Abstract
This dissertation explores the practices of a palliative care team in a tertiary hospital in South Korea. A tertiary hospital is an institution where patients with life-threatening diseases come with an expectation of recovery. Due to its mission as an acute care institution and its profit-seeking nature, a tertiary hospital is regarded as an unsuitable place for death. In particular, after a legal case in 1997, Korean doctors were extremely reluctant to stop treatments and, consequently, patients were forced to receive aggressive life-saving measures until the end. The ethnographic research for this dissertation was conducted in a terminal-cancer ward of S Hospital in Seoul, between 2016 and 2018, during the time in which a new law that finally permitted the withdrawal of life-sustaining treatment was introduced into the clinical setting.
Drawing upon this timely fieldwork, I explore the ways in which the palliative care staff endeavors to ensure their patients experience a good death in a tertiary hospital where death is marginalized. First, the legalization of treatment cessation brought into being a new way of dying—in hospitals—that had not officially existed previously in Korea. In order to institutionalize this form of dying within the hospital system, the palliative care staff members take into consideration all the delicate and diverse moral, technological, temporal, and spatial conditions necessary for good dying, in all their unpredictable variety. Second, within a medical system, when the terminal stage of cancer is declared, a sick body is transformed into a dying body. In contrast to this disease-centered configuration of terminal stage cancer, the patients and their families understand this time within their own life histories. Between these two ways of understanding the terminal stage, the palliative care team members negotiate the contested meaning of natural death, struggle to move up the timing of the activation of terminal stage, and strive to make their patients’ end of life meaningful. Third, because of the political-geographic inequity of the health care infrastructure, the marginalization of palliative and hospice care, and the profit-seeking nature of hospitals, terminal-stage patients are supposed to move to another place for dying, although they are not always able to do so. In part, the palliative care staff members carry out this displacement as hospital employees, but they struggle to arrange their patients’ destinations along with their criteria for good dying—painlessness, family presence, and love. Finally, I define the nature of the care of the palliative care staff as relational-generative care. Through trivial and small actions, the nurses and volunteers not only aim to strengthen family relationships but also generate new relations by linking isolated patients and family members to the palliative care team, to the local community, and to others.
