Doctoral Dissertation Research: Clinicians as Culture Bearers: A Study of the Dying Process in the American Hospital

虽然死亡在美国医院并不罕见，但“善终”却很难实现。病人的死亡显然与医院抢救、稳定和康复的使命相矛盾，但很少被描述为美国文化价值观的冲突。本文是一位文化人类学家的研究，探讨了两种美国价值观之间的冲突：拯救个人生命的承诺和有个人意义的死亡的愿望。核心问题是，在美国文化和医院内部，相互冲突的规范是如何阻止临床医生为即将死亡的病人恢复自我，从而使“有尊严的死亡”成为不可能的？通过回顾性访谈和对临床医生和管理人员的参与观察，学生将学习大西洋中部城市的两家城市医院，他们在寻求治疗危及生命的疾病时，必须在美国相互矛盾的救援理想和“有尊严的死亡”之间进行调解。更广泛的影响：美国医院缺乏“有尊严的死亡”，这在临终讨论中引起了公众的持续关注。在这个项目中使用不同的医院地点和环境将产生实际的发现，不仅与急症护理机构的临床医生有关，而且与病人死亡的其他设施，如临终关怀、长期护理和康复设施的临床医生有关。此外，该项目有助于培养一名年轻的社会科学家。

While death is not infrequent in the American hospital, a "good death" there is hard to come by. The death of the patient clearly contradicts the hospital mission of rescue, stabilization and recovery, but it is seldom described as a conflict in American cultural values. This dissertation research by a cultural anthropologist examines the conflict between two American values: the commitment to saving personal lives and the desire for a death with personal meaning. The central question is how do conflicting norms, both in American culture and within the hospital, prevent its clinicians from attending to the restoration of selfhood to the patient who is approaching death, making it impossible to achieve "death with dignity?" Using retrospective interviews and participant observation with clinicians and administrators the student will study two city hospitals in in a Mid Atlantic city who must mediate between America's contradictory ideals of rescue and "death with dignity" as they seek to treat life-threatening illness. Broader Impact: The scarcity of "death with dignity" in American hospitals receives continued public attention in end-of-life discussions. The use of diverse hospital sites and contexts in this project will generate practical findings relevant not only to clinicians in acute care institutions, but also to those in other facilities where patients die, such as hospices, long term care and rehabilitation settings. In addition the project contributes to the training of a young social scientist.