Awareness of Dying

Description

This book is the first application of grounded theory. Only two years later did Glaser and Strauss publish The Discovery of Grounded Theory, a book on the methodology they developed while working on Awareness of Dying.When Strauss came to the medical school of the University of California, San Francisco, he looked for an interesting subject that would also get the attention of medical people. Visiting hospitals, he discovered that dying was a highly problematic issue.Strauss started field studies and six months later hired Glaser from Columbia University. Both researchers already had personal experience with the subject: Strauss had lost his mother and a friend in recent years, Glaser his father.Strauss and Glaser suspected early on that the expectation of death by both the dying and the relatives were a key to understanding the interactions between those people. Their choice of hospitals and stations allowed them to compare various kinds of expectations. On a premature infant station, mortality was high but the patients were not aware of their impending deaths, while on an oncology station, dying was slow and differences in the awareness of dying were very pronounced. The typical situations were again different for emergency rooms and geriatrics or pediatrics departments.Out of these field studies grew Awareness of Dying, a theory on the influence of awareness on the interaction with dying people. It differentiated between closed awareness, suspicion, mutual deception, and open awareness. The field studies had shown that the type of awareness had a significant impact on interaction — for instance, if patients were not aware of their dying, the nursing was often limited to the absolutely necessary in order to prevent open awareness.Should patients be told they are dying? How do families react when one of their members is facing death? Who should reveal that death is imminent? How does hospital staff—doctors, nurses, and attendants—act toward the dying patient and his family?Death, as a social ritual, is one of the great turning points in human existence, but prior to this classic work, it had been subjected to little scientific study. American perspectives on death seem strangely paradoxical—the brutal fact of death is confronted daily in our newspapers yet Americans are unwilling to talk openly about the process of dying itself. Awareness of Dying, using a highly original theory of awareness, examines the dying patient and those about him in social interaction, it gives us a language and tools of analysis for understanding who knows what about dying, under what circumstances, and what difference it makes.The authors use their finely detailed observations to develop theoretical constructs that will be of use in many other interactions and situations. Awareness of Dying was the first study of dying in hospitals, and has proven a useful handbook for chaplains, social workers, nurses, and doctors in confronting the many ethical and personal problems that arise in the dying situation. Now available in paperback, it is destined to reach new audiences interested in this key part of all life.