Slowing Down Medicine: The Plural Worlds of Hospice Care
Keywords:Hospice Care, slow medicine, care, ontology
This ethnography reflects on a non-profit hospice care organization in the Midwestern US where caregivers “slow down” medical care by acknowledging the plurality of forces that constitute the illness experience, philosophically departing from their biomedical, non-hospice counterparts. It demonstrates the ontological effect of “slowing down” and attending to a set of patient problems that extends beyond the biological, or any distinct, domain. The result is a medical world that privileges the embodied, lived expression of disease—rather than the statistical, clinical expression—resulting in medical care that is enmeshed in the variables of everyday life. I therefore situate hospice care in a historical moment witnessing the emergence of a sophisticated and “non-modern” (Latour 1991) form of medical care.
Angus, DC, AE Barnato, WT Linde-Zwirble, LA Weissfeld, RS Watson, T Rickert, and GD Rubenfeld. 2004. “Use of intensive care at the end of life in the United States: An epidemiologic study.” Critical Care Medicine 32(3): 638-643.
Braga, S. 2011. “Why Do Our Patients Get Chemotherapy Until the End of life?” Annals of Oncology 22(11): 2345-2348.
Connolly, William. 2005. Pluralism. Durham: Duke University Press.
Dumit, Joseph. 2002. “Drugs for Life.” Molecular Interventions (2): 124-127.
Earle, Craig, Bridget Neville, Mary Beth Landrum, John Ayanian, Susan Block, and Jane Weeks. 2004. “Trends in the Aggressiveness of Cancer Care Near the End of Life.” Journal of Clinical Oncology 22(2): 315-321.
Fallowfield, L, D Ratcliffe, V Jenkins, and J Saul. 2001. “Psychiatric Morbidity and its Recognition by Doctors in Patients with Cancer.” British Journal of Cancer (84): 1011-1015.
Fuchs, Victor. 1972. “The Growing Demand for Medical Care.” In Essays in the Economics of Health and Medical Care, edited by Victor Fuchs, 61-69. New York: National Bureau of Economic Research.
Hardman, Anthony, Peter Maguire, and Derek Crowther. 1989. “The Recognition of Psychiatric Morbidity on a Medical Oncology Ward.” Journal of Psychosomatic Research 33(2) (1989): 235-239.
Kaufman, Sharon. 2005. ...And A Time To Die: How American Hospitals Shape the End of Life. Chicago: University of Chicago Press.
Koenig, Barbara. 1988. “The Technological Imperitives in Medical Practice.” In Biomedicine Examined, edited by Margaret Lock and Deborah Gordon, 465-496. Boston: Kluwer Academic Publishers.
Latour, Bruno. 1991. We Have Never Been Modern. Translated by Catherine Porter. Cambridge: Harvard University Press.
Lock, Margaret. 2002. Twice Dead: Organ Transplants and the Reinvention of Death. San Francisco: University of California Press.
Mol, Annemarie. 1999. “Ontological Politics: A Word and Some Questions.” The Sociological Review (1999).
—. 2008. The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.
—. 2003. The Body Multiple: Ontology in Medical Practice. Durham: Duke University Press.
Mol, Annemarie, and John Law. 2004. “Embodied Action, Enacted Bodies: the Example of Hypoglycaemia.” Body & Society (10): 43-62.
NHPCO. 2014. NHPCO Facts and Figures: Hospice Care in America. National Hospice and Palliative Care Organization. Accessed December 2014. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2014_Facts_Figures.pdf
Passik, Steven, Wiliam Dugan, Margaret McDonald, Bary Rosenfeld, Dale Theobald, Sara Edgerton. 1998. “Oncologists's Recognition of Depression in Their Patients with Cancer.” Journal of Clinical Oncology 16(4): 1594-1600.
Russ, Ann Julienne. 2005. “Love’s Labor Paid for: Gift and Commodity at the Threshold of Death.” Cultural Anthropolgy (20): 128-155.
Saunders, Cicely. 1996. “A Personal Therapeutic Journey.” British Medical Journal (313): 1599-1601.
Sollner, W, A DeVries, E Steixner, P Lukas, G Sprinzl, G Rumpold and S Maislinger. 2001. “How Successful Are Oncologists in Identifying Patient Distress, Perceived Social Support, and Need for Psychosocial Counseling?” British Journal of Cancer (2001): 179-185.
Stengers, Isabelle. 2005. “The Cosmopolitical Proposal.” In Making Things Public: Atmospheres of Democracy, edited by Bruno Latour and Peter Weibel. Cambridge: MIT Press.
Temel, Jennifer, Joseph Greer, Alona Muzikansky, Emily Gallagher, Sonal Admane, Vicki Jackson, Constance Dahlin, Craig Blinderman, Juliet Jacobsen, William Pirl, Andrew Billings, Thomas Lynch. 2010. “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer.” New England Journal of Medicine (363): 733-742.
Teno, Joan, Pedro Gozalo, Julie Bynum, Natalie Leland, Susan Miller, Nancy Morden, Thomas Scupp, David Goodman, Vincent Mor. 2013. “Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005 and 2009.” Journal of the American Medical Association 309(5): 470-7.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.