No matter where in Canada they occur, inquiries and inquests into untimely Indigenous deaths in state custody often tell the same story. Repeating details of fatty livers, mental illness, alcoholic belligerence, and a mysterious incapacity to cope with modern life, the legal proceedings declare that there are no villains here, only inevitable casualties of Indigenous life. But what about a sixty-seven-year-old man who dies in a hospital in police custody with a large, visible, purple boot print on his chest? Or a barely conscious, alcoholic older man, dropped off by police in a dark alley on a cold Vancouver night? Or Saskatoon’s infamous and lethal starlight tours, whose victims were left on the outskirts of town in sub-zero temperatures? How do we account for the repeated failure to care evident in so many cases of Indigenous deaths in custody? In Dying from Improvement, Sherene H. Razack argues that, amidst systematic state violence against Indigenous people, inquiries and inquests serve to obscure the violence of ongoing settler colonialism under the guise of benevolent concern. They tell settler society that it is caring, compassionate, and engaged in improving the lives of Indigenous people – even as the incarceration rate of Indigenous men and women increases and the number of those who die in custody rises. Razack’s powerful critique of the Canadian settler state and its legal system speaks to many of today’s most pressing issues of social justice: the treatment of Indigenous people, the unparalleled authority of the police and the justice system, and their systematic inhumanity towards those whose lives they perceive as insignificant.
When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."
This book celebrates the great stripping process of aging, dying and spiritual awakening. Beautiful, poignant, at times humorous, transcendent, messy, down to earth, refreshingly honest--the book explores death, and more importantly, being alive, through a rich mix of personal stories and spiritual reflections. Joan writes about her mother's final years and about being with friends and teachers at the end of their lives. She shares her own journey with aging, anal cancer, and other life challenges. She explores what it means to be alive in what may be the collapse of civilization and the possible extinction of life on earth due to climate change. Pointing beyond deficiency stories, future fantasies, and oppressive self-improvement projects, Joan invites an awakening to the immediacy of this moment and the wonder of ordinary life. She demonstrates a pathless path of genuine transformation, seeing all of life as sacred and worthy of devotion, and finding joy in the full range of our human experience.
This “comforting…thoughtful” (The Washington Post) guide to maintaining a high quality of life—from resilient old age to the first inklings of a serious illness to the final breath—by the New York Times bestselling author of Knocking on Heaven’s Door is a “roadmap to the end that combines medical, practical, and spiritual guidance” (The Boston Globe). “A common sense path to define what a ‘good’ death looks like” (USA TODAY), The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own “good death” more likely. Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with them, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event. This handbook of preparations—practical, communal, physical, and spiritual—will help you make the most of your remaining time, be it decades, years, or months. Based on Butler’s experience caring for aging parents, and hundreds of interviews with people who have successfully navigated our fragmented health system and helped their loved ones have good deaths, The Art of Dying Well also draws on the expertise of national leaders in family medicine, palliative care, geriatrics, oncology, and hospice. This “empowering guide clearly outlines the steps necessary to prepare for a beautiful death without fear” (Shelf Awareness).
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.
Structures of Indifference examines an Indigenous life and death in a Canadian city and what it reveals about the ongoing history of colonialism. In September 2008, Brian Sinclair, a middle-aged, non-Status Anishinaabe resident of Winnipeg, arrived in the emergency room of a major downtown hospital. Over a thirty-four- hour period, he was left untreated and unattended to, and ultimately died from an easily treatable infection. McCallum and Perry present the ways in which Sinclair, once erased and ignored, came to represent diffuse, yet singular and largely dehumanized ideas about Indigenous people, modernity, and decline in cities. This story tells us about ordinary indigeneity in the city of Winnipeg through Sinclair’s experience and restores the complex humanity denied him in his interactions with Canadian health and legal systems, both before and after his death.
Although the need for improved care for dying patients is widely recognized and frequently discussed, few books address the needs of the physicians, nurses, social workers, therapists, hospice team members, and pastoral counselors involved in care. Care of the Dying Patient contains material not found in other sources, offering advice and solutions to anyone—professional caregiver or family member—confronted with incurable illness and death. Its authors have lectured and published extensively on care of the dying patient and here review a wide range of topics to show that relief of physical suffering is not the only concern in providing care. This collection encompasses diverse aspects of end-of-life care across multiple disciplines, offering a broad perspective on such central issues as control of pain and other symptoms, spirituality, the needs of caregivers, and special concerns regarding the elderly. In its pages, readers will find out how to: effectively utilize palliative-care services and activate timely referral to hospice, arrange for care that takes into account patients’ cultural beliefs, and respond to spiritual and psychological distress, including the loss of hope that often overshadows physical suffering. The authors especially emphasize palliative care and hospice, since some physicians fear that such referrals may be viewed by patients and families as abandonment. They also address ethical and legal risks in pain management and warn that fear of overprescribing pain medication may inadvertently lead to ineffective pain relief and even place the treating team at risk of liability for undertreatment of pain. While physicians have the ability to treat disease, they also help to determine the time and place of death, and they must recognize that end-of-life choices are made more complex than ever before by advances in medicine and at the same time increasingly important. Care of the Dying Patient addresses some of the challenges frequently confronted in terminal care and points the way toward a more compassionate way of death.
This study presents an evaluation of the past, present and future of suicidal behaviour and efforts to prevent or facilitate suicide. Authors from the varying disciplines of psychology, sociology and psychiatry analyze suicide in the opening chapters. Through the exploration of the roles of these disciplines, the roles of primary physicians, and the impact of suicide prevention education in schools, the contributors describe the history of suicidology and the changes necessary for improvement. The book concludes with a section detailing the goals and activities of organizations designed to prevent or facilitate suicide.