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Example research essay topic: Terminally Ill Patients Medical Profession - 2,154 words

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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 medicalisation thesis will be given and illustrated by the case of the treatment of terminally ill patients. The medicalisation of death and dying will be highlighted by a review of sociological literature from both feminist and non-feminist perspectives. The limits of medicalisation will be provided as a rationale for the resistance of the medical model. Finally, the ways in which individuals negotiate and resist the medicalisation 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, discernable 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 marginalisation 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 medicina 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' (Button 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 zus (1964) believed that treatment of the mentally ill by drugs and electroconvulsiv 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 medicalisation is a more effective way of controlling deviance than legal punishment (Scampbler, 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 medicalisation 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 replacement 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 new for padding and pampering' (Taylor and Field, 1997 p 56) > Victor (1993) describes death in Britain as a highly medical ised 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 medical ised 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 4 d 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 independant can avoid the medicalisation of the end of life (Illich, 1976).

There is a popular misconception that by giving in to hospitalisation 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 medical ised 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 transferred has removed the responsibility of death from the largely feminine sphere of lay caring in the hom to the largely masculine sphere of professionals 9 Littlewood, 1994). Only (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 hospitalisation of many dying individuals rather than the process of medicalisation. 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 (Small, 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 hospitalisation 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) aliens 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 medicalisation 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 (Given, 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 mans 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 (Rachel's, 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 doctors: superior professional knowledge and altruistic intentions... warrant acting for a patients 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 described later. Feminist sociologists would argue this breakdown in the doctor-patient relationship is far more pronounced for female than for male patients. Physician...


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Research essay sample on Terminally Ill Patients Medical Profession

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