Dying Patient, The

Dying Patient, The

Orville G. Brim
Howard E. Freeman
Sol Levine
Norman A. Scotch
Copyright Date: 1970
Published by: Russell Sage Foundation
Pages: 416
  • Cite this Item
  • Book Info
    Dying Patient, The
    Book Description:

    There has hitherto been limited systematic social research on the prolongation and termination of life, and minimal agreement of the resolution of the moral and social dilemmas that dying provokes. Among the topics discussed by the contributors are: the social context of dying-when, where, and why people die; what they think about death; the cultural background of the patients' attitudes; and how medical practitioners cope with terminal illness. The social, ethical, legal, and economic problems arising from the prolongation and termination of life are also set forth.

    eISBN: 978-1-61044-082-0
    Subjects: Sociology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
    (pp. v-vi)
  3. Table of Contents
    (pp. vii-viii)
    (pp. ix-xii)
  5. INTRODUCTION New Dimensions of Dying
    (pp. xiii-2)
    Howard E. Freeman, Orville G. Brim Jr. and Greer Williams

    The death of an individual is about as significant to the survival of the community as the death of a cell is to the future of a complex biological organism. It happens all the time; the individual is dead but life continues in kind. The notion is well captured in the monarchic cliché: “The king is dead, long live the king.”

    At the same time, the human mystique requires that we treat the death of every individual as a universal tragedy, a loss to all as well as to him. “Any man’s death diminishes me,” John Donne said. Such a...


    • 1 When, Why, and Where People Die
      (pp. 5-29)
      Monroe Lerner

      Perhaps one of man’s greatest achievements in his endless quest to extend the limits of his control over nature has been his success in increasing the average duration of his lifetime. This success has been particularly substantial in the modern era, beginning with the mid-seventeenth century, and during the second third of the twentieth century it extended even to the far corners of the globe. During this period, and possibly for the first time in human history, the lifetimes of a substantial proportion of the world’s population have been extended well beyond even the economically productive years, so that most...

    • 2 What People Think About Death
      (pp. 30-41)
      John W. Riley Jr.

      During the next twelve months, nearly two million Americans will die. Throughout the whole world, between fifty and sixty million will die. Considering a phenomenon of such wide and deep personal significance, knowledge of how contemporary man relates to death is meager indeed. It has been said that man is loath to consider this most basic uncertainty (Feifel, 1959). It has been widely assumed that he prefers to ignore death–to take an ostrichlike view. Without historical insight, many of us have made this “truth” part of our own lore, an incorporation of that ancient taboo which man seems to...

    • 3 Cultural Beliefs on Life and Death
      (pp. 42-64)
      Andie L. Knutson

      In death man experiences the most awesome unknown. Since primitive times he has been at once frightened and challenged by death and has engaged in a continuous search to understand it and to find means of adapting to it or controlling it. Lacking any personal evidence as to what occurs in death, he has been limited to individual and group observations of what happens in others. His interpretations have been guided by his beliefs, ethical values, and attitudes; his hopes, wants, and desires; his fears, doubts, and uncertainties. From his personal and group projections of life after death have emerged...


    • 4 The Prognosis of Death
      (pp. 67-82)
      Louis Lasagna

      Since we are all moving at variable paces toward death, one might conceivably look upon all of life as a terminal illness from which only death can liberate us. Whether such a definition is excessively lugubrious can be debated; for the purposes of this chapter it is not a workable one. Operationally, therefore, I shall define “terminal illness” as a disease state whose presence raises in the mind of physician, patient, or family an expectation of death as a direct consequence of the illness. “Prognosis” will be used in its classic sense of forecasting, of predicting outcome, in this case...

    • 5 Physicians’ Behavior Toward the Dying Patient
      (pp. 83-101)
      Louis Lasagna

      The behavior of the doctor toward his seriously ill patient is inevitably affected by the physician’s biases and prejudices about the patient and his disease. What are some of the important determinants of this behavior?

      One important variable is the age of the patient. Our society tends at present to worship youthfulness (although not immaturity) and to equate aging with mental and physical deterioration. There is no compelling reason to believe that physicians differ significantly from the lay public in their orientation to aging. Accordingly, one would anticipate that total medical care for the moribund young patient will be more...

    • 6 Innovations and Heroic Acts in Prolonging Life
      (pp. 102-128)
      Robert J. Glaser

      The removal of the heart from one person and its substitution for a diseased organ in another is an enormously dramatic procedure. It is not surprising that Christiaan Barnard’s first cardiac transplantation in man, performed in December, 1967, was one of the most highly publicized events of our time. While many applauded this medical first, there were those who expressed less enthusiasm, and a few were indignant because of the moral and ethical implications that were inevitably brought to the fore. To me, however, the fact that attention should be focused on certain extramedical considerations of heart transplantation in man...

    • 7 Patterns of Dying
      (pp. 129-155)
      Anselm L. Strauss and Barney G. Glaser

      Probably less than one-third of all deaths in the United States now take place outside of a hospital or other institutional setting. Changing health practices and medical technology seem destined to bring about still further institutionalization of dying. That people elect to die in such institutions—or that their families make such choices for them—means that outsiders to the family have been delegated responsibility for taking care of the dying during their last days or hours. This delegation of responsibility, whether partial or total, is of immense importance for everyone concerned: for patients, families, and for the hospital staffs....

    • 8 The Dying Patient’s Point of View
      (pp. 156-170)
      Elisabeth K. Ross

      A new look at our care for the terminally ill has been taking place in the past decade. Innumerable papers have been published on this subject and a new Foundation of Thanatology has been created during the past year. Most articles have been written by sociologists, psychologists, and psychiatrists, the majority dealing with a philosophical, ethical, or religious aspect of the problems of the dying patient. Some literature gives statistical information about the patient and staff reactions relating to the care of the dying. Little indeed has been written about the patient’s own expressions in this great crisis. The reasons...

    • 9 Consequences of Death for Physicians, Nurses, and Hospitals
      (pp. 171-190)
      David L. Rabin and Laurel H. Rabin

      All the doctors!—helpless Hies now, climbing across the granite face of death.” With these words John Gunther, inDeath Be Not Proud, describes his son’s doctors just before the boy, after a long and brave fight, dies of a brain tumor. In such circumstances, those who would cure have always been in the position of helpless Hies.

      The significance of “the granite face of death” has varied from age to age, however. Just as “no other epoch has laid so much stress as the expiring Middle Ages on the thought of death” (Huizinga, 1956: 138), no other epoch has...

    • 10 Dying in a Public Hospital
      (pp. 191-208)
      David Sudnow

      The question in the medical profession over the definition of biological death, Robert Glaser suggests, appears to have been resolved, practically speaking, in favor of the brain, rather than the heart or lungs, as the place where human life makes its last stand. Further, medical authorities have held that, in heart transplantations, the definition must be applied by qualified persons not associated with anyone who has something to gain from seeing the owner of that life dead. Thus, medicine has moved from the traditional to a modern understanding of death and meanwhile reaffirmed the high value that physicians, and Western...


    • 11 Dying as an Emerging Social Problem
      (pp. 211-224)
      Sol Levine and Norman A. Scotch

      It may appear paradoxical to concern ourselves with death and dying in a society as advanced as our own, in which the value placed on human life is high and where the possibilities for warding off death are relatively good. Clearly, the United States and other highly developed societies have made major strides in decreasing various forms of morbidity and mortality.

      Our secular society in recent years has emphasized death and dying only as something to be avoided. John Spiegel (1964:297) has explained this aversion to contemplation of death as a product of an American tendency to view death as...

    • 12 Control of Medical Conduct
      (pp. 225-252)
      Osler L. Peterson

      The contemporary physician who goes to a cocktail party is often showered with criticism: physicians are difficult to see, do not give their patients enough time, are opposed to Medicare, make too much money, and do not provide care in the ghetto. Such criticism contradicts objective evidence that Americans are getting more medical care than they ever had before. The modern, well-trained physician who is compared—it is scarcely necessary to addunfavorably—to an older doctor who made house calls in a Model-T Ford or even with a team of horses must feel that his problem is unique and...

    • 13 Legal and Policy Issues in the Allocation of Death
      (pp. 253-274)
      Bayless Manning

      Law is the major tool by which society translates its ethical value structure into action. In general correspondence to the value system currently prevailing within the society, a society’s legal order allocates resources among its members, distributes powers, privileges, and immunities among them, and accommodates the competing claims of its members. Moreover, through its laws the society establishes the acceptableproceduresby which disputes are to be resolved. The use of force as the determinant for resolving dispute is considered to be centered as a monopoly in the society’s institutions of law enforcement. The more developed and sophisticated a legal...

    • 14 Economic and Social Costs of Death
      (pp. 275-302)
      Richard M. Bailey

      Medicine, as a profession, has traditionally resisted efforts to relate death and conditions of illness to economic factors. Perhaps there have been good reasons for such a professional stance, since physicians typically have had more than enough to do caring for the ill without becoming embroiled in economic issues with which they had little familiarity.

      Today, however, physicians are being forced to recognize the impact that our economic system has upon the organization, delivery, and allocation of health services. To force controversy to the surface, one need only raise the question of why we devote so many of society’s scarce...

  9. CONCLUSION Dying and Its Dilemmas as a Field of Research
    (pp. 303-326)
    Diana Crane

    There seems to be general agreement among the authors of this volume that the nature of dying has changed qualitatively in recent years because of advances in medical knowledge and technology. A shift in the statistical frequencies of deaths toward chronic disease has taken place. This, in conjunction with increases in the sophistication of treatments capable of prolonging life, has had the effect of lengthening the average amount of time that elapses between the onset of a fatal illness and the termination of life. As a result, problems of dying that always have existed have multiplied. This contrasts with the...

    (pp. 327-380)
    Richard A. Kalish
  11. INDEX
    (pp. 381-390)