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The Ecology of Dying: Commodity Chains, Governance, and the Medicalization of End-of-Life Care

Ecological Health: Society, Ecology and Health

ISBN: 978-1-78190-323-0

Publication date: 1 October 2013

Abstract

Purpose

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

Methodology

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Findings

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Practical implications

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

Originality

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

Keywords

Citation

Vatovec, C., Senier, L. and Bell, M.M. (2013), "The Ecology of Dying: Commodity Chains, Governance, and the Medicalization of End-of-Life Care", Ecological Health: Society, Ecology and Health (Advances in Medical Sociology, Vol. 15), Emerald Group Publishing Limited, Leeds, pp. 195-215. https://doi.org/10.1108/S1057-6290(2013)0000015013

Publisher

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Emerald Group Publishing Limited

Copyright © 2013 Emerald Group Publishing Limited