Policies and practices near the end of life in the us: The ambivalent pursuit of a good death

In this chapter I will argue that these contradictions, and several more that I will describe in more detail below, reflect two prominent characteristics of American society. Many Americans place a very high value on control, and also lack widelY shared frameworks qf meaning within which to experience death and dying. These characteristics lead in turn to two forms of ambivalence in the face of death, that manifest themselves at the level of social policy. One is the all-out effort to forestall death, followed by an insistence on painless, quick death once curative efforts fail. The other is a view of hospice and palliative care that expects more of them than they can deliver (i.e., the perfectly managed death) even while the society refuses to fund them adequately in the competition for limited health care resources. Care for the terminally ill, in other words, provides an excellent opportunity to observe the interplay between cultural meanings, professional practices, and public policy, which is one of the major themes of this book.