Biotech Interventions, Moral Entanglements, and the Everyday Practices of Critical Care in Urban Chinese Hospitals

Abstract

While anthropological scholarship on aging and eldercare has challenged overly medicalized approaches to understanding these complex processes, this paper takes a closer look at the sociopolitical context and cultural logics driving the medicalization of aging and dying in contemporary China. With over half of all deaths in urban China occurring in health facilities, the growing institutionalization of dying is transforming the ways in which Chinese patients, their family caregivers, and medical professionals confront mortality. As processes of dying shift to hospital settings in urban China, emerging practices and beliefs surrounding death are intersecting with changes in family-based caregiving in these new institutional venues. Medical anthropologists have demonstrated how the bureaucratic machinery of the American health care system prolongs death and dehumanizes care through the routine use of invasive life-sustaining technologies in the U.S. The increasingly fragmented and unevenly privatized Chinese health care system provides a crucial node of comparison for exploring the use of technological interventions for critically ill patients in a different sociohistorical context. As the former emphasis on state-funded preventive care during Mao's era of collectivism has given way to a market-driven pursuit of high-tech interventions under Deng and more recent efforts to redress growing health inequalities, these shifting state priorities are transforming end-of-life care in Chinese hospitals. In this paper, I will first discuss an initiative implemented by the Shanghai municipal government to promote home-based health services for residents aged 80 and older. While this program seemed attractive on paper, the low rates of utilization exposed the underlying reasons for urban residents' strong preference for seeking medical care at major tertiary hospitals. In the second half of my paper, I will take us into the Chinese hospital setting to illuminate the challenges posed by the increasing institutionalization of aging and dying.