Introduction; 1: Hospital Dying Situations; 2: Rescue, Stabilization, and Speed; 3: Configuring Dying and Death; 4: Death with as Little Dying as Possible; 5: “Every Medical Action Is a Transaction”; 6: How Rescue as Industry Minimizes Dying; 7: Order out of Chaos; 8: Ritual Display, Palliative Care, and Trust; 9: Making a Place for Dying in the Hospital
Helen Stanton Chapple, PhD, RN, CCRN, CT, is the Nurse Ethicist at Creighton University's Center for Health Policy and Ethics. Her twenty years of bedside nursing include oncology, research, hospice home care, cardiac and neuroscience critical care. A persistent interest in thanatology and the fate of hospitalized dying patients prompted her to pursue graduate degrees in bioethics and anthropology at the University of Virginia. She is the author of several articles in top anthropology and nursing journals.
"[S]he combined her study results with extensive supporting
material from relevant research to present a convincing case for
her conclusions. This is an aspect of the book that I particularly
enjoyed--Chapple thoroughly reviews the literature (references run
to 20Þ pages), provides a theoretical view and makes it ''real''
with case studies. She achieves a good mix of presenting hospital
procedures with the human results of those procedures. I highly
recommend it and hope it reaches a wide audience." -Jeanne Boland,
Death Studies"Helen Stanton Chapple does a masterful job of
portraying the ways that rescue minimizes death and contributes to
death denial in our culture. In hospitals where almost every aspect
of care has a code or label, dying patients are uncategorized.
Moreover, dying does not have an International Classification of
Diseases Clinical Modification, Ninth Revision (ICD-9-CM) code.
Clinicians in the acute care setting often feel helpless when a
person is dying and see themselves as being held hostage to the
dying instead of feeling a sense of honor. Acute and high tech care
can support vital signs and delay death, but it also promotes the
illusion that death can be infinitely postponed. Chapple argues
that society's complacent confidence in its agents' ability to
perform life-saving miracles distracts us from death's
inevitability. When hospitalized dying patients are minimized, each
member of society is shortchanged." -Gerontologist"While rooted in
an ethnographic study of staff in two quite different hospitals,
her analysis embraces insights into the roles of economics,
bioethics, the hospice and palliative care movement, and iconic
American cultural beliefs. This volume would be rewarding reading
for any student of American health care, including hospital
administrators and board members as well as clinicians and change
agents frustrated by the epidemic of over-treatment of hospitalized
patients at the end of life. This volume would be rewarding reading
for any student of American health care, including hospital
administrators and board members as well as clinicians and change
agents frustrated by the epidemic of over-treatment of hospitalized
patients at the end of life. Th[e] book is loaded with serious,
intellectually strenuous material, making some popular books on
dying in America seem downright breezy by contrast. Because Dr.
Chapple is a good writer and her volume is well organized, the book
is dense only in the best sense. Most importantly, clearly told
patients' stories and direct quotations from interviews with those
who cared for them keeps the analysis grounded in hospital
realities." -Patricia A. Murphy and David M. Price, Journal of
Palliative Medicine
"Readers familiar with the inner workings of hospital care will
instantly empathise with the 'ritual' described in all its guises
in the text. Chapple's skill is in deploying such a description
that raises awareness of the tacit cultural agendas that influence
clinicians' practice. The stark point being made by Chapple is that
dying patients often undergo rescue needlessly and that even if the
ritual permits their re-labelling as 'dying' (considered, by the
author, as a 'successful' outcome of the ritual), there follows a
disappointing lack of co-ordinated clinical care to meet their and
their loved one's particular needs at that crucial time.
[Q]ualitative evidence of this sort must be welcomed. Given the
equal-ninth ranking of the US and Canada on quality of death,
according to the Economist Intelligence Unit [1], Chapple's
analysis provides compelling evidence as to why this might be the
case. Whilst the academic reader will welcome the amount of wider
referencing and research that Chapple has used to develop her
thesis, it is to her credit that a non-clinical, lay reader will
also pick up this book and understand her points easily, thanks to
the skilful and coherent organisation and presentation of the
complex material she has chosen to study."- Milind Arolker,
Sociology of Health and Illness
"The right to life is a hard right to refuse. No Place for Dying:
Hospitals and the Ideology of Rescue is a text that discusses the
legal place of the rights of the dying, the thought process behind
these laws, and the position of modern medical facilities. The
first chapters discuss situations where death is gauged between
unavoidable and where rescue is successful. It then discusses the
place of profit, and the drive to save lives in American culture.
Finally, it analyzes culture and its own attitudes towards death. A
complete and comprehensive text on the role hospitals play in death
and dying, No Place for Dying is a scholarly and thoughtful work
that would do well in community and college anthropology
collections." - Five Stars from Midwest Book Review
"From time to time an author, speaker, teacher or advocate comes
along who breaks through the rubble, denial, lack of leadership and
unclear or non-existent values. This is one of those books and
Helen Chapple is the right person to carry the message. The book is
well organized and well written. Skip nothing in the book and, when
you finish it, read it again. Like the author, you need to claim or
reclaim your prophetic responsibilities. Tell others. Share the
message. Most of all, live (and die) the message."
-Richard B. Gilbert, PhD, CT, Galesburg, IL, for the journal
Illness, Crisis, and Loss
"It is a thought provoking ethnography, which offers the argument
that American hospitals are based on an imperative for heroic
rescue and stabilization, leaving little room for dying in the
space where rescue ends...The data collection effort appears to be
extensive, including involvement with chaplains, physicians,
nurses, therapists, and administrators, as well as observations on
and offsite, including in-service activities, trainings,
commemorations, retreats, and meetings on bereavement, ethics,
policy, and planning...Chapple is clearly knowledgeable about death
and dying in American hospitals and raises good questions and
compelling points about hospital death."
-Frances Norwood, Anthropological Quarterly
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