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THIS POST BRINGS TO YOU SOCIOLOGICAL INSIGHTS  THAT MAY MAKE YOUR JOURNEY THROUGH LIFE, IF NOT EASIER, AT LEAST MORE INTERESTING…

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1 MY FIRST POST: THE MANAGEMENT OF DEATH.

*MY VIEW OF THE SUBJECT

(1) There is a great difference between death and dying in a private hospital, where fees are high and every item has to be paid for, and in a public (government) hospital.

When a friend’s mother went on life-support in a private hospital, she was asked bluntly if she had the means to pay for life-support for her mother! “Of course,” she replied, “please keep her on life-support until she awakes from her coma.”

Her mum didn’t come out of her coma, and died in spite of the life-support. The bill came to RM30,000, a HUGE SUM for most of us, but nothing to my friend.

When my own mother died, it was expected. After a massive stroke that left her in a coma, the specialist recommended no surgery on the understanding that she might not even survive surgery as she was 91 and frail. We concurred. The interesting fact is that she was pronounced dead in the following way:

(a) A nurse realized that the machines that monitored her heart and brain no longer gave any reading. This was in the wee hours of the morning.
(b) I received a telephone call, and realized at once that it was an emergency related to Mother. You normally don’t get a call from any hospital at that time of the night unless it is really serious. To my many questions, the caller had the same answer, “Come now and see for yourself.” That sounded OMINOUS!
(c) I was taken to Mother’s room. The nurse pointed to both machines, and asked. “Do you agree that there is no reading?” “Yes,” I replied. “Do you agree that she is dead?” Even as I replied, “Yes,” it occurred to me that I WAS THE ONE MAKING THE PRONOUNCEMENT OF DEATH!

The death of my mother was processed during the ‘graveyard shift’. Her bed was cleared, and probably occupied by another patient the very next day!

Very efficient. Efficiency in a private hospital equals money…

(2) My mother-in-law died in a hospital bed after a long period of illness marked by diabetes and kidney failure. From a 2-day stay every month, she eventually stayed 3-5 days a week, and then died in hospital while under the care of nursing staff.

The nursing staff were caring and patient. Mother-in-law was an ex-teacher (BM was her subject), and thus, a pensioner. All nursing staff treated her gently and lovingly. They would have known that she was dying slowly, but never rejected her. They allowed her the luxury of being in almost no pain in her last days.

When we received the call from the General Hospital at 4.00 a.m., we rushed over. We were led quietly to her bed, to allow us to say goodbye.

It was all done in the wee hours of the morning, on the ‘graveyard shift’, too.

They would need the bed next day, as in all government hospitals, but here, it was neither efficiency nor money that was the guiding principle.

THEY CARED.

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Rather than viewing death as natural, some sociologists look at the management of death, particularly in ‘homes’ and hospitals. Death in these places are more appropriately viewed as ‘social’ death.

A pioneer, if not the pioneer, in this area of social research, was David Nathan Sudnow.

Sudnow, David. Passing On: The Social Organization of Dying. Englewood Cliffs, New Jersey:
Prentice-Hall, 1967.

This is, in a very real sense, one of my major sources for seeing error in science.
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People look on death as an event; death is something that happens to someone. Thus, any idiot can recognize that death has occurred, and there is no difficulty in distinguishing death from life.
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What this book does is make one aware of the process of dying. This process is essentially social.
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It is the shared social definition of death that is enumerated by the coroner. The author spent time in two hospitals. One was a large, metropolitan, teaching hospital. The second was a small, midwestern, sectarian facility. In both settings Sudnow looked at the process of death and it turns out to be something quite different from what one assumes.
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Death, especially in the large hospital, is a function of those who define it. For example, most deaths are recorded in hospitals when the daytime shift has come to work. This does not mean that people die at 8 o’clock but that the death is recorded at that time because it is more convenient for the daytime staff to deal with death. It is difficult for the “graveyard shift” to deal with the paperwork involved. This has two consequences: some people die in the wee hours and are left in their beds until 8.
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Others, near death at day’s end, are wrapped early in a shroud and
declared dead. It is a matter of convenience to the staff. Put another way, death is a label. It is applied by the living to those who are, more or less, physically dead. Not all who are physically dead are labeled; and those who are so labeled are not necessarily physically dead.
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Consider another example observed by Sudnow: in the emergency room, the staff must judge whether or not to use heroic measures on a particular person. The judgment to use or not is a matter of the resources of the hospital: should they be spent on this person?
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The answer to that question is contingent on several factors which influence the “worth” of the patient. Thus, is the patient young? Is the patient worthy? Is the patient a drunk? Does the staff need practice? All these questions are judged not in the abstract but in the concrete physical setting of the emergency room.
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If one would understand who gets saved and who is allowed to die, it is imperative that one study the decision making processes which go on in an ER. The horror stories found in this book are marvelous illustrations of labeling theory and its use.
Sudnow, David. Passing On: The Social Organization of Dying …

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DAVID SUDNOW’S PASSING ON REVISITED

The Sociological Quarterly © 1998 Midwest Sociological Society

Abstract:

In his classic Passing On, David Sudnow described how the presumed social value of patients affects whether the staff will attempt to revive them. Since this study was published, the health care field has undergone dramatic changes and commentators have questioned whether the social rationing described by Sudnow is still relevant. Specifically, critics point to the increased rationalization of medical practice via protocols, a widely accepted resuscitation theory, and legal initiatives to promote resuscitative efforts and protect patient autonomy. Based on observations of 112 resuscitative efforts and interviews with forty-two health care workers, I demonstrate that the recent changes in the health care system did not weaken but instead fostered social inequality in death and dying.

David Sudnow’s “Passing On” Revisited – jstor

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David Nathan Sudnow (1961)

David Nathan Sudnow (1961) | UC Berkeley Sociology Department

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DAVID SUDNOW WAS NOT ONLY A SOCIOLOGIST BUT A MUSICIAN AS WELL….

Piano Lesson Guru David Sudnow on Fox Interview

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