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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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“Do not ask me to remember, don’t try to make me understand. Let me rest and know you’re with me, kiss my cheek and hold my hand. I’m confused beyond your concept, I’m sad and sick and lost. All I know is that I need you, to be with me at all cost. Do not lose your patience with me, do not scold or curse or cry. I can’t help the way I’m acting, I can’t be different though I try. Just remember that I need you, that the best of me is gone. Please don’t fail to stand beside me, love me ‘til my life is gone.’”—Owen Darnell

The aging of the population is one of the major public health challenges of the 21st century (Centers for Disease Control and Prevention, 2012). Additionally, the cost of providing care for an older person is three to five times greater than the cost of someone under 65. As a result, the demands for healthcare services for an aging population are exploding. Furthermore, the demand for these services across the world is increasing alongside an astonishing rate of medical error; devastating rates of loneliness among the elderly—a risk factor for early death comparable to smoking 15 cigarettes a day; the inability to follow patient preferences around the end of life; competing visions of how to best organize systems of care delivery for the elderly; and international reports ← 1 | 2 → of widespread stress, burnout, and compassion fatigue among those...

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