On Feeding Tubes

What he intended to say must have been thought over.He said it looking ahead, as if afraid. [...]This rift, this tangle, this ultimate depth—this clinging, when it is so hardto unstick heart and thought.

—Karol Wojtyla, The Jeweler's Shop ([1960] 1992)

During the early spring of 2005, debates in the United States about the "right to die" centered on a single solitary figure in a Florida hospice—Terri Schiavo. Schiavo collapsed in 1990 from a potassium imbalance that her doctors believe resulted from an eating disorder; Schiavo lost consciousness, and blood flow to her brain was severely diminished for around five minutes. When she was revived, doctors found her significantly brain damaged, and declared her to be in a permanent vegetative state. Over the course of the next 15 years, Schiavo's husband and parents became involved in a bitter debate about whether or not she should be "allowed to die." After numerous attempts to adjudicate continuing life-support, in March 2005 Schiavo's parents finally lost their appeals to the Supreme Court. Within days, the feeding tube that provided water and nourishment to Schiavo was removed, and around 9:00 A.M. on 31 March, Terri Schiavo "died."

In the period between the removal of Schiavo's feeding tube and the signing of her death certificate, the Florida hospice where Schiavo was housed became the geographical battleground where "pro-life" activists and "right to die" advocates staged their conflict. The scene was highly publicized in the national media, and the space outside the hospice was quickly converted into an outdoor theatre: a staging area was set for press releases and statements from family members and doctors; small tents were constructed where religious activists could publicly sing and pray; and an array of picket signs and enlarged photographs created by representatives from both camps circulated slogans and images pleading either for the reinsertion of the tube or for support of her husband's decision to remove it. Hundreds of cameras captured the scene and reproduced it for newspapers and TV. The rhetoric of morbidity was transposed onto the body of Terri Schiavo; translated through the various images of her released to the public; and transfixed on the question of what it could possibly mean, in Schiavo's case, to choose to die.

The Schiavo case epitomizes the complicated nature of hunger as it functions at the very heart of mortality—or, in Freud's words, of the drive to die in one's own way (1961). The intensity of the question of hunger is especially strong at the site of the alternately lionized and demonized medical apparatus at the center of the controversy: the feeding tube. In standard medical practice, the feeding tube is used both as a short-term prosthetic esophagus for those who have temporarily lost the ability to swallow and as a long-term form of life-support for those who require permanent assistance with eating. But the broader history of the feeding tube includes other applications—most notably, the practice of force-feeding hunger strikers and anorectics who, despite their gastronomic competencies, refuse to eat. In this light, the feeding tube represents and facilitates the enforcement of normative alimentary exchange by the institutional apparatuses of the State—for example, prison and clinic.

But in these cases the feeding tube also represents the struggle between the enactment of individual will and the force of State intervention. Just as it seems to provide an intuitively simple solution to the problem of malnourishment, the feeding tube stands in as metaphor for what Michel Foucault called subjectivation: the simultaneous production of subjectivity and subordination to State power (1980). In Foucault's logic, subjectivation describes the manner in which we come to experience ourselves as subjects, defined by our "free will," in the context of ideological and institutional powers that regulate and constrain us. We could also call the process of becoming a subject—never fully preempted by the power of the State, but never fully complete in spite of it either—performative, dependent upon the citation of recognizable structures of meaning, but effective in producing the moment...