Making Up the Goodas Dead

The majority of organ transplants make use of organs procured from donors diagnosed as brain-dead. Creation of the concept of brain-death in the late 1960s, immediately following the world's first heart transplant, could not have happened without the prior invention of the artificial ventilator. This machine enables the heart and lungs of a patient whose brain is irreversibly damaged to continue functioning. Brain-dead entities are hybrids, both alive and dead, and their existence challenges, as do so many new biomedical technologies, the fundamental assumptions made until recently in the social sciences and in society at large about clear dichotomies between nature and culture, life and death, mind and body (Lock, 1997, 2000, 2001). Lock has shown how the ambiguous condition of the brain-dead has been largely repressed in the public domain in most of Europe and North America

(but see Hogle, 1999, in connection with Germany). The power of the metaphor of the "gift of life" passed along through organ donation has usurped uncertainties in connection with this new entity about where exactly organs come from. On the other hand, in clinical settings where medical practitioners and families must confront the ambiguities associated with the brain-dead at first hand, there is considerable evidence that these patients are not regarded as fully dead. However, in intensive care units (ICUs) in the United States and Canada sending the brain-dead for procurement of their organs is justified in people's minds, whether they be family or health care practitioners, on the assumption that the "person" is dead (Lock, 2000, 2002). In Japan, on the other hand, brain-dead patients have not been regarded as medically or legally dead until very recently, and then only if there is evidence of a clear indication on the part of the patient and their family that donation is acceptable. Lack of trust in the medical profession, a massive public debate about brain-death, and differing ideas about personhood are just three of the reasons that account for the Japanese situation.

Simple technologies such as tube-feeding in ICUs mean that patients who are permanently unconscious but whose lower brain continues to function (and therefore are not brain-dead) can be kept alive for years on end. Kaufman (2000) has shown that this condition too challenges our conventional ideas about identity, person-hood, and agency. Increasingly there is pressure, primarily economic, to count such patients as good-as-dead (Lock, 2002) so that "death" becomes an ever-more problematic category, as is the case for "life" in the world of reproductive technologies. As Kaufman (2000) notes, the very existence of technologically produced hybrid forms of human existence "subvert the meaning of nature" and of the "natural" (p. 79).

The new genetics and the mapping of the human genome present further challenges to the nature/culture divide. We can intervene in the body in ways never before possible and claims are being made by certain scientists that we will soon be able to manipulate fetuses so that babies will be made to order. Genetic testing and screening, often leading to abortion, are already well entrenched (see the entry Medicalization and the Naturalization of Social Control), but to date the hype associated with genetic enhancement technologies far exceeds what can actually be accomplished. It is not simply the implementation of those technologies that already exist to which we must pay attention, but also to the claims made about the imagined futures that technologies in the making may bring about. Anthropology has already given us plenty of evidence as to the way in which biomedical technologies, as they spread globally, are at once agents of hope and transformation and at the same time foster alienation and destruction. It is not to simply argue for technology as progress.

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