by Sharon R. Kaufman
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Product Description
Over the past thirty years, the way Americans experience death has been dramatically altered. The advent of medical technology capable of sustaining life without restoring health has changed where, when, and how we die. In this revelatory study, medical anthropologist Sharon R. Kaufman examines the powerful center of those changes: the hospital, where most Americans die today. She deftly links the experiences of patients and families, the work of hospital staff, and the ramifications of institutional bureaucracy to show the invisible power of the hospital system in shaping death and our individual experience of it. In doing so, Kaufman also speaks to the ways we understand what it means to be human and to be alive.
“An act of courage and a public service.”—San Francisco Chronicle
“This beautifully synthesized and disquieting account of how hospital patients die melds disciplined description with acute analysis, incorporating the voices of doctors, nurses, social workers, and patients in a provocative analysis of the modern American quest for a ‘good death.’”—Publishers Weekly
“Kaufman exposes the bureaucratic and ethical quandaries that hover over the modern deathbed.”—Psychology Today
“Kaufman’s analysis illuminates the complexity of the care of critically ill and dying patients [and] the ambiguity of slogans such as ‘death with dignity,’ ‘quality of life,’ and ‘stopping life support.’ . . . Thought-provoking reading for everyone contemplating the fate of us all.”—New England Journal of Medicine
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Average Customer Review:
2 of 2 people found the following review helpful:
 Good, but too long, 2008-03-11
All that can be said about this book has been said already in other reviews. It is a well written account of the modern reality of death in America today which tackles it from all angles. That being said, the book could have given the same message in about 100 or 150 pages, and cut out 2 to 3 times it's bulk. It is worth a read, but honestly too many times the same topics are brought up over and over again. It became very, very tedious.
2 of 2 people found the following review helpful:
 Be informed, 2006-09-29
Think you or your parent don't need a health care proxy? Think again, and use Sharon Kaufman's AND A TIME TO DIE to help you realize just how important it is to determine the direction you want your life to take at its conclusion, and to have someone who understands your wishes and can speak for you.
It's not a pleasant subject, but it's one that healthcare professionals deal with every day. I can certainly agree that the cases depicted here are unvarnished in their presentations, completely accurate. I've watched some of these same scenarios play out over and over again--only the patients are different.
The text maintains a certain distance from the patients and their families. There is not the in-depth interviews and emotional content of some other books of this type. However, I appreciated stepping back from the patient in order to see how the system had succeeded or failed in each case.
The author does a good job at showing just how we arrived at this current state of affairs, and why dying in America has become driven by treatments rather than by compassion. Medicare reimbursement is at the heart of some of the problem for the elderly.
If you want to change the system, to have compassion for the dying, to practice better medicine, or even to have a peaceful end for yourself when that time comes, this is a good place to start in understanding how we've come to this place, and to think about what we can do to create change.
3 of 3 people found the following review helpful:
One of the most valuable books I've read this year, 2006-07-21
I am a medical ethicist, and as I read Kaufman's "And a Time to Die" I found myself thinking back to the hospital case consultations I've been involved in. Her observations and conclusions helped me to piece together a much more detailed picture of what's really going on in those situations. Her discussion of pathways, time pressures, reimbursement concerns, and the use of language all ring true. Those who are familiar with hospital settings will recognize much of what Kaufman has observed (a fact that another reviewer objects to), but I believe that she is able to take a "bird's eye view" of these issues in a way that organizes and extends our understanding.
This book is a must-read for families who are facing end-of-life decisions, and for those in the health professions who try to help families through this process.
6 of 6 people found the following review helpful:
Circles, But Never Lands, 2006-05-22
The author of this book goes inside the modern American hospital system as an anthropologist, and reports what takes place there when the system is confronted with a terminally ill patient. She examines what cultural imperatives are being brought to bear there to make this an increasingly problematic and decidedly "unnatural" process.
You will get a few definite insights from this book. The author includes interviews with a variety of patients and their families. And she sits in on hospital conferences as all the people treating and speaking on behalf of a dying patient wrestle with the problem of what measures to take to prolong the patient's life, or less euphemistically, to prolong his dying.
There is also an interesting chapter on specialty care units that are either attached to some hospitals or that are hospital owned, but exist in their own removed compounds. These units maintain patients who only survive with the aid of artificial/mechanical aids. Some of them are in a vegetative state. Some are conscious to varying degrees. Most of the public still isn't aware of the existence of these adjunct facilities, despite the movie Coma - which featured a sinister version of such a high-tech "warehousing" center. The actuality, as Kaufman describes it, is infinitely more benign. The staff at these institutions sincerely care for their patients.
A few good summary points emerge from Kaufman's treatise. Insurance has largely shaped our medical care system by mandating that hospitals treat specific conditions in order to justify a patient's stay there. So generic old age can't be attended to. A patient must receive a diagnosis of something like "superlobar emphysema" and must be put on the pathway of aggressive treatment for that condition, if the hospital expects to be compensated.
Another point: Our system of so-called choice makes it difficult for the dying and their families. People don't know "what to want" in these life-and-death situations. The onus is on them to say when to pull the plug. Choice has replaced nature.
Kaufman explains how our far-reaching, albeit still limited, control over nature has left us without any way to anchor moral decisions. Whereas we could once let a person die "naturally," now we have transformed and become nature, so the decision can't be left outside ourselves. This is perhaps the main thesis of the whole book, and should have been stated at its beginning to orient the reader a little better.
In general, this book is five times longer than it needs to be. It's like a bird that circles and circles, riding the lofty currents of air, without ever swooping down to make a catch. At the end of the book's 300+ pages, we really don't know much more than when we started. Most of what Kaufman writes in between interviews is abstract and obvious.
Kaufman might have considered going beyond her passive role of anthropologist, and might have envisioned some more substantial solutions to the problem of medicalized dying if she had incorporated the works of philosophers such as Ivan Illich (author of Medical Nemesis) in her thinking. Illich approached the problem of our entire medical care system as a problem of glut and hubris. Just as we demand too many goods in this society, so we demand too many services. We insist on being serviced to the hilt, and institutions abound to sell us service, service, service. These institutions then take on a life of their own, and there's nothing any of us can do, client or provider alike, but go along for the ride. Kaufman's need to maintain cordial relations with hospital staff and patient families in order to conduct her research may explain some of her lack of critical perspective in this regard though.
As it is, her book is worth reading as rehearsal for what each one of us might face some day. But I would speed-read it, in order to avoid prolonging the process.
5 of 5 people found the following review helpful:
A powerful book for students, caregivers, and families dealing with end of life stages, 2006-03-27
This is an excellent book about a difficult subject: The ambivalent attitudes and approaches to dying in the culture of US hospital settings. Sharon Kaufman is professor of medical anthropology at the University of California, San Francisco.
Kaufman observed that time was the factor which most influenced many of the interactions and experiences of the participants in the drama of dealing with serious health challenges. Institutional pressures on the staff demanded that care be provided in the most efficient and economic manner. The staff were constantly faced with decisions around the timing of interventions and the pacing of the therapies and their effects and consequences. Staff had to deal with obstacles to the most efficient provision of care and with the timing of death. Patients were often unconscious, leaving relatives to have to make extremely important and difficult decisions - ones that they would have to live with for the rest of their lives, and ones that might set them in conflict with other family members who could not be present at the time.
The control that modern medicine has over the timing of death brings the patients, staff and families into discussions and negotiations over physical, psychological, relationship, moral, ethical and religious issues and concerns. When there is no living will/ directive, an urgent situation is created in which decisions of major consequences must be taken.
Much suffering seemed incredibly unnecessary, like octogenarians with living wills discovered after the fact, or aggressive surgeries on debilitated and chronically ill people who had not a fighting chance of surviving these insults.
This powerful book should be read by every student and caregiver dealing with seriously ill patients, and by families with people who are approaching the last stages of their lives. It would make an excellent focus for caregiver discussion groups.
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