Dying in and out of place: The American hospital as a setting for end-of-life care

Hospitals are sites where people give and receive care, seek cures and practice biomedical science. They are also places where we confront the limits of this science. Public discourse and healthcare policies have created a binary between 'good' home deaths and 'bad' institutional deaths, but very little research has examined how the physical, relational, and affective experiences of these places shape end-of-life experiences. In this essay, I use concepts of space and place to explore the American hospital as a setting for final care. I draw on interviews with 11 members of the inpatient palliative care team at Yale New Haven Hospital to describe how comfort-focused care is 'out of place' within a hospital setting designed for the delivery of acute and curative treatment. I reveal how palliative care clinicians engage in 'place making' work by shaping the material and affective surroundings to create comfort and meaning for patients at the end of life. I hope to position place as a central consideration for understanding and improving end-of-life care.