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5. Commissioning Death: From Living Cadavers to Dead Brains
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c h a p t e r 5 Commissioning Death From Living Cadavers to Dead Brains The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research published its findings in 1981 on the topic of brain death. The document, titled Defining Death,1 was the culmination of a long discussion beginning in the mid-1960s with the advent of cadaveric renal transplantation and ending with the commission’s recommendation of the Uniform Determination of Death Act. This act was accepted by every state in the Union in some version or another, either as a statute or in common law.2 I call the document a culmination not because it ended discussion about the question of brain death, but because it gave the semblance of finality on the question by virtue of ensconcing a definition of death in the law. The front cover of the commission’s report is illuminating. At first glance, the eye is pulled to a couple of bags—in the original, red on a blue background—hanging from an IV pole. These bags appear to be blood—the life blood. One’s eye is also pulled to a machine in the background , perhaps a ventilator, which is also red and, like the blood, sustains life. Two male figures in white—the doctors—appear to be leaning over a hospital bed. A female figure, a nurse, wearing an older-style, flowing nurse’s uniform, is standing at the foot of the bed. Or, is she • 141 wearing a nun’s habit? On closer inspection, however, the hospital bed is not a bed at all; it is a coffin. The two doctor-figures leaning over a coffin might be priests administering the sacrament of the last rites. No one is visible in the bed/coffin; we see only the shell of the coffin. And the IV pole might also represent a cross. For the commission, the triad of lungs, heart, and brain on which Bichat focused translated into the functions of respiration, circulation, and control as mediated by the brain stem. The commission set out to 142 • the anti cipat ory c or pse [52.91.255.225] Project MUSE (2024-03-28 18:41 GMT) avoid “arcane philosophical discourses,”3 and thus, it deliberately paid less attention to the higher brain, the space of personhood, than to the physiological characteristics of death. Its final report stated that the life blood and the ventilator are not what make one alive, but instead, it is the automatic function of the body made possible by the brain stem. I argue in this chapter that through a series of social machinations, death has moved more fully into the space of the brain. For the commission, this amounted to introducing a metaphysics of efficient causation in a document that supposedly avoided “arcane philosophical discourses” and whose main recommendation moved quickly into the law. I also explore the ways in which death, particularly brain death, has become part of the social imagination. Like Robert Zussman’s image of a patient who slips silently into the depths of the technological apparatus in the ICU4 —and thus no longer appears as a human being but as a technological object—similarly, the newly defined brain-dead patient slips into the morass of technology, into a hospital bed, and into a hospital coffin. Before Brain Death According to Julius Korein, as well as many others, technology itself creates the conditions for the redefinition of death as brain death: “Virtually all organisms (organ systems) are replaceable in man, with one exception, and that is the brain. The heart can be replaced by a pump, the kidneys by an appropriate dialysis unit, endocrine glands by hormonal replacement therapy, and so on.”5 Insofar as various bits of the mechanical body are replaceable by machines or other techniques, they are not central to defining either life or death. In a sense, then, death of the body is not possible because it has always been a lifeless mechanism replaceable by another mechanism. Our technology can maintain physiological functioning through mechanical control of the organ systems . If the only set of functions that cannot be replaced are housed in the brain, as Korein wrote in 1978, then brain death necessarily is death and ought to be the ground of the definition of death. Technology, then, necessitates the redefinition of death by proving what...