[This recent and thought-provoking post by Rana on lifestyle assumptions from mainstream privileged environmentalists got me to thinking of something I wrote at Pandagon in May, which I suddenly realized never got cross-posted over here. So go read Rana’s post, which is unsurprisingly excellent as are her expanding thoughts in comments, and then come back and read this, which has been edited slightly from its Pandagon form.]
I was chatting with a friend recently about his father, who has become, in his advancing years, more of a management problem than my friend’s mother can handle. The family made the difficult decision to place Dad in a nursing home. Not entirely coincidentally, that same day we had both read this piece by Mary Kay McKown, entitled “The Elusive ‘Good Death’ for Frail Elders”:
For many Americans, the notion of “a good death” evokes a vision of dying peacefully at home, in the presence of loved ones. Although the Medicare hospice benefit was created in 1985 to facilitate this possibility for adults over the age of 65, very few people over the age of 80 die at home.
As a… nurse practitioner, I have worked closely with elders and their families, community case managers, home health and hospice interdisciplinary teams, geriatricians, and hospital-based providers to facilitate “good deaths” for frail elders in their homes, hospitals, and intermediate care facilities… I am concerned that the specialty of hospital-based palliative care may be contributing to the “medicalization” of death. By this I mean that death in old age is increasingly viewed (by patients and providers) primarily as a highly compromised physiological state that needs complex medical management, rather than as an important family event that can be anticipated and skillfully supported outside of the hospital.
It’s a good and heartfelt article, and I agree with most of it: A hospital is the last place I’d want to die. But there was something familiar about the issue, something that reminded me of a number of other quality-of-life issues that have been getting more notice in the public mind of late. Quality of life is an admirable, if vague, goal, but the question comes up: of whose life are we contemplating the relative quality?
Yes, death has been increasingly medicalized, but McKown isn’t exactly advocating de-medicalizing the process, just changing the venue. The problem isn’t that death has been medicalized — no one seriously advocates getting rid of doctors and nurses for aid during the process — but that it has been corporatized, like so many other facets of life. We get sick enough to die, and then the course of what’s left of our lives is lived out in impersonal surroundings, our needs attended to by strangers — skilled strangers, true, but dispassionate nonetheless, our decisions circumscribed by HMO policy and procedures driven by monetary concerns of either the cost-cutting or ass-covering varieties.
But when parts of our lives get corporatized, it’s generally the case that the associated relationships get monetized. In English: suddenly we find ourselves paying someone for labor we once got for free.
Or, as Ron Sullivan put it a couple years back, reminiscing about the good ol’ days:
Remember how it felt when you realized those nice gentle brothers still thought you were a household appliance? The only household appliance they weren’t ready to give up when they went all wholegrain and groovily off-the-grid?
Well I do.
Like so many other arenas in which quality of life is seen to be dwindling in these here Modrun Times, the “good death,” in being cast as The Way Things Used To Be (though not by McKown, explicitly) is based on the assumption of unpaid female labor. Of course, there’s nothing intrinsic in dying at home that requires the presence of estrogen: men can turn over bedridden elders and clean out bed pans and advocate for the patient just as well as women can. But get real. What we’re talking about here is women — wives, sisters, daughters, mothers — taking care of the dying person for free, though perhaps with some paid expert help if they’re lucky, a nurse practitioner or attendant paid to come by for a couple hours a day.
This assumption runs deep in the quality of life movement. Ivan Illich — who not coincidentally was one of the first popular critics of overmedicalization — explicitly distinguished in his 1983 book Gender (Open Forum) between modern discrimination on the basis of gender, which he properly condemned as sexist, and forced gender role differences in traditional societies, which he called something like “gender differences” and defended as crucial to a sustainable, stable society. Illich’s conception of a sustainable stable society has influenced generations of cultural critics, for better or worse. His writings echo in the pronouncements of people from Amitai Etzioni to Wendell Berry, whose reluctance to get a word processor some years back provides my favorite example of this phenomenon:
My wife types my work on a Royal standard typewriter bought new in 1956 and as good now as it was then. As she types, she sees things that are wrong and marks them with small checks in the margins. She is my best critic because she is the one most familiar with my habitual errors and weaknesses. She also understands, sometimes better than I do, what ought to be said. We have, I think, a literary cottage industry that works well and pleasantly. I do not see anything wrong with it.
A number of people, by now, have told me that I could greatly improve things by buying a computer. My answer is that I am not going to do it. I have several reasons, and they are good ones.
The first is the one I mentioned at the beginning. I would hate to think that my work as a writer could not be done without a direct dependence on strip-mined coal. How could I write conscientiously against the rape of nature if I were, in the act of writing, implicated in the rape? For the same reason, it matters to me that my writing is done in the daytime, without electric light.
I do not admire the computer manufacturers a great deal more than I admire the energy industries. I have seen their advertisements. attempting to seduce struggling or failing farmers into the belief that they can solve their problems by buying yet another piece of expensive equipment. I am familiar with their propaganda campaigns that have put computers into public schools in need of books. That computers are expected to become as common as TV sets in “the future” does not impress me or matter to me. I do not own a TV set. I do not see that computers are bringing us one step nearer to anything that does matter to me: peace, economic justice, ecological health, political honesty, family and community stability, good work.
What would a computer cost me? More money, for one thing, than I can afford, and more than I wish to pay to people whom I do not admire. But the cost would not be just monetary. It is well understood that technological innovation always requires the discarding of the “old model”—the “old model” in this case being not just our old Royal standard. but my wife, my critic, closest reader, my fellow worker. Thus (and I think this is typical of present-day technological innovation). what would be superseded would be not only something, but somebody. In order to be technologically up-to-date as a writer, I would have to sacrifice an association that I am dependent upon and that I treasure.
Commenters may submit analyses of Berry’s insistence on exploiting female labor as a way to avoid taking part in metaphorical “rape” in fulfillment of the requirements for issuance of a Bachelor of Snark Degree from UCRN.
In a paper published a couple weeks ago, Dr. Sherilyn McGregor of Keele University in Staffordshire points out that when environmentally sound living requres extra work, that work is usually “women’s work.” Her paper is a useful and readable summation, and if it weren’t encrypted read-only I’d paste some of it here. Still, this is not news to environmentalist women. What decisions are environmentalist citizens asked to make? Choosing the green laundry detergent and toilet paper and buying organic groceries. Carrying cloth bags to the supermarket. Using non-toxic cleansers. Adding corporate citizenship to one’s list of brand loyalty factors and schlepping the Seafood Buying Guide around. Sorting trash into the proper containers for recyclables, compost, and landfilling.
Of course, we men carry all those containers to the curb, which perfectly balances the division of labor. But then you add Environmentalism 2.0 to the mix, and you have the Slow Food (read: hours spent in the kitchen) and Local Food (read: hours spent shopping) movements, and with that kind of scheduling pressure a woman likely wouldn’t even have enough time left in the day to type up her husband’s poetry.
The fact is that for all the ills the increasing corporatization of society has brought us, it has assigned value to certain forms of labor that were once devalued. It certainly hasn’t always assigned enough monetary value to those tasks, but even a paltry amount is more than nothing at all. Opposing that corporatization doesn’t have to include rolling back that valuation, trying to build an Illichian paradise where people quietly fulfill their forced gender role differences.
I’m a huge supporter of the various movements for restoring the quality of our lives, but until they rid themselves of this blind spot they will go nowhere worth going. Sadly, that patriarchal romanticism is seductive. Look at this Wikipedia description of the “Slow” movement’s goals:
Even in the recent past in the West it was standard to have a day of relaxation because all shops were closed on Sundays. However, the current tendency in many parts of the world to operate at 24 hours a day has disrupted this tradition. Now, because people can do everything all the time, some feel they have to do things all the time. The Slow movement counteracts this by extolling the virtues of the enjoyment and savouring of living.
I don’t know what it was like for your family, but I seem to recall my grandmothers working just as hard on Sundays as they did on Mondays. Though maybe they were just enjoying the process of vacuuming before people came over to relax and savouring the sinks full of dishes the relaxing generated. Ah, the good old days.
Posted by: Chris Clarke
Categories:
Politics
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