医学人类学 10 - Issues in Organ Transplants 器官移植中的问题
Issues in Organ Transplants: Death, Biopower, Gifts, Commodities, and Organs...
[1] Death
Hospital Death
- More than 50% of Americans die in hospitals
- Death increasingly managed by medical professionals
- Biomedicine defines death
- The “problem of death:” when to withdraw treatment
- Medicine tells us how to keep the body alive, but not when to stop to keep the body alive.
SUPPORT Study
“Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.”
4-year study beginning 1989
First phase recruited 4300 patients, second phase 5000
Reported unsatisfactory end-of-life care in American hospitals
“Technological Imperative”
Imperative to intervene with technology whenever there is an opportunity to do so - not necessary better quality of life
- Mechanical Ventilator, “Iron Lungs”
Brain Death
Cadaveric transplants require a brain-dead, but otherwise intact donor
“Brain death” defined by Harvard committee in 1968
Definition widely accepted in North America and Europe, but contested in Japan and Egypt.
[2] Biopower
Biopolitics
The politics of life itself. Life - provide knowledge & can intervene
Manage the process of life in the population (not just individual life)
Michel Foucault (1926-1984)
Sovereign Power
The power of a king, queen, or other absolute ruler
“The right to take life or let live” - Sovereign can kill or just let them go...
Disciplinary Power
Distributed through institutions, especially institutions like prisons or schools
One of its principle technologies is surveillance
More scientific, with new technologies
Biopower
[Sovereign Disciplinary Powers are repressive]
Biopower: Power over bodies and populations, especially as exercised by modern scientific and medical disciplines - The power to “make live and let die”
Subjectification: process of becoming a certain kind of subject
Distributed, to populations - provide knowledge & manage live & death
Creating system for people to live - death managed by withdrawal services, inverse system of Sovereign Power
Who we are as people / subject - shaped by biopower - the productive power
[3] Gifts, Commodities, and Organs
Organ Donation Scandals
1999 Alder Hey scandal
1990s revelation that previous blood transfusion patients had been exposed to hepatitis C
2004 UCLA Willed Body Program direct resigns after accusation of illegally selling body parts
Gift Exchange
Marcel Mauss, The Gift (1925)
Kula Ring exchange in South Pacific
Promotes social solidarity
Commodity Exchange
Karl Marx, Capital, Volume I (1867)
Promotes alienation
Contemporary Approaches
Arijun Appadurai, The Social Life of Things (1986)
Objects move in and out of commodity situations
Gifts, Commodities, Transplants
The organ transplant industry involves the industrialization of gift and commodity exchange
Donated organs can dissolve social relationships while organ sales can build them.
