No Place for Dying: Hospitals and the Ideology of Rescue
"Helen Chapple provides a relentless look at the sequestration of dying in hospitals from ordinary human experiences and from the work that is valued in hospitals. She lets us in on the special language and codes that nurses and physicians use when discussing patientsand also the nuanced expressions that rank a dying patient's position down the ladder of importance at a hospital. It shakes our confidence that hospice and palliative care have changed society's perception of and response to dying markedly. We are let into a world with both explicit and tacit understandings that 'more time alive' is all that matters, and into a world where consequences unfold because dying is not a reimbursable code. Thanatologists may conclude that a new Cicely Saunders is needed to face down the hospital culture of avoiding death and of sequestering dying from all else human. From Chapple's book we know, however, that the typical hospital physicians, nurses, administrators, coders, and other staff members argue for the marginalization of dying and of death in order that the hospital may do the work of life prolonging medicine that makes possible more time alive." —David Balk, Brooklyn College, associate editor for Death Studies"What makes an American hospital No Place for Dying? Helen Chapple offers a complex, multilayered reply that extends well beyond her ethnographic research methods to implicate bioethics, the wider American culture, and health care economics. She explains how rescue becomes a ritual that eventually entraps both patients and staff. The ritual begins by affirming the social value of the patient, but only at the cost of withdrawing recognition and affirmation as soon as the patient is relegated to the category 'dying.' She offers cogent observations on how the future hospital might continue the work of rescue where appropriate, while still affirming the full dignity and worth of those beyond rescue."  --Howard Brody, MD, PhD, Director, Institute for the Medical Humanities, University of Texas Medical Branch-Galveston; author of The Healer's Power and The Future of Bioethics"Chapple's focus on the organization rather than the case makes this book stand out. What she does with the institutional conditions of dying is something that only someone who has spent her life at the bedside, the hospice bedside, the ICU bedside, could possibly do. As an anthropologically trained insider, she uncovers the irresistible but invisible forces of ritual, ideology, power, and economics that condition dying in hospitals. Reading this book was a process of increasing understanding, like watching film develop before all cameras went digital. For me as a bioethicist, I actually become less frustrated with the frustrating situations, the deaths that one suffers to watch. It helps to understand why. It helps a lot. This is a rare book." --Mary Rorty, Center for Biomedical Ethics, Stanford University"The right to life is a hard right to refuse. No Place for Dying: Hospitals and the Ideology of Rescueis a text that discusses the legal place of the rights of the dying, the thought process behind these laws, and the position of modern medical facilities. The first chapters discuss situations where death is gauged between unavoidable and where rescue is successful. It then discusses the place of profit, and the drive to save lives in American culture. Finally, it analyzes culture and its own attitudes towards death. A complete and comprehensive text on the role hospitals play in death and dying,No Place for Dyingis a scholarly and thoughtful work that would do well in community and college anthropology collections." - Five Stars from Midwest Book Review"It is a thought provoking ethnography, which offers the argument that American hospitals are based on an imperative for heroic rescue and stabilization, leaving little room for dying in the space where rescue ends...The data collection effort appears to be extensive, including involvement with chaplains, physicians, nurses, therapists, and administrators, as well as observations on and offsite, including in-service activities, trainings, commemorations, retreats, and meetings on bereavement, ethics, policy, and planning...Chapple is clearly knowledgeable about death and dying in American hospitals and raises good questions and compelling points about hospital death."-Frances Norwood,Anthropological Quarterly"From time to time an author, speaker, teacher or advocate comes along who breaks through the rubble, denial, lack of leadership and unclear or non-existent values. This is one of those books and Helen Chapple is the right person to carry the message. The book is well organized and well written.  Skip nothing in the book and, when you finish it, read it again. Like the author, you need to claim or reclaim your prophetic responsibilities. Tell others. Share the message. Most of all, live (and die) the message."-Richard B. Gilbert, PhD, CT, Galesburg, IL, for the journalIllness, Crisis, and Loss"Readers familiar with the inner workings of hospital care will  instantly empathise with the ‘ritual’ described in all its guises in the  text. Chapple’s skill is in deploying such a description that raises  awareness of the tacit cultural agendas that influence clinicians’  practice. The stark point being made by Chapple is that dying patients  often undergo rescue needlessly and that even if the ritual permits  their re-labelling as ‘dying’ (considered, by the author, as a  ‘successful’ outcome of the ritual), there follows a disappointing lack  of co-ordinated clinical care to meet their and their loved one’s  particular needs at that crucial time. [Q]ualitative evidence of this  sort must be welcomed. Given the equal-ninth ranking of the US and  Canada on quality of death, according to the Economist Intelligence Unit  [1], Chapple’s analysis provides compelling evidence as to why this  might be the case. Whilst the academic reader will welcome the amount of  wider referencing and research that Chapple has used to develop her  thesis, it is to her credit that a non-clinical, lay reader will also  pick up this book and understand her points easily, thanks to the  skilful and coherent organisation and presentation of the complex  material she has chosen to study."- Milind Arolker, Sociology of Health and Illness"[S]he combined her study results with extensive supporting material  from relevant research to present a convincing case for her conclusions.  This is an aspect of the book that I particularly enjoyed—Chapple  thoroughly reviews the literature (references run to 20þ pages),  provides a theoretical view and makes it ‘‘real’’ with case studies. She  achieves a good mix of presenting hospital procedures with the human  results of those procedures. I highly recommend it and hope it reaches a  wide audience." -Jeanne Boland, Death Studies"Helen Stanton Chapple does a masterful job of portraying the ways that  rescue minimizes death and contributes to death denial in our culture.  In hospitals where almost every aspect of care has a code or label,  dying patients are uncategorized. Moreover, dying does not have an  International Classification of Diseases Clinical Modification, Ninth  Revision (ICD-9-CM) code. Clinicians in the acute care setting often  feel helpless when a person is dying and see themselves as being held  hostage to the dying instead of feeling a sense of honor. Acute and high  tech care can support vital signs and delay death, but it also promotes  the illusion that death can be infinitely postponed. Chapple argues  that society’s complacent confidence in its agents’ ability to perform  life-saving miracles distracts us from death’s inevitability. When  hospitalized dying patients are minimized, each member of society is  shortchanged." -Gerontologist"While rooted in an ethnographic study of staff in two quite different  hospitals, her analysis embraces insights into the roles of economics,  bioethics, the hospice and palliative care movement, and iconic American  cultural beliefs. This volume would be rewarding reading for any  student of American health care, including hospital administrators and  board members as well as clinicians and change agents frustrated by the  epidemic of over-treatment of hospitalized patients at the end of life.  This volume would be rewarding reading for any student of American  health care, including hospital administrators and board members as well  as clinicians and change agents frustrated by the epidemic of  over-treatment of hospitalized patients at the end of life.  Th[e] book is loaded with serious, intellectually strenuous material,  making some popular books on dying in America seem downright breezy by  contrast. Because Dr. Chapple is a good writer and her volume is well  organized, the book is dense only in the best sense. Most importantly,  clearly told patients’ stories and direct quotations from interviews  with those who cared for them keeps the analysis grounded in hospital  realities." -Patricia A. Murphy and David M. Price, Journal of Palliative Medicine