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

Abstract

.eduSharon 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). Contact information: Institute for Health and Aging, Box 0646, University of California, San Francisco, 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 notquite-life. Highlighting the unique dimensions of gerontological time on chronic life support, the article

Healthcare Intensity at Initiation of Chronic Dialysis among Older Adults

“…9,19 While current guidelines recommend timely discussion of treatment options in the outpatient setting, 20 our results demonstrate that in a sizable number of patients, the decision to initiate chronic dialysis is made in the context of severe acute illness and in concert with decisions about other intensive procedures intended to prolong life, such as mechanical ventilation, feeding tube placement, and CPR. Moreover, patients who receive more intensive care around the time of dialysis initiation are more likely to follow more intensive patterns of health care utilization in the future.…”

“…Available data suggest that dialysis is often presented to patients as a "necessity" rather than as a true treatment "choice," 19 and when asked after the fact, many older patients express powerlessness about their decision to undergo chronic dialysis. 9,19 While current guidelines recommend timely discussion of treatment options in the outpatient setting, 20 our results demonstrate that in a sizable number of patients, the decision to initiate chronic dialysis is made in the context of severe acute illness and in concert with decisions about other intensive procedures intended to prolong life, such as mechanical ventilation, feeding tube placement, and CPR.…”

The value of “life at any cost”: Talk about stopping kidney dialysis

“…It is also explicitly described in their ruminations about treatment discontinuation-about those circumstances wherein it might be determined living no longer holds the worth that it once did, that it still should, or that life itself no longer justifies support. Previously, we noted that many older patients describe feeling suspended between life and death on dialysis (Russ, Shim & & Kaufman, 2005). Most patients, though, also express the desire to live, and continue dialysis despite their only dubious sense of having "chosen" the treatment in the first place.…”

Giorgio agamben and the spatialities of the camp: an introduction

“…22 How Israeli governments have gradually folded the sacralization of the Land of Israel into the reduction of the Palestinian people to homines sacri has also been analysed and commented upon from an Agamben point of view (Gregory, 2003(Gregory, , 2004a(Gregory, , 2004cEnns, 2004). In addition, Agamben's work has finally been a creative injection in research areas such as legal studies (Schûtz, 2000;Newman, 2004;Rosén, 2005) and social and cultural studies of science and medicine (Palladino, 2003;Cohn, 2004;Cresswell, 2005;Moreira and Palladino, 2005;Russ et al, 2005). The large volume of literature on Agamben includes of course valuable critique, with various degrees of sympathy.…”