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Books, Journals, New Media
July 6, 2005

End of Life

JAMA. 2005;294(1):114-115. doi:10.1001/jama.294.1.114

A bit of wisdom attributed to German Chancellor Otto von Bismarck says, “There are two things you don’t want to see being made—sausage and legislation.” After reading this remarkable and unsettling ethnographic study of contemporary death in US hospitals, one could add to this list “decision-making at the end of life.”

The author, a medical anthropologist, spent months in intensive care units, observing family conferences and speaking with patients, families, physicians, and nurses. Through 27 compelling narratives, she describes with uncanny accuracy and a gift for vivid detail the complex and often troubled dance that patients, families, physicians, nurses, and hospitals engage in as death nears. The book illuminates the central dilemma of dying in contemporary hospital culture. Hospitals, with their remarkable ability to sustain life at the threshold of dying, can place patients in perpetual limbo between life and death, until it is decided that “it is time for them to die.”

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