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When Hospice Isn’t a ‘Choice’: Disregard, Care and End of Life on the American Periphery

Tuesday 28 February 2023
Pieter de la Court
Wassenaarseweg 52
2333 AK Leiden

About the talk When Hospice Isn’t a ‘Choice’: Disregard, Care and End of Life on the American Periphery

In this talk, I discuss the peculiar role of hospice care on the island of St. Croix, U.S. Virgin Islands—and its tragic, deleterious consequences for older adults nearing the end of life there. Originally designed, and codified into U.S. federal law, as care for individuals facing terminal prognoses for whom curative treatments are no longer viable or desirable, hospice is predicated on an assumptive background of an integrated, functional healthcare system. That is, in the U.S., hospice is assumed to be, and is legislated as, an option that individuals can choose when—and if—they are ready. On St. Croix, however, situated as it is in an unincorporated territory of the United States, (post)colonial conditions—including a deeply deficient healthcare infrastructure, high rates of poverty, and lack of political sovereignty—converge to create a situation in which, for many medically fragile older adults, hospice is their only option for professional care. I argue that this situation came to be and is maintained through racialized, biopolitical processes of disregard that continually reproduce St. Croix as ‘peripheral’ to the American nation. Through detailed case studies of the lives, and deaths, of individuals on St. Croix who ‘chose’ hospice care during the time of my research, I trace how this disregard in fact serves to push the island’s older residents toward death.

Biography Devin Flaherty

Devin Flaherty is a medical and psychological anthropologist. She received her Ph.D. in Anthropology from UCLA in 2018 for her work studying aging, care and end of life in St. Croix, U.S Virgin Islands. Since 2019, she has been an Assistant Professor in the Department of Anthropology at University of Texas at San Antonio. She is currently also a Visiting Researcher at the University of Copenhagen, Department of Anthropology.


This talk is organized by the Globalizing Palliative Care research project and the Leiden University Medical Anthropology Network (LUMAN) and hosted at the Institute of Cultural Anthropology and Development Sociology. 

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