One is an inner-city, hospital-affiliated unit with an ethnically diverse patient population including mainly African American, Chinese, and Russian-speaking patients, many of whom are financially compromised and have little social or family support. This paper draws on the experiences of persons age 70 and over in two renal dialysis units in California to consider the relationships between living and quality of life, dying and the awareness of (even the desire for) death, in this new kind of penultimate time crafted in the clinical postponement of death. They include the displacement of ethical by technical concerns and approaches to decline the reconceptualization and altered expression of kin and intimate relations the contribution to a new life form in which death is increasingly brought into life and the emergence as well of a new kind of time before death, one marked simultaneously by decisions and denial, anxious anticipation and active avoidance of lifeвЂ™s close. The existential and social ramifications of medically delayed death are profound, pervasive, and only beginning to be understood. E-mail: growing numbers of older individuals in the United States, lifeвЂ™s end is indefinitely forestalled through the routine implementation of medical procedures. Contact information: Institute for Health and Aging, Box 0646, University of California, San Francisco, CA 94143-0646. She is the author, most recently, of вЂ¦ And a Time to Die: How American Hospitals Shape the End of Life (Scribner, 2005). Her recent research explores life extension, technologies of dying, and subjectification in an aging society. Kaufman is professor of medical anthropology at the University of California, San Francisco.

Her publications have appeared in Sociology of Health and Illness, American Sociological Review, and Social Studies of Science. Her research in medical sociology has focused on issues at the intersections of health inequalities, biomedical science and technologies, and race, gender, and aging. Shim is assistant adjunct professor at the University of California, San Francisco. Her publications have appeared in Cultural Anthropology and Culture, Medicine and Psychiatry. Her research has focused on end-of-life care and communication among clinicians, patients, and their families in hospice and high-tech medical environments. Ann Julienne Russ is a medical anthropologist and member of the research faculty at the University of California, San Francisco.

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