The modern hospice movement began in the 1960s as a response to the rationalization of care for the dying. Ironically, however, hospice organizations have themselves become increasingly rationalized over time, with the advent of Medicare certification and conventional accreditation practices. Despite this, contemporary hospice practitioners must still attempt to follow the holistic philosophy which originally made hospice unique. Thus, they encounter a dilemma of trying to enact an alternative philosophy while being tied to the conventional. This dissertation is a case study of a hospice organization in the Southeastern United States ("Hometown Hospice"). I use observational and interview data to illustrate the rationalization process and discuss its consequences for hospice practitioners. I show how the attempt to follow an alternative medical philosophy while also pleasing regulatory bodies created mixed messages for front-line workers at this organization. Next, I discuss how the workers used humor to manage the unpleasant emotions that resulted from this dilemma. I then discuss how Hometown Hospice perpetuated racial and class inequalities common throughout health care, despite their interdisciplinary team approach to fulfilling the philosophy of holistic care. I conclude with a discussion of other sites where the dilemma between philosophy and expected practices occurs.
| Identifer | oai:union.ndltd.org:NCSU/oai:NCSU:etd-06172003-165404 |
| Date | 18 June 2003 |
| Creators | Monahan, Molly Bernice |
| Contributors | Maxine P. Atkinson, Amy G. Halberstadt, Maxine S. Thompson, Michael L. Schwalbe, Barbara J. Risman |
| Publisher | NCSU |
| Source Sets | North Carolina State University |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://www.lib.ncsu.edu/theses/available/etd-06172003-165404/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to NC State University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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