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91 A Rhetoric of Death and Dying 5 A Rhetoric of Death and Dying Some of what transpires between health professionals and patients or their family members in conversation at the end of life—and, indeed, some of what is taken to constitute “shared decision making” or to warrant “informed consent”—does not meet all of the conditions for rhetoric itself. Chaim Perelman and Lucie Olbrechts-Tyteca say the conditions for rhetoric include conditions for “a contact of minds,” and if these conditions are not met, then the people addressed do not properly constitute a rhetorical audience, and what is going on is not really rhetoric at all but something else: coercion, perhaps. “The indispensable minimum for argumentation appears to be the existence of a common language” (Perelman and Olbrechts-Tyteca 15). So, two people are not engaged in a properly rhetorical process if only one of them really speaks the language of exchange. Another condition for rhetoric, according to Perelman and Olbrechts-Tyteca, is mutual respect: “To engage in an argument a person must attach importance to gaining the adherence of his interlocutor, to securing his assent, his mental cooperation” (16). Furthermore, “[a]chievement of the conditions preliminary to the contact of minds is facilitated by such factors as membership in the same social class, exchange of visits and other social relations” (17). For Aristotle himself, a proper audience was the relevant judge in a particular case; these were persons to whom appeals could be made because they had the power to act once their minds were made up. For eighteenth-century rhetorician George Campbell, an 92 A Rhetoric of Death and Dying audience was a body poised to act once the understanding had been informed , and the will, then, moved.1 This chapter takes death and dying as its topic. Reporting on complementary research studies, it illustrates the problematic nature of end-of-life conversations between medical professionals and patients/family members. The first study centers on a narrative account of one family facing the nursing -home death of a parent. The second study offers an analysis of transcripts collected in connection with a hospital-based research project aimed at establishing an interview protocol for end-of-life decision making .2 The relation itself of the two studies suggests something about a trajectory for humanities research in health. The first project is driven by a question that emerges from an individual researcher’s personal experience and reflections on experience; the question is then explored for the most part in the library. The work leads to her participation in the second study, which responds to an experimental question and is carried out in a clinical setting by an interdisciplinary team of researchers. The idea that is specified by both studies is that there are competing discourses of death and dying and that some means of traveling between these discourses is necessary in order for the most productive rhetorical process to take place. As Susan Sontag, Virginia Warren, Howard F. Stein (“Domestic Wars”), and Assya Pascalev have described, death in biomedicine is tied to a war narrative of professional practice. (The metaphor is discussed in more detail in chapter 6.) In biomedicine’s story, the body’s defence mechanisms resist invading microbes; pharmaceutical magic bullets target enemy cells; and physicians are warriors whose calling is to defeat death and save us to die another day. The metaphor is not evenly distributed through health settings: It holds more sway in hospitals than in hospices, for example. Meanwhile, increasingly, in public discourse, death is quite a different matter. It is a matter, above all, of reluctant inevitability . This difference between biomedical and public discourses on death seems to sustain itself despite the usual power of biomedical thinking in everyday life—its ability, as Pascalev says, to “penetrate the patterns of thinking and the imagination of laymen” (223).3 Certainly, we have seen in the past decade or so an increased quantity of public discourse on death. The quality of public discourse on death has also changed: Death talk has become oddly neutralized. It is not that death is no longer an uncomfortable subject, but we can read in our local newspapers that “smoking is an economic boon because it kills off people before they become a health burden” (Binder) and respond not by recoiling but by doing the math. Public discourse has taken a death turn. 93 A Rhetoric of Death and Dying We find, for example, discussions of caskets and memorials...


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