Process Of Increased Medical Intervention Into Areas example essay topic

Critical evaluation of: whether medical explanations predominate and how individuals negotiate and resist the medical model. In order to illustrate the predominance of medical explanations, a definition of the thesis will be given and illustrated by the case of the treatment of terminally ill patients. The of death and dying will be highlighted by a review of sociological literature from both feminist and non-feminist perspectives. The limits of will be provided as a rationale for the resistance of the medical model. Finally, the ways in which individuals negotiate and resist the of death will be discussed including the rise of pro-euthanasia groups, increasing use of complementary medicine, and the popularity of the hospice movement.

The main elements of the medical model of health are the search for objective, discern able signs of disease, its diagnosis and treatment (Biswas, 1993). Therefore, by adhering to this reductionist view, the human body is seen as a biochemical machine (Turner, 1995) and health merely as an absence of disease, a commodity to be bought and sold. The rise of hospitals with their goal of curing and controlling disease has led to the marginalization of lay medicine, and a focus upon the individual rather than society as a cause of ill health. Health education and promotion with their focus upon 'victim blaming' and individualism have extended the remit of the medical profession from the hospital into the community. With medical imperialism the power of medicine has grown and medicine has all but replaced religion as an institution of social control. Illich (1976, p 53) describes medicine as a: 'moral enterprise... [which] gives content to good and evil... like law and religion [it] defines what is normal, proper or desirable'.

Medicalisation is defined as:' a process of increased medical intervention into areas that hitherto would be outside he medical domain' (Bilton et al, 1996 p 422). Areas of life which could be considered 'natural's uch as pregnancy, childbirth, unhappiness, ageing and death have been brought within the medical remit (Taylor & Field, 1997) and therefore are increasingly viewed under the principles of the medical model. Indeed many of these 'ailments' cannot be cured by medical intervention but are still subjected to the 'medical gaze's zas z (1964) believed that treatment of the mentally ill by drugs and therapy was not only unnecessary but a violation of human rights (cited in Scambler, 1991). Social problems such as child abuse, violence and alcoholism have become redefined as medical problems as is a more effective way of controlling deviance than legal punishment (Scambler, 1991).

The medical profession have claimed victory over the eradication of many acute infectious diseases although critics would argue advances in social conditions and nutrition were more instrumental. People are now living longer and their expectations of health have changed. Whatever the cause, the pattern of disease has altered with the acute killers of the past being replaced with chronic long-term, often degenerative diseases for which there are no cures. The effect of the of increasing areas of life has increased the power of the medical profession and relatively decreased the power of their patients.

Ther has been a: 'stripping away from human culture of ways of coping with pain, birth and death and their by a sanitized technological medical intervention against which individuals and society are unable to fight back' (Jones, 1994 p 456). Zola (1972 cited in Armstrong, 1989) maintains that this causes a loss of autonomy, creating passive patients who conform to whatever the medical profession dictate. This is damaging because: 'not only is the process masked as a technical, scientific, objective one, but one done for our own good' (Jones, 1994 p 456). Illich claims that this process has undermined our ability to cope with the normal human condition and that we can no longer accept suffering as inevitable: 'every ache is an indication for a need for padding and pampering' (Taylor and Field, 1997 p 56) Victor (1993) describes death in Britain as a highly event. Due to the 1836 Births and Deaths Registration Act, a doctor is required to certify both death and the underlying causes. The majority of deaths now occur in a medical context be it a hospital ward, under General Practitioner supervision or in an accident and emergency unit (Bradbury, 1993).

Death has become a medical event studied by medical sociologists and even bereavement has become by its association with medically trained psychiatrists rather than academic psychologists (Walter, 1993). In the United Kingdom a bereaved person is more likely to visit their family doctor for assistance than any other professional (Walter, 1999) and there is a tendency to prescribe pills rather than give supportive care to the grieving (Fennell et al, 1988). It has become much less common to say that an elderly person has died of 'old age' but rather a set of medically defined signs and symptoms (Ahmedzai, 1993). 'Death has pale 4d into a metamorphic al figure and killer disease has taken his place' (Illich, 1976 p 199). In the past, the typical death bed scenario was a family concern where loved ones gathered around the dying individuals to make their peace in the final hours (Hoefler and Kamoie, 1994). However, in recent times the death bed is typically found in a hospital or long-term medical facility.

Over 70% of deaths today in urban areas take place in hospitals (Fennell et al, 1988) whereas in 1900, 80% of all deaths occurred in the home (Hoefler and Kamoie, 1994). Whilst most people are pushed into institutions, the home becomes increasingly inhospitable to those who elect to hang on, only the very rich and vert in dependant can avoid the of the end of life (Illich, 1976). There is a popular misconception that by giving in to hospitalization pain will be reduced and changes of longevity increased, Illich (1976 p 112) denies that this is so: 'of those admitted with a fatal condition to the average British clinic 10% died on the day of arrival, 30% within a week, 75% within a month and 97% within three months... In terminal cancer there is no difference in life expectancy between those who end their days in a home and those who die in the hospital'. The Voluntary Euthanasia Society (1999) state that at least 5% of terminal pain cannot be fully controlled and Kearl (1999) reveals that one half of conscious patients who died in hospitals reported moderate to severe pain at least one half of the time. Religious interest in the process of dying has been undermined as medicine replaced its presence at the death bed (Walter, 1999).

This destruction of the typical scenario has resulted in terminally ill patients being physically and emotionally removed from their families. By denying the community the opportunity to care for their dying, the medical profession have successfully death. When death took place within the home, the sick and the dying were the responsibility of the family, this responsibility has now been transferred to intermediaries in the form of medical professionals, funeral directors and solicitors (Clark, 1993). Feminist writers argue that this transfer ral has removed the responsibility of death from the largely feminine sphere of lay caring in the him to the largely masculine sphere of professionals 9 Littlewood, 1994). Oakley (1979) reiterates this de-feminization of death and adds that it is women who still do the: 'bulk of the often dirty and demanding care of the dying' in their roles as nurses and lay carers (cited in Walter, 1993).

Of those fortunate enough to remain in the home, approximately 75% are cared for by a female relative (Abbott and Wallace, 1990). However, the alternative argument suggests it is changes in wider society itself that have resulted in the hospitalization of many dying individuals rather than the process of. Changes in the structure of families along with geographical and social mobility have resulted in many people living alone or with their spouses. The eradication of the extended family has reduced the likelihood that their will be a carer available within the home when the elderly become sick (Seale, 1993). the increasing number of women in the workforce also me 4 ans that many women do not have the time, energy or financial resources to care for their ailing relatives in the demanding terminal phase (Field and James, 1993). It is also argued that due to falling death rates because of medical advances, and improvements in social conditions and nutrition, people are less accustomed to dealing with death. Death is becoming an increasingly elderly concern as two thirds of deaths are now associated with diseases of old age (Illich, 1976) and many people therefore feel removed from its presence.

Thus by seeking ways to avoid the distress associated with death we attempt to compartmentalize it, shut it away from view. The increasing trend of hospitalization for the dying may be merely a symptom of medical success rather then a deliberate attempt to exert power over all areas of life: 'death is characterised by fear and shame, people who are dying to provoke unease and embarrassment therefore it is seen to be appropriate that they are removed from the community to die in isolation' (Littlewood, 1993 p 70). Crowther (1993 p 113) a likens hospitals to top security prisons as: 'both institutions are looking after a section of the community which society as a whole does not wish to be involved with'. Other sociologists argue that the process of has resulted in a change in the way death is perceived. Once a natural event, death is now seen as a failure of technology and science: 'something that ought not to have happened and which people find more difficult to accept and come to terms with' (Taylor and Field, 1997 p 56).

It is seen as the end of an individual life rather than, as in traditional societies, a process of renewal of the generations (Givens, 1997). The apparent obsession with death prevention stems from the medical profession viewing death, even when it is by no means premature, as a failure of their science and skill in what Kearl (1999) describes as the: 'stone age ethics of space age medicine'. As a result new invasive sophisticated procedures have been developed in order to maintain life. Although to some these technological advances are invaluable, to others they are potentially destructive. This: 'therapeutical relentlessness in its commitment to the preservation of life... has come to symbolism a prototypically modern form of torture combining benevolence, indifference and technological wizardry' (Hoefler and Kamoie, 1994 p 82).

Illich (1976, p 106) states:' the line separating the physician from the mortician has been blurred. Beds are filled with bodies neither dead nor alive'. The aggressive over treatment of the terminally ill is something of a new phenomena. Pneumonia, the 'old man's friend' was often the cause of many frail patients' demise, however with use of antibiotics this condition can now be remedied with the result of, in some cases, denying the patient a quiet and speedy death (Kennedy, 1990). More sophisticated technology has led to the power to:' keep almost anybody alive indefinitely... without thought of feeling, or hope of recovery' (Rachels, 1986 p 106). 'Doctors have a tendency to strive or longevity rather than quality' (Kennedy, 1990 p 26).

Robert Blank (1988 cited in Hoefler & Kamoie, 1994) has devised a title for this: 'the technological imperative'. The power of the medical profession and dominance of hospital medicine have resulted in the concentration of death within the hospital where the form of care previously described is often inappropriate for terminal patients (Victor, 1993). More sophisticated and invasive medical procedures persistently alienate the patient from the physician. New diagnostic techniques have distanced the doctors from their patients and their felt experiences thus:' medical training produces a collection of caretakers that are best described as strangers and mechanics rather than friends and humanists' (Hoefler & Kamoie, 1994 p 79). It is alleged that medical technological progress has left behind the necessary skills of communication and that: 'understanding attitudes have not advanced or even kept pace... they have been sacrificed in the name of progress' (Crowther, 1993 p 115). This inadequate training coupled with a strict allegiance to the 'technological imperative' has led to the breakdown of the patient-doctor relationship.

Thompson (1993 p 111) describes the situation as 'paternalistic benevolence' where the doctor's:'s uperior professional knowledge and altruistic intentions... warrant acting for a patient's best interest without fully informing the patient of the nature of the diagnosis or treatment'. Perhaps this has resulted in an increasing number of individuals opting to resist the medical model in ways to be de scr i bed later. Feminist sociologists would argue this breakdown in the doctor-patient relationship is far more pronounced for female than for male patients. Physicians, more frequently male, are trained by a:' medical culture which emphasizes and highlights the health problems of women, thereby constituting women as patients... women's disorders are characteristically conceived to be psychogenic in character relating to women's neurotic behaviour (Turner, 1995).

As women have a longer life expectancy than men (Mulkay, 1993) they often outlive their partners thus are statistically more likely to require more medical support in later life. Thus women are increasingly the victims of the drawbacks of already mentioned. In addition, it has been discovered that adult men of working age receive more attention from hospital staff and are more likely to be told their terminal diagnosis than women (Field et al, 1997). An elderly woman's chances of being institutionalized are also far higher than that of men and the differential increases with age (see appendix 1).

Elderly women in Britain have a 55% higher chance of ending their days in an institutional home (Arber & Ginn, 1991). Men are much more likely to die in their homes with comfort from a female lay carer and as a result are less likely to lose their independence and feelings of self-identity. Illich (1976) advocates a resistance to the medical dominance over all areas of life, and encourages people to take responsibility for their own health care. It is important to view death as a natural process rather than a pathological condition in order to avoid the 'social death' that results in the alienation and of the terminally ill (Taylor & Field, 1997). As a reaction to a number of groups have developed which actively reject medical lifesaving interventions in their terminal phase:' for them a good death is one where the only medical intervention that takes place is that of pain relief' (Bradbury, 1993 p 70). This is an example of individuals attempting to wrestle back control from the medical system.

The rise of the 'right to die' movement is indicative of people's willingness to:' challenge the neglect and poor quality of service available in many traditional hospital settings' (Fennell et al 1988 p 168). In recent years this attitude has developed with the emergence of many pro-euthanasia groups including: Euthanasia Research and Guidance Organisation (ERGO); Voluntary Euthanasia Society (VES-UK); Choice in Dying, Hemlock Society (USA) and Dying with Dignity (Canada) all advocating the rights of the terminally ill to have control over their death. In a study concerning reasons why patients requested euthanasia, dependency and loss of autonomy were mentioned in 33% of cases (Dunlop & Hockley, 1998). The Voluntary Euthanasia Society (1999) states that:' requests for euthanasia may indicate not that the patients are giving up in the face of suffering but that they are positively asserting their desire to control events'.

It would appear that the medical professions obsession with hiding the true nature of a patient's condition 'for the patient's own good' is prompting patients to take matters into their own hands. Hoefler & Kamoie (1994 p 95) found that:' 60 - 90% of physicians would still rather withhold information about the condition of terminally ill patients'. Women in particular are attempting to regain control from the medical profession of the formerly feminine tasks of caring for the dying. 'The de-feminization of the power to define and control the management of death is being challenged and alternatives to male, hospital based technological approaches to terminal illness are being sought' (Littlewood, 1994). The advent of hospice care as an alternative to traditional hospitalization has been led by powerful women figures such as Dame Cicely Saunders.

The emphasis on palliative rather than terminal care can be construed as a battle against the medical establishment (Walter, 1999) in its preference for an holistic approach. The World Health Organisation (1990) has defined palliative care as:' the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal is achievement of the best possible quality of life for patients and their families' (WHO, 1990 cited in Dunlop & Hockley, 1998 p 2).

This definition appears to be more centred around emotional support for the dying and their family, an area sadly lacking in the typical hospital environment with its emphasis on the physical aspects of disease (fe nell et al, 1988). ' The authority of (male) clergy to define post-death care in a time when the concern with the spiritual destination of the deceased wanes, is being supplanted by that of (female) bereavement counsellors and befriend ers. A re-feminization of death is under way, led by women' (Walter, 1993 p 277). Cruse bereavement care is battling against the increasing of bereavement and was founded by Margaret Torrie, herself a widow (Field et al, 1997). It would appear that the re-feminization of dying and death is well-under way prompted by a dissatisfaction in the of these areas.

However, although challenging the of death in many respects, the hospice organisation has been criticised as offering only a limited number of places, and mainly concentrating on terminal cancer patients (Seale, 1993) although deaths from cancer only account for 26% of all deaths (Victor, 1993). Biswas (1993 p 132) maintains that: 'the recent expansion of the hospice movement has seen the increasing of hospice care' and that palliative care has become a part of general medicine and thus it is at the mercy of medical professionals rather than being a patient-led service. There is no denying the success of hospice care for many terminal patients but it would appear that 'creeping ' is having an effect on the quality of care these institutions provide. The rising popularity of complementary medicine for the terminally ill may also be seen as a reaction to dissatisfaction with. Techniques such as breathing exercises, muscular relaxation, meditation, visualization, massage, aromatherapy, acupuncture and spiritual healing are more often practised in hospices than within mainstream curative medicine establishments (Pietroni, 1993).

Once displaced by medical science, lay medicine is experiencing a re-emergence to provide hope and comfort for those the medics have failed. In conclusion it appears that the medical profession have successfully monopolised the process of dying and death. Society is becoming increasingly dependent upon the tenets of the medical model although in many areas its contribution to well-being is refuted. With advancements in medical technology and new sophisticated invasive procedures a number of terminal individuals are being kept alive long after all meaning and quality of life have diminished. The inability to cure and control all ailments coupled with a therapeutical relentlessness which refuses to admit to failure has led to dissatisfaction with medical care of the dying. Feminist sociologists particularly are involved with wrestling back control over the process of dying from the medical professionals and seeking alternatives in the re-feminization of death.

The increasing use of complementary medicine would appear to be a response to this dissatisfaction as is the rising popularity of the hospice movement. Euthanasia would seem to be a topic that, as time goes on, is becoming increasing difficult to ignore, although vehemently opposed by the British Medical Association.