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The Inevitable Hour

, 240 pages

3 b&w illus.

June 2017



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The Inevitable Hour

A History of Caring for Dying Patients in America


At the turn of the twentieth century, medicine’s imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients.

Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell’s Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience.

With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved—though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.

Emily K. Abel is professor emerita at the UCLA–Fielding School of Public Health. She is the author of many books, including After the Cure: The Untold Stories of Breast Cancer Survivors and Hearts of Wisdom: American Women Caring for Kin, 1850–1940.

"A powerful assessment of medicine's involvement with death and dying: a history highly recommended for any medical or ethical issues holding."

"Few libraries specializing in the history of medicine will not find this a valuable book to include in their collections."

"This is an important book that sets current debates over end-of-life care in their historical context, and reminds readers of the numerous historical decisions that shape the current situation."

"Abel's book is a strong and welcome addition to the historiography of death and dying."

"An invaluable contribution. Abel does an admirable job uncovering a topic that was mostly absent in the medical literature. She successfully highlights a striking consequence of medicine's curative paradigm while also recovering the vital work that family and faith performed to fill the gap left by medical professionals in the twentieth century."

"Lively and engaging. The Inevitable Hour offers a sensitive, patient-centered view of end-of-life experiences. Abel's gift for biography, of both the eminent and the obscure, provides a glimpse into a rich yet private world. It makes an important contribution to American medical history and to our understanding of human responses to suffering and adversity."

"Through her in-depth analyses of hundreds of letters, articles, and books from the mid-eighteenth century to 1965 in the United States, the author of this book provides a very sobering and enlightening perspective on the perennial challenge of caring for the dying and the history of medical science's own avoidance of it even while trying to treat it."

"The US way of dying is costly, conflicted, and confused, and apparently has long been so, according to Emily Abel’s deeply researched and carefully argued The Inevitable Hour ... The book is richly researched with an impressive range of documentation."

"Emily Abel’s thoroughly researched book steps into [a] broad historical narrative and gives context, detail, and definition."

"While the work's narrative structure makes it ideal to read as a whole, each chapter could be excerpted in both upper- and lower-level classes in history, health policy, bioethics and religion. The work's accessible style makes it accommodating to undergraduates and laypeople, while its rigorous, inventive methods and ambitious claims ensure its value for scholars... Ultimately, Abel's book is of great importance to not only historical scholarship but also contemporary bioethics and health policy."

"With breadth and compassion, Abel presents a historical moment in health care through the lens of dying patients and their families, and, as such, contributes to our understanding of our modern ethos of medical treatment and medical failures."

"With the immediacy of a novelist and the critical insights of a historian, Emily Abel offers a sobering reinterpretation of medical history from the perspective of the dying. Intimate, eye-opening, and altogether engrossing, The Inevitable Hour should change how we live as well as how we die."

" The Inevitable Hour is as much a history of medical care as it is a cultural history of dying in the United States. Through careful and creative scholarship, Emily Abel critically explores key misconceptions in the understanding of care for the dying and undermines the assumptions supporting each. The book clearly documents that disparities exist for the disadvantaged in dying as well as in health status and access to health care. Because many deaths prior to Medicare legislation in 1965 occurred in settings rarely characterized by advances in medical care or in private homes, scholars have paid scant attention to this essential time of life. Abel has remedied that lack. Her work is timely and of considerable import for policy makers, scholars, and the general public as the population continues to age and increasing numbers of the baby boomer generation confront their ‘Inevitable Hour.’"

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