I began to think about the quandary of drawing the line while I was con-
ducting my study of American hospitals and how death happens there
(published as . . . And a Time to Die). After that study was completed I
thought about ways I could understand and document both the sources
and effects of that quandary. I started paying close attention to those
sources that are located well beyond hospital walls, in the social and po-
liti cal arena of debates about health care access, Medicare solvency, and
who controls the end of life, in the ascendance of the value of evidence-
based medicine and the surge in clinical trials, and in the contradictory
fact that we desire advanced medical interventions without limit or end
yet protest the overuse or inappropriate use of those tools and the suffer-
ing they sometimes cause.
I wanted to construct the project so that the perfect storm of our aging
society, the escalating pace of clinical innovation, the technological im-
perative, and the changing relationship of medicine to old age would be
data I could scrutinize in the actual deliberations of doctors, patients,
and families and the conversations among them. My initial goal was
to examine how certain medical interventions, all of them on the rise
among older persons, were affecting patients and families and how those
treatments were shaping the practice of medicine. How did doctors and
their older patients decide to go forward with cardiac interventions, kid-
ney transplants, and renal dialysis? What were doctors telling patients,
and how were patients responding? And then more broadly, what factors
in the clinical world and in American life were contributing to the fact
that increasing numbers of el derly patients were receiving high- tech,
life- sustaining treatments and at ever older ages? In short, what specific
factors were giving shape to the quandary of the line, and how were pa-
tients and families living in its midst?
The anthropological research on which this book is based was funded
in two phases, both supported by the National Institute on Aging. The
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