Respirators, Morphine and Trocars: Cultures of Death and Dying in Medical Institutions, Hospices and Funeral Work
In this dissertation I explore the cultures of death and dying in medical institutions, hospices and funeral work. I argue that not only are there competing cultures of death and dying in American society, but within these institutions that produce tension and conflict, sometimes among the workers, other times between the workers and those they serve, and other times between the institution and outside organizations. Medical institutions, by medicalizing death and dying, constructed a "death as enemy" orientation in which doctors fight death with the use of medical technology, practice detached concern from their patients, and marginalize religion and spirituality. On the other hand, a "suffering as enemy" orientation has also emerged, primarily in the form of palliative medicine, in which needless suffering is considered worse than death, therefore life-saving technology is removed, doctors empathize with patients and families, and spirituality is incorporated. Hospice started as a social movement to change how dying patients were treated at the end of life, addressing patients' physical, spiritual and emotional pain. However, the bureaucratization of hospice, particularly the Medicare Hospice Benefit, has led to a compromise of the social movement's ideals and these competing orientations shape how hospice workers, particularly nurses and social workers, express frustrations with their work. Funeral directors assert their jurisdictional claims of the right to handle the corpse and assuage the grief of the bereaved, through embalming, informal grief counseling and the funeral performance, but funeral directors encounter resistance from large funeral corporations and the funeral societies. Large corporations centralize embalming, turning the corpse from a craft to a product, recruit other professionals to practice grief counseling, and sell standardized funeral packages. Funeral societies challenge the necessity of embalming, funeral directors' expertise in grief counseling, and focusing on the value of simple, dignified and affordable funerals. I conclude this dissertation by showing how orientations toward death and dying vary in American society and these institutions because of tension between experts who espouse a particular orientation and activists who resist the claims of the experts.