The institutionalization of the good death.

There has been some recent concern in Britain and North America that the increasing institutionalization of hospice care may compromise the movement's founding ideals. The threats posed by the encroachment of mainstream 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 participant observation in an in-patient hospice unit and a community based hospice service to investigate whether the Good Death ideal, as central to the hospice philosophy, is compatible with the institutionalization of hospice care. The issues that arise, although interrelated are conceptualized as the following five challenges to hospice care: (1) encroachment of mainstream medicine and the medical technical imperative; (2) competing motivations; (3) delimitation of intellectual structures; (4) organizational maintenance; and (5) routinization of the Good Death. This conceptual framework is based on the way in which nurses and other health care professionals have used shared logic and strategies to negotiate the daily demands of their work and illustrates the tension that arises between the maintenance of the ideal and the maintenance of the organization.