title: Clinical life: expectation and the double edge of medical promise.
abstract: This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical possibility and clinical promise, and thus assume that life can and will be improved by medical intervention in late life. Rather than anticipating a range of potential treatment outcomes, patients therefore expect the best-case scenario: that medical procedures will reverse aging, disease and the march of time. Second, patients then assess the value of their post-procedure lives in accordance with that expectation. Norms regarding what life 'should be like' at particular ages are continually recalibrated to the horizon of what is clinically possible. And third, the price of living longer entails a double-edged relationship with the clinic--it generates opportunities for bodily restoration and increased self-worth but also creates ambivalence about the value of life. This latter feature of clinical life is rarely publicly acknowledged in an environment that emphasizes medical promise.
authors.affiliation: University of California, CA 94143-0612, USA. Janet.Shim@ucsf.edu
authors.forename: Janet K
authors.initials: JK
authors.lastname: Shim
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Russ
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Kaufman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000523:psychology* / Q000534:rehabilitation; D001294:Attitude to Health; D001026:Coronary Artery Bypass / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D008136:Longevity; D018570:Risk Assessment; D012649:Self Concept; D012962:Sociology, Medical; D015607:Stents / Q000523:psychology*; D014481:United States; D026712:Value of Life