The American Journal of Bioethics 2.3 (2002) 63-65
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Anthropologist Margaret Lock's Twice Dead is a meticulously researched history of transplantation in North America and Japan that also analyzes the increasingly ubiquitous medical practices of declaring brain death, recovering organs, and transplantation. While there are minor elements in this work that are slightly misleading and manipulative, it is one of the most compelling examples of how medical policy and practices intertwine to dictate our attitudes about life, death and our bodies.
Cultural anthropology's strongest contribution to the study of medical practices is that it illuminates the everyday practices that we often take for granted in a way that makes the invisible transparent. Through anthropological analysis it is possible to examine our most common assumptions, to make the familiar unfamiliar. In doing so, societies' hidden assumptions are brought to light, and they are often found to be contrary to many of our most widely accepted beliefs.
In both popular culture and the specialized field of transplantation, the definition and understanding of death is self-evident, although, Lock shows, the definitions of this term in these two realms are often contradictory. In the popular realm death is understood as occurring when the heart stops beating and a person ceases to breath. The specialists' definition involves a more complex and biomedical understanding of brain death. Lock, interestingly, chooses to describe death using a term that encompasses elements of each of these definitions. Living cadaver includes reference both to the "live" heart-beating, brain-dead donor and to the cadaver that popular culture is familiar. Living cadaver reexamines the unstated assumptions of each of these uses and consequently will make both lay and professional readers uncomfortable. For those with knowledge of the practice of transplantation, the term living cadaver is too sensationalist and contradicts the dominant philosophies of transplantation. To those who have little experience with transplantation, living cadaver implies a frightful dualism that is oxymoronic. It evokes a sense of alarm, of the impossibility of being both alive and dead simultaneously. While Lock's use of the term is novel, she does not explain its origin. This, combined with her persistent use of the term, leaves readers with no foundation to judge or understand her terminology.
What the use of the term living cadaver does do, however, is exemplify the inadequacy of language to express this new state of "being." Compelling are the moments when either Lock's subjects or Lock herself are unable to articulate whether the person is living or dead. A brain dead patient, after organ recovery, is taken off "life support"—yet the person has already been declared dead. At what point does a patient become a cadaver? The same ambiguity and blurred distinctions exist when human subjects are discussed in clinical trials: At what point is one transformed from "patient" to "subject"? At what [End Page 63] point do our distinctions merely help to ease our own misgivings.
Biomedicine has an expansive tradition of creating and adhering to categories. As a result it has created categories of diseases, of patients, of insurance coverage, and of location (hospital floors and units). Both biomedicine and those who analyze that institution are accustomed to distinctions, to absolutes and binaries; our very use of language reinscribes and reinforces these distinctions daily. The problem of defining death in many ways is a problem inherent to a Western cultural context that rejects liminality, neutral space, and gray zones. Discomfort with organ donation and declaration of brain death is an example of how larger culturally inscribed attitudes dictate how we view the world. If we are unable to describe those who are brain dead as "dead," then we must, our society says, be compelled to consider them "alive."
Lock describes this issue well and clearly, but her analysis is at times hampered by her failure to separate and distinguish transplant practices in the United States and...