Rationality Unveiled: Philosophy and Practices in a Hospice Organization

Abstract

The modern hospice movement began in the 1960s as a response to the rationalization of care for the dying. Ironically, however, hospice organizations have themselves become increasingly rationalized over time, with the advent of Medicare certification and conventional accreditation practices. Despite this, contemporary hospice practitioners must still attempt to follow the holistic philosophy which originally made hospice unique. Thus, they encounter a dilemma of trying to enact an alternative philosophy while being tied to the conventional. This dissertation is a case study of a hospice organization in the Southeastern United States ("Hometown Hospice"). I use observational and interview data to illustrate the rationalization process and discuss its consequences for hospice practitioners. I show how the attempt to follow an alternative medical philosophy while also pleasing regulatory bodies created mixed messages for front-line workers at this organization. Next, I discuss how the workers used humor to manage the unpleasant emotions that resulted from this dilemma. I then discuss how Hometown Hospice perpetuated racial and class inequalities common throughout health care, despite their interdisciplinary team approach to fulfilling the philosophy of holistic care. I conclude with a discussion of other sites where the dilemma between philosophy and expected practices occurs.