Inevitable Hour A History of Caring for Dying Patients in America

A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.

At the turn of the twentieth century, medicine’s imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients.

Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell’s Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience.

With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved—though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.

"A powerful assessment of medicine's involvement with death and dying: a history highly recommended for any medical or ethical issues holding."—Midwest Book Review

"Few libraries specializing in the history of medicine will not find this a valuable book to include in their collections."—Watermark

"This is an important book that sets current debates over end-of-life care in their historical context, and reminds readers of the numerous historical decisions that shape the current situation."—Choice

"Abel's book is a strong and welcome addition to the historiography of death and dying."—Journal of American History

"An invaluable contribution. Abel does an admirable job uncovering a topic that was mostly absent in the medical literature. She successfully highlights a striking consequence of medicine's curative paradigm while also recovering the vital work that family and faith performed to fill the gap left by medical professionals in the twentieth century."—Journal of the History of Medicine and Allied Sciences

"Lively and engaging. The Inevitable Hour offers a sensitive, patient-centered view of end-of-life experiences. Abel's gift for biography, of both the eminent and the obscure, provides a glimpse into a rich yet private world. It makes an important contribution to American medical history and to our understanding of human responses to suffering and adversity."—Bulletin of the History of Medicine

Emily K. Abel is professor emerita at the UCLA–Fielding School of Public Health. She is the author of many books, including After the Cure: The Untold Stories of Breast Cancer Survivors and Hearts of Wisdom: American Women Caring for Kin, 1850–1940.

At the turn of the twentieth century, medicine's imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients. Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell's Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience. With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved-though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.