Ann J. Russ

“Is There Life on Dialysis?”: Time and Aging in a Clinically Sustained Existence

ABSTRACT Increasingly, in the United States, lives are being extended at ever-older ages through the implementation of routine medical procedures such as renal dialysis. This paper discusses the lives and experiences of a number of individuals 70 years of age and older at two dialysis units in California. It considers what kind of life it is that is being sustained and prolonged in these units, the meanings of the time gained through (and lost to) dialysis for older people, and the relationship of “normal” life outside the units to an exceptional state on the inside that some patients see as not-quite-life. Highlighting the unique dimensions of gerontological time on chronic life support, the article offers a phenomenology of the end of life as that end is drawn out, deferred by technological means, and effaced by the ethos and experiential course of dialysis treatment. ANN JULIENNE RUSS is a medical anthropologist and member of the research faculty at the University of California, San Francisco. Her research has focused on end-of-life care and communication among clinicians, patients, and their families in hospice and high-tech medical environments. Her publications have appeared in Cultural Anthropology and Culture, Medicine and Psychiatry. JANET K. SHIM is assistant adjunct professor at the University of California, San Francisco. Her research in medical sociology has focused on issues at the intersections of health inequalities, biomedical science and technologies, and race, gender, and aging. Her publications have appeared in Sociology of Health and Illness, American Sociological Review, and Social Studies of Science. SHARON R. KAUFMAN is professor of medical anthropology at the University of California, San Francisco. Her recent research explores life extension, technologies of dying, and subjectification in an aging society. She is the author, most recently, of … And a Time to Die: How American Hospitals Shape the End of Life (Scribner, 2005).

Late-Life Cardiac Interventions and the Treatment Imperative

The treatment imperative, say the authors, refers to the almost inexorable momentum towards intervention that is experienced by physicians, patients, and family members alike.

Clinical life: expectation and the double edge of medical promise

This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical possibility and clinical promise, and thus assume that life can and will be improved by medical intervention in late life. Rather than anticipating a range of potential treatment outcomes, patients therefore expect the best-case scenario: that medical procedures will reverse aging, disease and the march of time. Second, patients then assess the value of their post-procedure lives in accordance with that expectation. Norms regarding what life ‘should be like’ at particular ages are continually recalibrated to the horizon of what is clinically possible. And third, the price of living longer entails a double-edged relationship with the clinic – it generates opportunities for bodily restoration and increased self-worth but also creates ambivalence about the value of life. This latter feature of clinical life is rarely publicly acknowledged in an environment that emphasizes medical promise.