| The common practices and resources used to provide end-of-life medical care in the U.S. have many potential impacts on the health of our environment and our broader community. This dissertation explores the tension created between medical care at the patient level and the health of our ecological community by asking two overarching questions: (1) what are the ecological and public health outcomes that result from medical resource use at end-of-life, and (2) why are these broader concerns not currently given more consideration within end-of-life medical practice. Through ethnographic fieldwork in a conventional cancer unit, a palliative care unit, and a hospice inpatient unit, conducted from 2008 to 2010, this research provides a comparative examination of the impacts of end-of-life medical care on the environment and public health.;The impacts explored include the upstream, midstream, and downstream effects of medical supply chains, medical waste, and pharmaceuticals, as well as the cumulative impacts that result when patients are not afforded open communication about their prognoses and end-of-life medical care options. Results suggest that each of the three medicalized end-of-life care models has impacts on the environment and public health. Recommendations for more broadly incorporating concern for these impacts into end-of-life medical practice build upon the sociological theory of environmental flows. The central argument is that the ecological and public health impacts of end-of-life medical practices arise from problems of visibility, mobility, and governance of environmental flows. |
