Whose Good Death? Understanding Inequality and the End of Life

TitleWhose Good Death? Understanding Inequality and the End of Life
Publication TypeThesis
Year of Publication2020
AuthorsHauschildt, KE
Academic DepartmentSociology
DegreeDoctor of Philosophy
UniversityUniversity of Michigan
CityAnn Arbor, MI
KeywordsDeath & Dying, Health Care, socioeconomic status

Traditionally disadvantaged groups are more likely to want life-sustaining treatments and are
the beneficiaries of greater spending and intervention at the end of life, yet these outcomes are
considered disadvantageous by clinicians and scholars. This dissertation investigates how
diverse individuals experience end-of-life health care, and how and when differences become
disparities. First, I use Health and Retirement Survey data to demonstrate racial and
socioeconomic differences in end-of-life preferences and decisions and demonstrate
preferences for more aggressive treatment are correlated with a lower likelihood of congruent
decisions. Second, I employ ethnographic and interview methods to examine communication
and decision-making about life-sustaining treatments and find that population-level inequities
arise through 1) clinical patterns of valuation and standardization in medicine, and
2) differences in institutional resources among hospitals that treat demographically different
populations. Collectively, my findings reinforce the need for a nuanced understanding of the
mechanisms that produce inequality when designing health care interventions focused on
alleviating disparities. Further, this research reveals how cultural tastes influence the clinical
valuation of treatments and provides clinicians and policymakers with strategies for improving
the health care experiences of disadvantaged groups.

Citation Key11231