THE INSTITUTIONALIZATION OF THE GOOD DEATH

There has been some recent concern in Britain and North America that t he increasing institutionalization of hospice care may compromise the movement's founding ideals. The threats posed by the encroachment of m ainstream medicine and the medical technological imperative to treat, are also a source of concern to hospice administrators and staff. This study uses Australian data based on interviews with nurses and partic ipant observation in an in-patient hospice unit and a community based hospice service to investigate whether the Good Death ideal, as centra l to the hospice philosophy, is compatible with the institutionalizati on of hospice care. The issues that arise, although interrelated are c onceptualized as the following five challenges to hospice care: (1) en croachment of mainstream medicine and the medical technical imperative ; (2) competing motivations; (3) delimitation of intellectual structur es; (4) organizational maintenance; and (5) routinization of the Good Death. This conceptual framework is based on the way in which nurses a nd other health care professionals have used shared logic and strategi es to negotiate the daily demands of their work and illustrates the te nsion that arises between the maintenance of the ideal and the mainten ance of the organization.