In her career as a medical anthropologist, Sharon Kaufman, 71, has done extensive research into why individuals, their families and physicians often choose to take a more intervention-heavy, technology-laden approach to care. Kaufman wrote “ … And a Time to Die: How American Hospitals Shape the End of Life” and “Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line” and is professor emerita and former chair of the Department of Anthropology, History and Social Medicine at UCSF. The lifelong Bay Area resident and her husband, Seth, raised a son and daughter and have been married for 46 years. She lives in Marin.
J.: Though medical science and technology have advanced patient care, why do you say they’ve been a default response in cases when less intervention would have proved more effective?
Sharon Kaufman: We have huge expectations of medical technology. Scientists push the boundaries, such as in fertility treatments and in the ways in which a family can now be constructed. And hospitals are structured to promote life-saving technology. The ethical priority is to save life at all costs, and in many instances, this has been positive. Look at defibrillator technology and the advances in kidney transplants. But the system has gone overboard in one direction. “… And a Time to Die” came out of many conversations [and] complaints about too much technology and not enough comfort.
But now there’s more of a focus on palliative care and on making sure that people have living wills, health-care directives and durable powers of attorney so that extreme measures will not be taken, right?
Unless patients are proactive or have relatives available to speak on behalf of them — and many do not — durable powers of attorney are either overridden or ignored. This is such a huge problem. The policy is to apply CPR and intubate. Hospital legal teams are worried [about litigation]. And anxiety, discomfort and guilt also often collide. You don’t want to say, “Don’t intubate my mother.”
There are large cultural expectations [that hospitals and doctors] can fix the very frail individual [who illustrates] the revolving-door scenario: coming to the hospital with shortness of breath, getting stabilized there, being discharged to a nursing home and then returning to the hospital with the same problem. Sometimes, you can only “fix” a problem to a certain extent.
So how do we actually fix seemingly unfixable problems?
Hospice care and palliative care are important and really good. They are institutional, organized structures that are ameliorative. We need to support and mentor young physicians who want to know more about palliative care. We also need to support teamwork that focuses on pain management. And we need more beds in hospitals for palliative care.
In addition to four books, you have written many articles, such as “Losing My Self: A Poet’s Ironies and a Daughter’s Reflections on Dementia,” about your late mother, Shirley Kaufman, a renowned American Israeli poet. Did you encourage good writing during your tenure at UCSF?
Through UCSF’s Office of Medical Education, I brought in outstanding researchers in sociology, anthropology, history and other fields to talk about the clinical issues addressed in their books. Many students and faculty would read the books [beforehand]. The authors included some UCSF faculty, including Kelly Ray Knight (“Addicted.pregnant.poor”), Seth Holmes (“Fresh Fruit, Broken Bodies: Indigenous Mexican Farmworkers in the U.S.”) and Carolyn Beth Sufrin (“Jailcare: Finding the Safety Net for Women Behind Bars”).
How did your father and grandfather influence your work?
My father, Bernard Kaufman Jr., who was born in San Francisco, was a physician for many years at what was then Mount Zion Hospital, where he served the Jewish and African American communities from the Western Addition neighborhood. He retired when he was 83, and he lived to 93. And my grandfather was also a physician in San Francisco. He was originally from Melbourne, Australia.
Serving the community and Jewish community, in particular, is a trait in your family.
One of my sisters, Deborah Kaufman, founded the San Francisco Jewish Film Festival [in 1980]. And my son, Jacob, an attorney, is called Jacob “Muffin Man” Kaufman, because he started making muffins for the homeless in San Francisco and turned his baking into National Muffin Day to support homeless services. For me, my work is all about trying to make a better society.