Values at the End of Life
The Logic of Palliative Care
Published on 1. June 2019
Book
Hardback
360 pages
978-0-674-54517-5 (ISBN)
Description
This insightful study examines the deeply personal and heart-wrenching tensions among financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions.
America's health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living.
Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient's suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means.
Once defiant of death-or even in denial-many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.
America's health care system was built on the principle that life should be prolonged whenever possible, regardless of the costs. This commitment has often meant that patients spend their last days suffering from heroic interventions that extend their life by only weeks or months. Increasingly, this approach to end-of-life care is coming under scrutiny, from a moral as well as a financial perspective. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and growing acceptance of the idea that a life consumed by suffering may not be worth living.
Values at the End of Life combines an in-depth historical analysis with an extensive study conducted in three hospitals, where Livne observed terminally ill patients, their families, and caregivers negotiating treatment. Livne describes the ambivalent, conflicted moments when people articulate and act on their moral intuitions about dying. Interviews with medical staff allowed him to isolate the strategies clinicians use to help families understand their options. As Livne discovered, clinicians are advancing the idea that invasive, expensive hospital procedures often compound a patient's suffering. Affluent, educated families were more readily persuaded by this moral calculus than those of less means.
Once defiant of death-or even in denial-many American families and professionals in the health care system are beginning to embrace the notion that less treatment in the end may be better treatment.
Reviews / Votes
Most of us think that money and death belong to opposite moral terrains. Roi Livne demolishes that boundary as he traces the deeply moral roots of a new economy of dying. Drawing from vivid interviews and observations of physicians, patients, and family, Values at the End of Life will not only shape scholarly debates but also fascinate a broad audience eager to understand twenty-first-century death practices. -- Viviana Zelizer, author of <i>Economic Lives: How Culture Shapes the Economy</i> Roi Livne's eye-opening investigation reveals a pervasive regime of valuation embedded in medical treatment today. By scrutinizing the history and practice of palliative care, Livne artfully outlines the battle of economization over whether to do less or more when life is at stake. -- Sharon Kaufman, author of <i>Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line</i> Livne addresses the personal, intimate concerns of every reader in this uncommonly deep sociological study. Combining ethnographic 'thick description' with precise, accessible argument, this book explores the interconnection between the morally-oriented project of palliative care and its seemingly inescapable economic imperatives. Values at the End of Life sheds light on that interconnection, rendering explicit an awareness that is implicit in the interactions among clinicians, patients, and families. -- Steven Lukes, author of <i>Moral Relativism</i> [A] masterfully researched work...Likely to have staying power as an important contribution to the sociological literatures on medicine, healthcare, health financing, death and dying, and professionalization. It will also surely be of interest to economists, health policymakers, and clinicians who navigate every day the structures of this new economy of dying...Provides food for thought about one's own wishes at the end-of-life, long after the last page is turned. -- Tania M. Jenkins * Social Forces * If you work in palliative care and have an interest in the sociological angles, you will enjoy this book and it will give you a lot to think about. -- Roger Woodruff * IAHPC Book Reviews * While still acknowledging the issue of power differentials between end-of-life care clinicians and the people they serve, he disentangles the relationship in a way that brings to light the importance of patient agency within a much larger cultural context...Provides an in-depth descriptive analysis of end-of-life care...A highly informative read. -- Courtney R. Petruik * Canadian Journal of Sociology * Sheds light on the institutional history of the rise of hospice and palliative care in the U.S., and provides an honest and richly documented account of the inner workings of hospital care for patients at the end of life...Should be widely read not only by academic sociologists, but by policymakers, patient advocates, health professionals, and even members of the general public. No one can predict what their last weeks or days are going to be like...[but] learning about how these decisions are made is of great practical value to us all. -- Alya Guseva * European Journal of Sociology * By studying a new economy of death and dying, Livne contributes both to the field of economic sociology...and to the sociological study of death. -- Lucas Faial Soneghet * International Sociology * A substantial and thought-provoking contribution to a complex and highly sensitive topic...Illuminates the normalization processes in a key ethical area and brilliantly perpetuates the critical legacy of the discipline. It is also an indispensable reading for economic scholars, sociologists or not, to stimulate new insights and promote in-depth approaches that focus on the issue of ambivalence, dissensus, and moral perplexity. -- Natasia Hamarat * Sociology of Health and Illness * This powerful work is poised to be a future classic in economic sociology, medical sociology, and health policy. Livne provides a fascinating glimpse into the challenges that nearly every American will face, as they and their loved ones grapple with end-of-life decision-making. The book's important conclusions extend beyond the case of hospice and palliative care; they reveal how economies can emerge in morally contested areas and the role that stakeholders can play in this emergence. -- Deborah Carr * Contemporary Sociology * A sweeping and cohesive narrative of how economic and moral values were brought into alignment through public pressure, professional advocacy, and financial incentives to create both a supply and demand for an economizing palliative care gaze. This book is a worthwhile read for a broad audience and provides fascinating insight into the moral, ethical, and financial roots of a bourgeoning field. -- Elizabeth Dzeng * American Journal of Sociology * Amid the coronavirus pandemic, questions about how to ethically ration medical treatment have become a practical concern for those working on the front lines...But, as Values at the End of Life demonstrates, health care has always been a service that has to be rationed...In a time when many people are wondering how to rebuild the economy, Values at the End of Life makes a compelling case for the merit of treating economization not as an abstract domain but as a set of practices through which our work and our lives become valued in particular ways. -- Katherine Gibson * Social Service Review * Livne accomplishes a lot for a study of palliative care. -- Barbara Kiviat * British Journal of Sociology *More details
Language
English
Place of publication
Cambridge, Mass
United States
Target group
Professional and scholarly
Illustrations
10 illus.
Dimensions
Height: 235 mm
Width: 156 mm
ISBN-13
978-0-674-54517-5 (9780674545175)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Person
Roi Livne is Assistant Professor of Sociology at the University of Michigan. He has been awarded fellowships from the Center for Research on Social Change and the Charlotte Newcombe Foundation. His work has won awards from the American Sociological Association, the Society for the Advancement of Socio-Economics, the Israeli Sociological Association, and the University of California, Berkeley.