Set 9: Pick your Viscera

A gift is usually something given on your birthday or some other special occasion and can be small or grand. Gifts, in our culture, have come to allow individuals to monetarily quantify their feelings towards another person, of love, appreciation, or gratitude. However, a new gift has emerged from within the biomedical field: the “gift of life” via organ donation. How has the medical profession shaped this perception of organ donation and what are the implications for organ donors, recipients and the general public?

Organ transplants, a procedure that was unheard of fifty years ago, have become a normalized procedure and electing to be an organ donor is as simple as checking a box on your driver’s license application. Kaufman, Russ, and Shim’s article “Aged Bodies and Kinship Matters: The ethical field of kidney transplant” discuss this normalization of organ transplantation and really bring to light how new this procedure still is. In our society today, a kidney transplant is not an extremely common occurrence but isn’t thought of as a completely shocking medical intervention. Kaufman, Russ and Shim focus on kidney transplants for people over age 70 and posit that the construction of organ transplant for this age group is just one perpetuation of the widespread expectation “that one can grow older-and that one can strive to grow older, despite chronic disease and even terminal disease” (91) Our class has previously analyzed this expectation and shown how it has resulted in a hyper youth and longevity obsessed culture. And so how did this procedure become normalized? One process is the normalization of medical technology in general. This procedure has become more utilized for treatment and in terms of intervention forms, our mentality has evolved to a “whatever it takes” stance especially when dealing with end of life treatment. This mentality has pervaded medical decisions where now “choice is eclipsed by the routine treatment” (82) and the lengths a donor recipient will need to go through (hemodialysis, organ transplant, immuno-suppressant drugs after) have been normalized as needed in order to sustain life. Patients are expected to fight the war against death and seek extension of life at all costs.

The clip above is satirical but highlights the way our culture has come to view organ donation. Along with the great influence of medical technology, there is also the construction of organ donation as “the gift of life” often used by organ donation organizations and also medical professions. As with many relatives interviewed in the article, many of them come to symbolize the organ they donate as a physical manifestation of their love and appreciation for the recipient. Even among non-relatives, donors cited a strong family-like kinship that drove them to donate. This point is an interesting one because it seems to go in exactly the opposite direction of biomedicine historically. Biomedicine has prized itself for being objective and unbiased and medical students spend their entire medical education devoted to stripping away emotional attachment to viscera and organs in cadaver labs and patient diagnoses. But yet, donors place that emotional attachment back onto their organs. Donors explained many reasons for their donation such as “a thank you for all the years she has given me” or “donors feel obligated to allow their parent…to continue living” (85) and these loaded feelings are sometimes felt by recipients. Interviewed recipients demonstrated a lot of ambivalence towards receiving an organ and much of it was rooted as taking something from the donor, of being in debt to the donor where many “recipients…[feel] obligated to live for their families” (85). I believe that this understanding of organ donation has been constructed by donation organizations and also health care workers themselves, in skimming over Donate Life’s website, phrases such as “It’s About Living” and “the power to change someone’s life” are all conscious efforts to emotionally charge the act of donation and push people to sign up. How much free will do these organs donors really utilize in their choice to donate when looking at the loaded construction of how we view the process and act?

Nancy Scheper-Hughe’s article “The Last Commodity” focuses on individuals that have markedly less free will in terms of organ donation. Organ donors highlighted in the piece come typically from slums and ghettos and have donated organs as a means to an end. Gone are any romantic notions of a gift of life to a relative and instead the process is seen more as a business transaction of a commoditized good, our bodies. “Transplant tourism” is one notion brought up and organ donation is seen as a market consisting of “mortally sick bodies travelling in one direction…and “healthy” organs..in another (149). Although this idea may seem inherently wrong to some, the economists in the Freakonomics Radio episode "You say Repugnant..I say let's do it!" propose doing just this and treating organ matching as another business market. Treating organs as a commoditized product, at first seems repugnant, but have we not already put some emotional value on organs? What can prohibit placing monetary or trade value on them? As the article brings up “the ethical slippery slope occurs the first time one ailing human looks at another living human and realizes that inside that body is something capable of prolonging or enhancing his or her life” (161) and it is my view that we are now trying to climb back up after there has been evidence of negative repercussions around organ transplant. Like it or not, our organs have become constructed as valid entities outside of our bodies.

We have seen impoverished individuals with healthy organs exploited and preyed upon by more affluent, sick persons and this of great concern but where do we draw the line of free will over one’s body? How can we talk about the shortage of organ supply versus organ demand and then judge from our developed world the commodification of organ transplant seen in developing worlds?

Works Cited

Nancy Scheper-Hughes. 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.

Sharon R. Kaufman, 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.

"You Say Repugnant...I Say Let's Do it!". Freakonomics Radio. WNYC. Radio. December 2010

"Youtube: Anonymous Donor Donates Hospital 200 Human Kidneys". Web. March 2008

"Youtube: Man Lives Thanks To Heart Stolen From Dead Man". Web. March 2008

Site 8: Dying

My Grandfather and Grandmother in the process of a Buddhist housewarming ceremony.

My grandparents emigrated from Vietnam after the Fall of Saigon, leaving their entire lives and the cities where they grew up and raised their eight-child family. Almost all of my aunts and uncles live now in the United States and my grandparents live relatively close to my mom and our family. My mom has always enjoyed the company of my grandparents and has gone on cruises and other trips with them. In my eyes, my mom has always been the most involved with my grandparents, helping them with any errands they need to do or going along with them to help translate. In the past five or more years, my grandfather’s health had been unstable and shaky. He was diabetic and would often forget to take his insulin and fall into a coma. He was in and out of the hospital often and my grandmother and mother were the people who dealt with the majority of his health problems. This early November, my grandfather went to the hospital for another health complication and this visit, at first, felt all too familiar. Only along the timeline of his deteriorating health that my family and I were able to experience a completely different side of the how we understand and shape the idea of death and dying.

My grandfather entered the hospital with an already long medical history and it was initially treated within my family as another hospital visit. Soon he started having more complications and his prognosis began to look bleaker. In the beginning, my grandfather had to undergo hemodialysis and my grandmother and mother came to his hospital room everyday to help care for him and to translate for him. My mom, recently unemployed, carried most of the work of navigating the medical system for my grandfather. Two weeks before Christmas, my grandfather went into a coma and eventually had to be put on life support. He was put on an artificial respirator completely and was still on hemodialysis. Although my grandfather was not brain dead, I still relate to a lot of the concepts Margaret Lock brings up in “Living Cadavers and the Calculation of Death”. Not officially diagnosed as brain-dead, my grandfather, on all of this artificial support, was unable to sustain life with his own bodily processes thereby position in “betwixt and between, both alive and dead, breathing with technological assistance but…unconscious” (Lock 136). In a sense, I myself had already begun to deal with him no longer being “here” anymore. “Here” in the sense of his presence, his essence, his spirit. My mother and grandmother, the people who had been there for all his delusional outbursts and painful procedures during this time, I feel, had also begun to accept his passing. My grandfather remained on life support for one week or so until the difficult discussion of what the next step in treatment should be. Trying to gain conscious was the biggest thing but there were also his other underlying medical problems that had still yet to be dealt with. Would his life be for the better if we were to keep him alive? Or would another disease take him? The end of life debate is one that is complex with no right answer. So began a very hard process for my mother’s family.

"What Are We Going To Do About Dad?"

The NPR clip above was from an article I had previously read by Dr. Jerald Winakur titled “What Are We Going to Do About Dad” where he writes both about his experiences as an adult child caring for an father with dementia but also as a geriatric doctor. In his own personal experiences he expresses the dilemmas adult children face in navigating the parent’s medical decisions, culminating in the question his only sibling asks him every time he sees the author, “What are we going to do with dad?” Although I never heard exact conversations, my mother and her own siblings must have exchanged the same words among each other, as my grandfather’s health had been on the decline for some time. But there seemed to be no conclusion because my grandparents remained in their home, with my grandmother taking care of his day to day and my mom assisting. It was only until the question of if my grandfather should be taken off life support. My uncles and my grandfather’s brothers vetoed my grandmother and mother’s acceptance to take him off of life support. Instead they argued that he should remain on the life support, to “wait it out” maybe for a month, a year, who knows. For me, I found this incredibly frustrating because these people, who had not been there with my grandfather, had not had to go to the hospital in the middle of the night if the nurses called, wanted to keep him in the Intensive Care Unit where he was for however long. Dr. Winakur points out a huge weakness in geriatrics care of unintentional negligence, that this population takes much more attention and care than most workers are able to devote. While my grandfather was on life support and unresponsive, my grandmother and mother slept with him through the night and would sit by his bedside, offering the intense care end of life patients need. “Free from the Infirmity of (the) Age” by Eric Krakauer summarizes the sentiments I feel was happening with my uncle’s wishes to keep my grandfather alive that “Deferring death becomes more important than attending to the soul or preparation for the afterlife or the next life; it becomes more important than being with or saying farewell to loved ones, reconciling with estranged loved ones, or being home; it becomes more important even than a patient’s inability to do any of these tasks” (390). The decision to keep my grandfather on life support, in some ways seemed more rooted in the wishes of those living (my family) than the dying (my grandfather). Even if my grandfather did regain consciousness, it was highly likely he would just die from another cause (a “medical catastrophe” that one doctor in video watched in classed described) as all his organs began shutting down. Those who wished for him to stay on life support, wanted to fight to keep him alive at all costs as opposed to allowing him to pass away as peacefully as possible.

Ultimately, this hard decision was due to my grandfather’s stubborn denial to plan his end of the life decisions while he was still healthy. My mother brought it up many times and my grandfather refused to discuss the topic. In the end, his refusal to plan for the future resulted in frustration for everyone involved. My family had no clear plans or ideas of what my grandpa would have wanted in this situation. This divided my family and drew out an already painful process, both emotionally and physically. This denial of dying seems to span the American and the Vietnamese culture, that we have become unable to accept our inevitable demise. As previously discussed, medical technology and advances have had a large part to do with our staving off of aging and dying. But with these benefits are the greater costs of our extremely life centric and death fearing society.

Works Cited

Krakauer, Eric L. 2007. “To Be Freed from the Infirmity of (the) Age”: Subjectivity, Life-Sustaining Treatment, and Palliative Medicine.” In Subjectivity: Ethnographic Investigations. Joao Biehl, Byron Good, and Arthur Kleinman, eds. Berkeley: University of California Press. Pp 381-397.

Lock, Margaret. 2004. “Living Cadavers and the Calculation of Death.” Body and Society 10(2-3): 135-152.

"What Are We Going to Do About Dad?". Fresh Air. National Public Radio. August 18. 2005. Internet. Radio