Tag Archives: mortality

Bobby Nieland: “Life and death”

I believe that my personal discovery of the field of medical anthropology, though occurring relatively late in my time at university, has nonetheless been one of the most influential aspects of the liberal arts education that I attained at UNC. And though the readings from my med anth classes reached far and wide in content, one text in particular from a class with Professor Rivkin-Fish continues to stand out with rippling effects in my life: …And a Time to Die. How American Hospitals Shape the End of Life by Sharon Kaufman.

Kaufman’s book grapples with a topic that is by its very nature innumerable shades of grey in every respect. How do we think about death? How do we think about others’, our own, as a concept, or as an acute reality? How are specific ways of dying created and promoted in the American hospital setting? What sociocultural, political, and economic factors play into creating these paths and guiding (or forcing) people along them? How much of the decision process do you want responsibility for, or do you think you should be responsible for, in another’s death? In your own? How do you want to die? When? Where? Why do people think they can ultimately have a real choice when it comes to these questions? I hadn’t honestly thought in depth about many of these ideas before coming in contact with Kaufman’s book. My major take away from the text: death is an invaluable discussion to have with friends and family during life and any time is the right time. In respect to life and death, I personally believe that ignoring the inevitability of the later can truly detriment one’s experience of the former.

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Hannah Friedman: “Flailing with Dignity: How the Medical Anthropological Lens Allowed Me to Interpret and Cope with My Grandmother’s Death”

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In October my grandmother died. I’m still not sure what to say Meme died from – she had early onset Alzheimer’s, but her technical cause of death was “failure to thrive.”

Meme was my mother’s mother. My mom spent the last few years of Meme’s life making frequent trips to upstate New York, where Meme lived in a retirement community not far from her home. Last summer, it became clear that it was best for her to move down to an elderly care community in Durham, North Carolina, where my parents live. In Meme’s final weeks, she moved in with my parents. There, my mother, father, and sister Jess took care of her. My mother has a background in community health and social work, my father is a primary care physician, and Jess is in medical school at Duke. Jess’ twin, Kait, and I visited from Philadelphia and New York City, respectively.

It is difficult for me to try to point out exclusive instances when my coursework in medical anthropology affected my experience of Meme’s death, because medical anthropology was the lens through which I experienced absolutely everything. Without this lens, I imagine I would have seen the process of Meme’s death as generally predetermined: this is just the way death happens. Yet medical anthropology taught me to look at each health narrative as distinctly subjective, complex, and unique. Readings and class discussions on dignity, the language of disease, patient agency, moral economies of health, and the politics of end-of-life care suddenly became very real, and even more complicated than I had imagined. Every tiny decision and interaction was a critical opportunity to explore how we – my particular family, in this particular time and place and culture, with this particular relationship to healthcare – attempted to make sense of and make peace with Meme’s illness. In this essay, I examine how medical anthropology as an intellectual tool for engaging with my grandmother’s death profoundly enriched my emotional and spiritual experience as a granddaughter, daughter, and sister.

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Peter Redfield on his latest book “Life In Crisis: The Ethical Journey of Doctors Without Borders”

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1. How did the idea for Life in Crisis: The Ethical Journey of Doctors Without Borders came about? What inspired you?

I had friends who had worked for Médecins Sans Frontières (MSF) so I’d heard about them for some time. I thought it would be an interesting subject in part because the phrase sans frontières — “without borders” — later became a tagline for globalization. Historically this is the group that popularized that expression, if with rather different aims than to open markets. The organization’s core movement in France began to engage a “borderless” world of sorts in the early 1970’s, imagining that doctors should be able to reach patients anywhere, overcoming all barriers. I wanted to look at what it means to practice medicine with this global ambition in mind: How to take biomedicine (i.e. the sort of healing taught in medical schools) and move it anywhere in the world and try to make it work.

I’d also just finished my first book and started to teach at UNC. I was meeting a lot of undergraduates who wanted to do something good in the world — to make a difference, to live a meaningful life. Whether they were actively thinking about it or not, many of them were likely going to work in the world of NGOs, nonprofits, etc. So I wanted to look at such engagement once you put it in practice, into motion. What happens when your great idea actually takes off?

While there have been lots of things written about MSF in French, at the time there was little in English, even at a journalistic level. There was not a great deal of analysis in an anthropological sense (although now there is much more). Over the last dozen years, global health has emerged as a key term. Even the School of Public Health changed its name! Looking at MSF is a way to try and think about global health, or one version of it in practice. To see it in motion over time, to see what it means to try to be global in the most literal sense of direct cross-border mobility as opposed to having “international” relationships in the nation-to-nation sense. Historically, one of MSF’s claims (which is exaggerated but has a kernel of truth) is that the group can go anywhere in the world in 48 hours. That’s the kind of infrastructure for emergency response they sought to realize, and to a certain extent they succeeded. They can go to most places in the world relatively quickly, and as long as everything cooperates — all the people and things — they can set up an operation. There’s a similar conception of the “global” in global health, which tends to focus on particular projects and campaigns as opposed to general system building in a given nation state (unlike the older international health). It likewise generally shares MSF’s secular, medical focus on “saving human lives”. This notion of biomedicine as a response to human suffering reveals complex technical and ethical issues, particularly when cast at a global scale.

I should also note that MSF is no longer really a French organization; it became European in the 1980s and has increasingly grown transnational. Indeed the French part is a minority at this point. The dominant language across MSF has increasingly become English, which is also the dominant language of aid, trade etc., often in an asymmetrical way. At the same time most people involved with the group believe strongly in human equality, value diversity and don’t want to mimic colonial empire. So there are several kinds of globalization at work, not all of which neatly line up. That’s anthropologically interesting.

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