This project would not have been possible without the permission, sup-
port, guidance and sincere engagement of many doctors, nurses, social
workers, and other health care providers and patients and families. To
protect the confidentiality of research sites and of individual health
professionals, I thank them here anonymously. They know who they
are. Doctors and all health professionals are under enormous time and
administrative pressures today, and I thank all who helped with this proj-
ect for so graciously taking the time to answer our questions and for
allowing us to be present for intimate and confidential discussions. I
thank them also for candid conversations, whether in formal interviews
or on- the- fly dialogue, about their own treatment dilemmas, the changes
they have seen in patients and medical practice, and the host of problems
generated by a fragmented health care delivery system. My deep appre-
ciation goes to the patients and families who welcomed us into clinic
exams and into their homes for long interview conversations about the
course of illness and treatment and the qualms about what to do.
The National Institute on Aging, an agency of the National Institutes
of Health, supported this project in full. I thank the anthropologists,
sociologists, psychologists, physicians, and nurses who evaluated my
proposals and offered suggestions for strengthening the project. Sidney
Stahl, my project officer at the nia, provided welcome advice and impor-
tant guidance over many years. This research was funded in two phases,
by nia Grant #r01ag20962 and nia Grant #r01ag28426.
Three research associates, Lakshmi Fjord, Ann Russ, and Janet Shim,
participated in different phases of this research. I thank them for their
enthusiastic commitment, astute observations, probing interviews, and
important insights. Their work expanded the scope and depth of this
For critical conversations along the way about the practice of medicine,
the ethics of medical research, the problems new technologies generate
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