Postmodernity and determination of death

Extract

[...] determination of death becomes primarily a moral and not medical matter” (Franklin & Lock, 2003). The element of individual choice rather than of universal truth pervades the acceptance of brain death as an available diagnostic criterion for organ transplantation. The decision in determining the moment of death is removed from the modern expert (in the form of the medical professional), and offered to the individual or their family. Looking more widely, individual choice for the moment of death in a medical setting not only includes organ donation, but also do-not-resuscitate orders, living wills, and other forms of personalizing the specific determination of death for use with a particular individual. [...]

[...] Regardless of the broader sociological traits that lure the United States toward a multi-faceted determination of death, this phenomenon appears legally beyond the heart/brain duality of the Uniform Declaration of Death Act as well. Several states, including New Jersey and New York, have adopted “religious exceptions” in their statutes to supplement the medical aspect with an assurance of no “pronouncement of death in violation of religious belief” (Rosen, 1985). These additions serve as a form of “conscience clause”: [The clause is] an attempt to allow people to choose an alternative concept of death, and which Robert Olick said “signals a new direction for the development of public policy governing the declaration of death in pluralistic communities”(Morioka, 2001). [...]

[...] The contemporary determination of death appeals to individuality rather than collectivity. In this sense, with neither demand for nor expectation of universality, the determination of death displays a thoroughly postmodern character. Lock remarks that “death is not an entity, a substance, or a presence of something. On the contrary it is the absence of something namely, life whose definition is elusive” (Franklin & Lock, 2003). In recognizing the postmodern nature of the popular understanding of death, as a more properly social event (rather than a biological event) whose moment of occurrence depends on the individual choice (rather than a universally defined condition), we begin to capture the intricate character of death in the contemporary United States. [...]

[...] Margaret Lock approaches the self in determination of death as an essentially confounding entity wreaking troubles for brain death determinations. As brain death exists in the popular mind as the moment of departure for the soul or self, attempts to draw this self into rational comprehensions require categorization. The struggle to grasp the meaning of self calls into question the validity of “clinical homogeneity” in determination of death, and so indicts the modern model for failure to properly capture the intricacies of life (Franklin & Lock, 2003). [...]

[...] Determination of death rests upon the satisfaction of preset medical criteria involving the cessation of cardiopulmonary or neurological activity. The exactitude of the measurements in a determination has been increasingly expanded from basic reflex testing, to monitoring for electrical activity, to measurement of specific chemical levels. Such empirically based microbiological tests are exceedingly refined prior to endorsement by the state medical boards, with the preset checklists often including precise intervals of error for the measured diagnostic criteria. For example, declaration of brain death in Massachusetts requires that certain reflexes be unresponsive, that the eye pupils remain between 4mm and 9mm, and that certain levels of blood pH, systolic blood pressure, and body temperature are found (Massachusetts General Hospital, 2001). [...]