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Technology and Culture 44.2 (2003) 433-435



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Twice Dead: Organ Transplants and the Reinvention of Death. By Margaret Lock. Berkeley: University of California Press, 2002. Pp. xii+429. $65/$24.95.

In this long-awaited volume, anthropologist Margaret Lock has collected and expanded upon her work on brain death and organ transplantation. Her research spans a decade and two distinct types of society, Japan and North America. Japan, more than many societies, has struggled with both the medico-legal concept of death that allows organs to be removed from bodies and the ethics of transferring those organs to others. Physicians and [End Page 433] ethicists often blame this struggle on culture and "tradition," often interpreted as an aversion to technology in modernity. Lock convincingly counters such essentialized depictions of Japanese attitudes by exposing the complexity of the rhetorics of difference. The individualism, utilitarianism, and rationalism that undergird organ donation are distinctly Western values. The concept of an autonomous individual whose "self" resides in the brain does not mesh with Japanese society, in which a "person" is constituted in the public domain of relationships and exchange.

Likewise, practices and meanings around the body at death—both biological and social—differ, particularly in a society with a history of deaths that make statements about social conflicts or conditions, as in ritual suicide. The Japanese must navigate participation in contemporary legal and technological worlds with their own histories and attitudes and with other elements of a changing moral order, including a growing mistrust of physicians, conflicting discourses that influence notions of "self," and the ability to manipulate the natural world as never before. A resort to tradition and cultural uniqueness can be mobilized by groups for specific purposes, Lock maintains, such as dealing with threats to the social order imposed by globalizing forces of technological medicine and the existence of ambiguous entities ushered in by organ transplantation.

Twice Dead is organized into chapters that move back and forth between North American and Japanese settings. This prevents either from being put in the role of the "exotic Other" while making the point that Japanese attitudes toward modernization—and Western assumptions about such attitudes—cannot be understood outside of the relations between the two. No¯shi mondai (the brain death "problem") involves more than legal or medical constructions of an organ donor's biological status or personhood. Lock innovatively illustrates this by inserting vignettes about donation from interviews and media accounts (although it is not always clear what the source is) between the chapters. These cases add dimension to the text and demonstrate the ambiguities of being a "living cadaver." Such narratives, along with the wide-ranging discussion of pragmatic technical, ethical, and legal problems involved in keeping a cadaver biologically "alive," acknowledge the assemblage of objects, discourses, reasoning, clinical practices, and grieving practices bound up in managing ambiguous entities within certain conceptual categories.

Lock's work has been ongoing for a long time and its scope is broad, which could explain why some of the information is outdated. Practices have changed since the references listed from the mid-1980s. Some Technology and Culture readers may be somewhat disappointed in the relatively slight treatment of the actual interaction of technologies and the body in the clinic, which could have provided important insights on the mutual construction of the body and biology-sustaining technologies in a non-Western society. [End Page 434]

This was not Lock's aim. Rather, she challenges the presumed dichotomy between nature and culture by raising doubts about the determination of biological death, and by demonstrating that societies have different understandings of and relations with different technologies. The Japanese are simply less concerned than North Americans about "transcending" death, yet they "animate" machines in all walks of life in complex ways, and accept genetic and reproductive techniques with little difficulty, in contrast to many Western societies, leading to the conclusion that one cannot generalize about any "technological imperative" operating in industrialized societies. Despite some shortcomings, Lock's book will be essential reading for medical and cultural anthropologists, and for...

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