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Economies of Dying

As efforts are made to contain health care spending, the decision to stop trying to cure severely ill patients and focus on comfort care has become an economic as well as a moral issue. This article examines the intricate intersection of economics and morality in U.S. hospice care. Using historical, interview, and ethnographic methods, I explain the resonance between hospice practitioners’ moral motivations and policymakers’, insurers’, and providers’ efforts to economize near the end of life. Drawing on theoretical literature on morality in markets, I analyze the moralization of economic scarcity. I argue that rather than posing an external financial constraint on the achievement of moral goals, scarcity itself can bear moral meanings. In the case of hospice care, the view that “less is better” and the wish to save patients from over-treatment converge with financial interests to limit spending on end-of-life care and imbue financial constraints with positive moral meanings.