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Changes in health care have dramatically altered the experience of dying in America. 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 First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become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.

Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a \"legal transactional approach\" to a \"communications approach,\" the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients' goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients' wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice.

Individual physicians are widely believed to play a large role in patients' decisions about end-of-life care, but little empirical evidence supports this view. We developed a novel method for measuring the relationship between physician characteristics and hospice enrollment, in a nationally representative sample of Medicare patients. We focused on patients who died with a diagnosis of poor-prognosis cancer in the period 2006-11, for whom palliative treatment and hospice would be considered the standard of care. We found that the proportion of a physician's patients who were enrolled in hospice was a strong predictor of whether or not that physician's other patients would enroll in hospice. The magnitude of this association was larger than that of other known predictors of hospice enrollment that we examined, including patients' medical comorbidity, age, race, and sex. Patients cared for by medical oncologists and those cared for in not-for-profit hospitals were significantly more likely than other patients to enroll in hospice. These findings suggest that physician characteristics are among the strongest predictors of whether a patient receives hospice care-which mounting evidence indicates can improve care quality and reduce costs. Interventions geared toward physicians, both by specialty and by previous history of patients' hospice enrollment, may help optimize appropriate hospice use.

As the twentieth century began, Black and white southerners alike dealt with low life expectancy and poor healthcare in a region synonymous with early death. But the modernization of death care by a diverse group of actors changed not only death rituals but fundamental ideas about health and wellness. Kristine McCusker charts the dramatic transformation that took place when southerners in particular and Americans in general changed their thinking about when one should die, how that death could occur, and what decent burial really means. As she shows, death care evolved from being a community act to a commercial one where purchasing a purple coffin and hearse ride to the cemetery became a political statement and the norm. That evolution also required interactions between perfect strangers, especially during the world wars as families searched for their missing soldiers. In either case, being put away decent, as southerners called burial, came to mean something fundamentally different in 1955 than it had just fifty years earlier.

Nearly 40 years of work to improve end-of-life care has revealed the difficulty of aligning care with patients' needs and preferences to ease the dying process. The problem must be attacked at all levels, from individual rights to relationships to systemic reform. More than 2.5 million people die in the United States each year, most of them from progressive health conditions. Facing death is a profound challenge for patients, their relatives and friends, their caregivers, and health care institutions. Nearly 40 years of intensive work to improve care at the end of life has shown that aligning care with patients' needs and preferences in order to ease the dying process is surprisingly difficult — although there has been some incremental progress. Early optimism that the establishment of patients' legal and ethical rights to make decisions about their own care would lead to . . .

Over the past hundred years, average life expectancy in America has nearly doubled, due largely to scientific and medical advances, but also as a consequence of safer working conditions, a heightened awareness of the importance of diet and health, and other factors. Yet while longevity is celebrated as an achievement in modern civilization, the longer people live, the more likely they are to succumb to chronic, terminal illnesses. In 1900, the average life expectancy was 47 years, with a majority of American deaths attributed to influenza, tuberculosis, pneumonia, or other diseases. In 2000, the average life expectancy was nearly 80 years, and for too many people, these long lifespans included cancer, heart failure, Lou Gehrig's disease, AIDS, or other fatal illnesses, and with them, came debilitating pain and the loss of a once-full and often independent lifestyle. In this compelling and provocative book, noted legal scholar Howard Ball poses the pressing question: is it appropriate, legally and ethically, for a competent individual to have the liberty to decide how and when to die when faced with a terminal illness? At Liberty to Die charts how, the right of a competent, terminally ill person to die on his or her own terms with the help of a doctor has come deeply embroiled in debates about the relationship between religion, civil liberties, politics, and law in American life. Exploring both the legal rulings and the media frenzies that accompanied the Terry Schiavo case and others like it, Howard Ball contends that despite raging battles in all the states where right to die legislation has been proposed, the opposition to the right to die is intractable in its stance. Combining constitutional analysis, legal history, and current events, Ball surveys the constitutional arguments that have driven the right to die debate.

After a decades-long trend toward dying in the hospital, a movement toward palliative care, hospice, and dying at home began in the 1980s. But even as increasing numbers of Americans choose to die at home, ICU stays toward the end of life have increased. Until well into the 20th century in the United States, the appropriate place to die was a foregone conclusion: by expectation and practice, it was at home, surrounded by family and friends (Figure 1). A case in point was death from consumption (tuberculosis) in pre–Civil War New England. In tightly knit, homogeneous communities, a network of friends, neighbors, relatives, and clergymen comforted the dying, expecting, as Sheila Rothman has written, to walk with them “down to the borders of the River of death.” 1 Physicians, once they had ascertained that the disease was in its last stages, were peripheral to the . . .

Hospices have played a critical role in transforming ideas about death and dying. Viewing death as a natural event, hospices seek to enable people approaching mortality to live as fully and painlessly as possible. Award-winning medical historian Emily K. Abel provides insight into several important issues surrounding the growth of hospice care. Using a unique set of records,Prelude to Hospiceexpands our understanding of the history of U.S. hospices. Compiled largely by Florence Wald, the founder of the first U.S. hospice, the records provide a detailed account of her experiences studying and caring for dying people and their families in the late 1960s and early 1970s. Although Wald never published a report of her findings, she often presented her material informally. Like many others seeking to found new institutions, she believed she could garner support only by demonstrating that her facility would be superior in every respect to what currently existed. As a result, she generated inflated expectations about what a hospice could accomplish. Wald's records enable us to glimpse the complexities of the work of tending to dying people.

The AIDS crisis of the 1980s looms large in recent histories of sexuality, medicine, and politics, and justly so-an unknown virus without a cure ravages an already persecuted minority, medical professionals are unprepared and sometimes unwilling to care for the sick, and a national health bureaucracy is slow to invest resources in finding a cure. Yet this widely accepted narrative, while accurate, creates the impression that the gay community lacked any capacity to address AIDS. In fact, as Katie Batza demonstrates in this path-breaking book, there was already a well-developed network of gay-health clinics in American cities when the epidemic struck, and these clinics served as the first responders to the disease. Before AIDS explores this heretofore unrecognized story, chronicling the development of a national gay health network by highlighting the origins of longstanding gay health institutions in Boston, Chicago, and Los Angeles, placing them in a larger political context, and following them into the first five years of the AIDS crisis. Like many other minority communities in the 1970s, gay men faced public health challenges that resulted as much from their political marginalization and social stigmatization as from any disease. Gay men mistrusted mainstream health institutions, fearing outing, ostracism, misdiagnosis, and the possibility that their sexuality itself would be treated as a medical condition. In response to these problems, a colorful cast of doctors and activists built a largely self-sufficient gay medical system that challenged, collaborated with, and educated mainstream health practitioners. Taking inspiration from rhetoric employed by the Black Panther, feminist, and anti-urban renewal movements, and putting government funding to new and often unintended uses, gay health activists of the 1970s changed the medical and political understandings of sexuality and health to reflect the new realities of their own sexual revolution.

Hundreds of thousands of individuals perished in the epic conflict of the American Civil War. As battles raged and the specter of death and dying hung over the divided nation, the living worked not only to bury their dead but also to commemorate them. President Abraham Lincoln's Gettysburg Address perhaps best voiced the public yearning to memorialize the war dead. His address marked the beginning of a new tradition of commemorating American soldiers and also signaled a transformation in the relationship between the government and the citizenry through an embedded promise and obligation for the living to remember the dead. In Death at the Edges of Empire Shannon Bontrager examines the culture of death, burial, and commemoration of American war dead. By focusing on the Civil War, the Spanish-Cuban-American War, the Philippine-American War, and World War I, Bontrager produces a history of collective memories of war expressed through American cultural traditions emerging within broader transatlantic and transpacific networks. Examining the pragmatic collaborations between middle-class Americans and government officials negotiating the contradictory terrain of empire and nation,Death at the Edges of Empire shows how Americans imposed modern order on the inevitability of death as well as how they used the war dead to reimagine political identities and opportunities into imperial ambitions.