At the turn of the twentieth century, medicine's imperative to
cure disease increasingly took priority over the demand to relieve
pain and suffering at the end of life. Filled with heartbreaking
stories, "The Inevitable Hour" demonstrates that professional
attention and resources gradually were diverted from dying
patients.
Emily K. Abel challenges three myths about health care and dying
in America. First, that medicine has always sought authority over
death and dying; second, that medicine superseded the role of
families and spirituality at the end of life; and finally, that
only with the advent of the high-tech hospital did an institutional
death become dehumanized. Abel shows that hospitals resisted
accepting dying patients and often worked hard to move them
elsewhere. Poor, terminally ill patients, for example, were shipped
from Bellevue Hospital in open boats across the East River to
Blackwell's Island, where they died in hovels, mostly without
medical care. Some terminal patients were not forced to leave, yet
long before the advent of feeding tubes and respirators, dying in a
hospital was a profoundly dehumanizing experience.
With technological advances, passage of the Social Security Act,
and enactment of Medicare and Medicaid, almshouses slowly
disappeared and conditions for dying patients improved--though, as
Abel argues, the prejudices and approaches of the past are still
with us. The problems that plagued nineteenth-century almshouses
can be found in many nursing homes today, where residents often
receive substandard treatment. A frank portrayal of the medical
care of dying people past and present, "The Inevitable Hour" helps
to explain why a movement to restore dignity to the dying arose in
the early 1970s and why its goals have been so difficult to
achieve.
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