The Inevitable Hour

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. -- Julie A. Fairman, University of Pennsylvania 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. -- Alice Wexler, author of The Woman Who Walked into the Sea: Huntington's and the Making of a Genetic Disease 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.' -- Andrea Sankar, author of Dying at Home and editor of Medical Anthropology Quarterly

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.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 First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become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.