A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.
DiTullio, M. and MacDonald, D. (2010), "Mediating hospice care: mapping relations of ruling in the interdisciplinary group meeting", Jacobs Kronenfeld, J. (Ed.) The Impact of Demographics on Health and Health Care: Race, Ethnicity and Other Social Factors (Research in the Sociology of Health Care, Vol. 28), Emerald Group Publishing Limited, Bingley, pp. 269-299. https://doi.org/10.1108/S0275-4959(2010)0000028015Download as .RIS
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