Slowing Down Medicine: The Plural Worlds of Hospice Care


  • Lilly Lerer University of Chicago



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.

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.