The Ultimate Extension

In The Postmortal Condition: From the Biomedical Deconstruction of Death to the Extension of Longevity, Celine Lafontaine discusses how the pursuit of clinical and scientific medicine has driven individual health to become a main concern in our culture. With boundaries and parameters around death itself being altered and complex, new frameworks concerning aging and the value of the body begin to shift. There are “social and ethical consequences for this marked desire to conquer death scientifically,” and to try and live without an aging body (Lafontaine 297). While the focus of health and the older population run sided by side with advancements in modern medicine, the deconstruction, or destruction of death continues to gain speed and power. By having a compulsive population determined to live forever, mixed with this unlimited power and control of medical knowledge at the very core of social regulation, the health care system, and policy makers begin spiraling into an uneven growing network. While modern medical treatments are working to extend a patient’s life, and health insurance companies are funding treatments to significantly lengthen survival rates for failing bodies, public policy and laws to support these new changes are not moving fast enough to keep up.

In Aged bodies and kinship matters: The ethical field of kidney transplant, the authors discuss how “contemporary medicine” places “death within a framework of ethical decision making that emphasizes the fight against specific moral diseases and conditions” (Kaufman & Russ 81). The treatments set up within the health system, such as programs that fund renal dialysis for kidney failure, in turn, keep patients alive much longer, thereby contributing to the increase of demand for kidney transplants. Because of the technological advances in medicine and increased funding for life sustaining treatment, the demand has grown for transplants. Without finding a balanced system that sets forth policy and strategy, aligned  with an industry that is working hard to extend life at all cost, we will continue to see a decline in “humanistic social values and social relations” (Sheper-Hughes 9). This warped relationship is fueling many of the inequalities and health problems that continue to exist, if not creating more. It seems are current organ donation system is set up to pay the recipients with a kidney and pay the doctors, while leaving the donor with absolutely nothing. How are donors compensated for their body, time, life and services? However, this thought brings up serious ethical and legal concern. Is it possible to have a program set up that supports the changing technological environments of biomedicine, the growing number of elderly, and the increasing populations that are misrepresented with limited resources?  Has our current system influenced and set up black market activities around the selling of organs? 

Nancy Scheper-Hughes says, “new relations between capital and labor, bodies and the state, inclusion and exclusion have taken shape,” and some have created inequalities (9).  She questions the ways in which this market functions, and breaks apart the organized relations within it. The flow of kidneys move from the poor to the rich, coming from poorer countries and traveling to the richer ones, such as the United States. These transplants transactions are circulating from South to North, “from black and brown bodies to white ones, and from females to males” (Scheper-Hughes 150). The exchange and sacrifice of the body pulls in many questions concerning beliefs in the holiness and value of the body. By participating in free market medicine a person must divide and detach from their body. Those that are “lured into selling their organs” are motivated because of money which will provide some temporary band-aid, providing a moment of security or resource to take care of debt or pay for food (Scheper-Hughes 147). The teamwork associated with luring and finding a donor requires not just one person, but multiple educated experts in all areas of medicine and business. It becomes a very scary thought that the body is seen by some as just a bundle of parts that can be easily broken up and sold. How does a kidney get a price tagged on its value and regulated?  “The arguments for regulation are out of touch with the social and medical realities operating in many parts of the world, but especially in second and third world nations” (Scheper-Hughes 160). The articles this week bring up many complex topics, including the multiple frameworks that biomedicine has bounded around “choice,” along with their influence on the various ways to prolong life.  While different in many ways compared to organ trafficking, a personal experience that I recently had with biomedicine, surgery and the value of the body were very similar. 

Emergency Abdominal Surgery (six hours after leaving anthropology)

Almost 45 days after surgery.

When your body is trying to survive, your instinct is to do whatever it takes to continuing living. Our bodies are hard-wired to resist death. After having emergency abdominal surgery five months ago, the ideas around my body, medicine and life have shifted and changed. With twenty-seven inches of my colon gone (hemi-colectomy), two tumors and appendix removed, the value of my life became even more sacred.  While biomedicine has been a very hot topic in this class, addressing tough issues surrounding power and technology, it saved my life. Just part of the price tag to extend my life: $48, 111.73. 

                                                                                                                                     

 The surgery gave me an extension on life, placed a value on my body parts along with the services the institution deemed appropriate.  

First bill that gave a list of what services cost

Although I had to believe and trust in the medical team that was taking care of me, I still questioned everything they were doing to my body. Mentally my mind was challenged to get rid of these social norms I had attached to being sick, and let my body express itself as it needed to. For the first time in my life I was physically incapable of doing normal bodily movements, wondering when will I get my “body back.”   Was I thinking about the greater good of the people and what was appropriate as I am trying to survive and stay alive? No I wasn’t, but I had a choice, a privileged choice about my body that was influenced by the University of Washington Medical Center. Even though I had a choice, the institution was a huge influence on every decision I made through the ten days of recovery in the hospital, but the months of care at home were left up to me. This only makes me wonder what happens afterward to the people that are donating their body and their organs to keep someone else alive. This surgery for me was the “ultimate extension” of life. I would not be alive today without it, and I would take advantage of the advanced technology that we have at any stage of my life if it would give me the feeling I currently have within my body and mind. 

What the "extension of life" looks like today

Works Cited:

• Kaufman, Sharon., Ann J. Russ, and Janet K. Shim. 2006. "Aged Bodies and Kinship Matters: The Ethical Field of Kidney Transplant." American Ethnologist 33 (1): 81-99.

• Scheper-Hughes, Nancy . 2005. "The Last Commodity: Post-Human Ethics and the Global Traffic in ‘Fresh’ Organs." Pp. 145-167. In Global Assemblages: Technology, Politics, and Ethics as Anthropological Problems. Malden, MA: Blackwell Publishers. 

•  Lafontaine, Celine , 2009. The Postmortal Condition: From the Biomedical Deconstruction of Death to the Extension of Longevity. Science as Culture 18930: 297-312.

A Good Death

“Whether normal aging is a disease, whether senility in old age is normal, and whether aging per se leads inevitably to death are all questions that persisted long before recent forms of medicocultural negotiation emerged” (Kaufman 25). With the sophistication of biomedical knowledge, a constant shift of ideas and debates continue to surface in our health care system. In Dementia-Near Death and “Life Itself,” Sharon Kaufman discusses the politics behind a “diminishing life,” the “quality of life,” and what comprises a normal decline towards the final moments of life (23). The value of life and the body of the person becomes normalized in our health care system in ways that enable more clinical approaches to control the time of death and to medicalizing aging. Kaufman points out that “life, health, illness categories, and death were objects to be acted on via the instrumentalization techniques that the biological sciences and clinical medicine offered” (24). These biomedical advancements shape our understanding of how a person with dementia and other diseases affecting the brain are bodily represented. The frameworks that are placed around healing, intervening and diagnosing conditions that slowly destroy the brain, continue to convert living bodies into “victims, patients, and research subjects” (Kaufman 25). The medicalized body therefore becomes a product of changing knowledge within our cultural belief system.

 What then is considered a normal way to age, or a natural, “good” death? Our western culture is consumed and obsessed with youth, and in denial of aging and death. Even after all the wonderful advances that modern medicine has offered, 100% of people will still die. Science might help delay, post-pone or interrupt the process of dying, but eventually everyone dies.  The youth today are infatuated with sex appeal and looking “older,” while the “older” population are trying to emulate the young. After reading through the articles for this week, it seems that when “we” want something from someone, and can use “them” in our society, then we consider them alive and living. However, if they can’t contribute mentally or physically, then we deem them unusable and sometimes even dead. Margaret Lock discuses this issue in her article Living Cadaver and the Calculation of Death. “Because a brain-dead body is entirely dependent upon ventilator support, its very existence is determined by technology…” (Lock 136). While many believe that this person is no longer alive, organs can still be transplanted and the body is therefore treated as if it were going to wake up one day. The body is kept “functioning as close to normal as is possible,” resembling what would be done if they were actually going to survive (Lock 140). This is similar to the way the elderly, the terminally ill and the aging population is viewed in our culture. If a person is unable to give back to the community and powerless, they are viewed to be more of a problem then a productive part of society. If the “essence” is gone, is the person gone?  Some cultures believe that the concept of brain death was mainly created to help aid organ transplants, where brain dead bodies are still considered living people and basic “human rights remain attached” (Lock 138). Although different cultures have variations in belief systems around death and dying, in North America a body that is brain dead “is biologically alive in the minds of those who work closely with it, but it is no longer a person” (Lock 150). Again, this goes back to the questions of what constitutes a natural, good death especially if the body is considered not even to be a person anymore. 

I believe that we fear death because we are not as familiar with it.  Because death is controlled by our medical institutions we fear that we will no longer have control over our own body and mind when death approaches. Hospitals replace the home, physicians replace religious function, private rooms with curtains replace small gatherings of friends and family. Margaret Lock calls this the “new dying,” death occurring not as it will “naturally but delayed, managed, and timed” (Green 47). Death is hidden and put away until the very last moment. We live life in ways to avoid aging, to postpone death, and forget that as we are working so hard planning on how to live, life has already moved forward. Most Americans seem afraid not just of dying, but also of thinking and talking about death. Our culture influences the way we recognize, accept and identify with experiences throughout our lives. 

For terminally ill patients a big question arises around supportive care when there is no cure for their disease. In the video below, the lives of 4 terminally ill people are followed throughout their journey of dying. This documentary touches on many aspects concerning what is a “good death,” and attempts to bring the viewer closer to the dying process. Sacred Heart Palliative Care Center is a thirty-nine bed clinic that serves terminally ill patients that are dying. They provides services to the ill that help them deal with the symptoms and suffering that comes with their disease. Palliative medicine approaches each person without having an agenda; listening to individuals and helping them achieve a good death. In the documentary it becomes easier to understand what is important in each of the individuals lives.  Sharon Kaufman points out that “staff and family must respond to the life that is being maintained at the threshold of death enacting what they perceive to be the most respectful and lease painful passage to death or the best methods for continued maintenance of life” (Kaufman 40). This is clearly something that Sacred Heart is able to offer, and is seen through the chosen interventions that the staff provides for the patients. I feel that each person has meaning and value until the very last breath they take. With more people living longer, the task of finding high-quality care for the terminally ill, or the aging population who can no longer look after themselves is getting harder. Every life has value, and every person has meaning.

Sacred Heart Palliative Care Center

While the human body ages, changes shape and form, the importance and value of that person does not diminish, but if anything becomes priceless. The photo of the hands below visually represent a life of meaning. This aging body shows the shifts and changes in the skin, and tells a unique story of a women who has lived a meaningful life. Each crease and groove in the fingers give an idea about a life that was fully lived, and one that has left an imprint for others to carry on into the next generation.

Works Cited:

Green, James W. Beyond The Good Death, The Anthropology of Modern Dying. Philadelphia: University of Pennsylvania Press, 2008.

Lock, Margaret.  “Living Cadavers and the Calculation of Death.” 2004 Body and Society 10(23): 135-152.

Kaufman, Sharon R, Ann J Russ, and Janet K Shim. “Dementia-Near-Death.” 2006 Body and Society.

Lafforgue, Eric. (Very) old Borana women hands. 2 March 2011 <http://www.flickr.com/photos/tywak/galleries/72157622422969995/>.

Health Awards Category 2 A Good Death You Tube. <http://www.youtube.com/watch?v=vLYMUdiUIrs>.