, and tension-filled, thereby putting into play competing relationships around end of life. In short, discourses around end of life are in crisis.

I use the word crisis not to define that our ways of responding to death are broken because, as I mentioned in Chapter One, that suggests there are ways to fix it. This is not the case. Rather, by crisis I mean a crisis over meaning and a crisis over what to value at the end of life. The good thing is that a crisis can be a turning point in a sequence of events (Treichler, 1990). Healthcare reform in many ways bespeaks of a society trying to figure out what to value. And what to value is largely determined by meanings surrounding health. This study has not judged health care practices, but looked at how dying patterns shed light on a larger system of meaning. ← 121 | 122 →

A crisis over meaning surrounding health care offers society...

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