Sharon Kaufman
UCSF Medical Anthropologist Sharon Kaufman, PhD, has received the Millennium Book Award, one of the most prestigious honors bestowed by the Society for Medical Anthropology.
Kaufman is a professor of medical anthropology in the UCSF Institute for Health & Aging, the School of Nursing Department of Social and Behavioral Sciences, and the School of Medicine Department of Anthropology, History and Social Medicine.
The award is being given for her most recent book,
And a Time to Die: How American Hospitals Shape the End of Life, which examines the complex interactions between physicians, patients and families in end-of-life situations.
Aging, the focus of Kaufman's research, is of particular relevance at the start of 2008. This year marks the official beginning of retirement for the baby boomer generation. More than 3 million Americans will turn 62 this year and, over the next 20 years, 78 million people will join them as baby boomers age.
Kaufman teaches students in the fields of anthropology, sociology, gerontology, medicine, nursing, public health and social welfare. She has served on the UCSF Committee on Human Research and the Chancellor's committee investigating the Second World War radiation experiments conducted on patients at UCSF Hospital.
"We are immensely fortunate to have one of the world's most eminent medical anthropologists working at UCSF and undertaking research which is providing vitally innovative insights into the complex interrelationships of clinical worlds and their cultural structures," said Dorothy Porter, PhD, professor and chair, Department of Anthropology, History and Social Medicine.
Kaufman's research over the past two decades has focused on aging in our society. Her published books include
The Ageless Self: Sources of Meaning in Late Life, an analysis of identity in late life, and
The Healer's Tale: Transforming Medicine and Culture, a collective biography of seven distinguished physicians.
"Dr. Kaufman's most recent book on the clinical world of the dying has received international acclaim," said Porter. "Kaufman's thesis has profound implications for clinical practice with terminal patients and is an equally valuable resource of understanding for families and patients. It is wonderful that we have Sharon's pioneering research and great scholarship available for our students and our community at UCSF."
Specifically,
And a Time to Die encapsulates Kaufman's research in public hospitals around the United States. "I realized after spending months in the hospital that timing is everything," said Kaufman. "There is a concern about the number of days a patient is in the hospital. Our fractured health care delivery system and our payment mechanisms drive a great deal about how patients and their families are processed through the hospital."
The Gray Zone
Kaufman examined what she refers to as the "gray zone," the period after which patients have undergone intensive care treatments to prolong their lives, but which now is a zone where decisions need to be made that will impact whether they live or die.
"The gray zone creates huge dilemmas for health care professionals and families," said Kaufman. "There is an overall tension around determining the moment to withdraw care. We want a humane end to life, yet don't want to end that life too soon."
According to Kaufman, even when advance directives from patients to end life have been signed, patients still often end up in this gray zone because physicians believe that the patients have come in for an acute incident and that they can take the patients through it, or because families are often unwilling to accept the responsibility of being the ones to end life.
At times, even patients may go against their own advanced directive. In
And a Time to Die, Kaufman cites an example of a woman who had signed an advanced directive to not resuscitate, but then changed her mind at the moment when she couldn't breathe.
"None of us filling out that form at home over a glass of wine can imagine what it would be like to not be able to breathe. The decisions you and I make now are largely hypothetical," said Kaufman.
If patients can no longer receive acute care at a hospital - because, according to Kaufman, they've timed out of the system but need life support and therefore cannot go to a nursing home - they often end up at institutions that are places where technology is a major factor in allowing for the prolongation of life, Kaufman found during her research.
"These look like a cross between acute care units and nursing homes," Kaufman said. "People can live there for a very long time - 15 years, 20 years - if no one makes the decision to stop care. As a society, this is one form of life that we have created to enable the lack of decision making around this gray zone to continue."
Looking Ahead
Kaufman's current primary area of research, supported by the National Institute on Aging, continues her commitment to analyzing health care delivery in an aging society. She is examining our rapidly aging society and the role that medical techniques play.
"I'm interested in life-prolonging technologies and procedures in the most elderly citizens of society," said Kaufman. "In particular, I'm examining the ways in which medical techniques link ethics to intervention and consumption, and how the substance of the body and its ever greater malleability become implicated in care, love and the understanding of value."
Formed in 1967, the Society for Medical Anthropology seeks to promote the study of the anthropological aspects of health, illness, health care and related topics. The organization is a section of the American Anthropological Association.
The Millennium Award is given to an author whose book is judged to be significant and influential in the field of medical anthropology.
Photo/Susan Merrell
Related Link:
Society for Medical Anthropology
