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Twice Dead: Organ Transplants and the Reinvention of Death

di Margaret Lock

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Tales about organ transplants appear in mythology and folk stories, and surface in documents from medieval times, but only during the past twenty years has medical knowledge and technology been sufficiently advanced for surgeons to perform thousands of transplants each year. In the majority of cases individuals diagnosed as "brain dead" are the source of the organs without which transplants could not take place. In this compelling and provocative examination, Margaret Lock traces the discourse over the past thirty years that contributed to the locating of a new criterion of death in the brain, and its routinization in clinical practice in North America. She compares this situation with that in Japan where, despite the availability of the necessary technology and expertise, brain death was legally recognized only in 1997, and then under limited and contested circumstances. Twice Dead explores the cultural, historical, political, and clinical reasons for the ready acceptance of the new criterion of death in North America and its rejection, until recently, in Japan, with the result that organ transplantation has been severely restricted in that country. This incisive and timely discussion demonstrates that death is not self-evident, that the space between life and death is historically and culturally constructed, fluid, multiple, and open to dispute. In addition to an analysis of that professional literature on and popular representations of the subject, Lock draws on extensive interviews conducted over ten years with physicians working in intensive care units, transplant surgeons, organ recipients, donor families, members of the general public in both Japan and North America, and political activists in Japan opposed to the recognition of brain death. By showing that death can never be understood merely as a biological event, and that cultural, medical, legal, and political dimensions are inevitably implicated in the invention of brain death, Twice Dead confronts one of the most troubling questions of our era.… (altro)
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In Twice Dead: Organ Transplants and the Reinvention of Death, Margaret Lock “explores the way in which developments in medical technology have forced a reconsideration of the recognized boundaries between life and death, and how these debates reflect deeply held social values and political interests” (pg. 2). Lock examines these boundaries and how they affect social values and politics through a comparison of organ transplants in Japan and in Western countries, such as the United States and Canada. In describing the Japanese response, Lock writes, “The majority of Japanese with whom I have talked about brain death dismiss arguments that reify Japanese tradition” (pg. 5). On the other hand, “in North America, discussion about brain death has been limited for the most part to a small group of doctors and an even smaller group of lawyers and intellectuals,” though the debate rarely focuses on “the contribution to culture” (pg. 7). Finally, Lock establishes the “living cadaver” as a category to describe those who suffer brain death yet are kept alive by artificial means (pg. 1). This category plays a crucial role in her argument.
Discussing the conflict over brain-death as a category in Japan, Lock argues, “The culture of tradition is self-consciously put to work to aid those opposed to the recognition of brain death” (pg. 11). In the West, however, acceptance of brain-death was not a foregone conclusion as it forces one to consider what defines a person, either their physical living body or their consciousness (pg. 37). Lock writes, “Cerebral death confronts us with yet another ambiguous life-form that until recently was imaginable only in science fiction. The determination of cerebral death is made on the basis of an irreversible loss of consciousness” (pg. 119). This goes further to define the limits of what qualifies as death, either physical or social. In the West, concepts of brain-death limit death to a physical, quantifiable event, whereas in Japan, death exists as a social occurrence involving the relationships of the person and their family (pg. 183). The machinery that prolongs life also plays a role in defining the limits of humanity. Lock writes that the machinery of artificial respiration displaces the personhood of the patients , though in Japan, “some people may conceptualize machine and human as working in partnership, creating an animated hybrid that can overcome all odds” (pg. 370). Further, examining the role of organ transplant in a gift system, Lock cites Marcel Mauss, who concluded, “all gifts carry reciprocal expectations, and gift exchange is a means of establishing lifelong commitments that create the structure of social institutions and their hierarchies” (pg. 315). This creates a host of problems in Japanese society, where gift giving involves culturally ingrained practices that recipients cannot follow through on since the donor is deceased. Even when the donor is not anonymous, the recipient fears lifelong obligation to the family that they cannot repay. Even in the West, organs are fetishized, imbued with personality about the “gender, ethnicity, skin color, personality, and social status of their donors” (pg. 320). Even the process of keeping an organ alive apart from the body defies traditional conventions of the body. ( )
  DarthDeverell | Mar 31, 2017 |
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Tales about organ transplants appear in mythology and folk stories, and surface in documents from medieval times, but only during the past twenty years has medical knowledge and technology been sufficiently advanced for surgeons to perform thousands of transplants each year. In the majority of cases individuals diagnosed as "brain dead" are the source of the organs without which transplants could not take place. In this compelling and provocative examination, Margaret Lock traces the discourse over the past thirty years that contributed to the locating of a new criterion of death in the brain, and its routinization in clinical practice in North America. She compares this situation with that in Japan where, despite the availability of the necessary technology and expertise, brain death was legally recognized only in 1997, and then under limited and contested circumstances. Twice Dead explores the cultural, historical, political, and clinical reasons for the ready acceptance of the new criterion of death in North America and its rejection, until recently, in Japan, with the result that organ transplantation has been severely restricted in that country. This incisive and timely discussion demonstrates that death is not self-evident, that the space between life and death is historically and culturally constructed, fluid, multiple, and open to dispute. In addition to an analysis of that professional literature on and popular representations of the subject, Lock draws on extensive interviews conducted over ten years with physicians working in intensive care units, transplant surgeons, organ recipients, donor families, members of the general public in both Japan and North America, and political activists in Japan opposed to the recognition of brain death. By showing that death can never be understood merely as a biological event, and that cultural, medical, legal, and political dimensions are inevitably implicated in the invention of brain death, Twice Dead confronts one of the most troubling questions of our era.

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