“Brain death,” the determination of human death by showing the irreversible loss of all clinical functions of the brain, has become a worldwide practice. A biophilosophical account of brain death requires four sequential tasks: agreeing on the paradigm of death, a set of preconditions that frame the discussion; determining the definition of death by making explicit the consensual concept of death; determining the criterion of death that proves the definition has been fulfilled by being both necessary and sufficient for death; (...) and determining the tests of death for physicians to employ at the patient's bedside to demonstrate that the criterion of death has been fulfilled. The best definition of death is “the cessation of functioning of the organism as a whole.” The whole-brain criterion is the only criterion that is both necessary and sufficient for death. Brain death tests are used only in the unusual case in which a patient's ventilation is being supported. Brain death critics have identified weaknesses in its formulation. But despite its shortcomings, the whole-brain death formulation comprises a concept and public policy that make intuitive and practical sense and that has been well accepted by many societies. (shrink)

This remarkable book--the fruit of almost two decades of study--traces in compelling fashion the changes in Western attitudes toward death and dying from the earliest Christian times to the present day. A truly landmark study, The Hour of Our Death reveals a pattern of gradually developing evolutionary stages in our perceptions of life in relation to death, each stage representing a virtual redefinition of human nature. Starting at the very foundations of Western culture, the eminent historian Phillipe Aries shows how, (...) from Graeco-Roman times through the first ten centuries of the Common Era, death was too common to be frightening; each life was quietly subordinated to the community, which paid its respects and then moved on. Aries identifies the first major shift in attitude with the turn of the eleventh century when a sense of individuality began to rise and with it, profound consequences: death no longer meant merely the weakening of community, but rather the destruction of self. Hence the growing fear of the afterlife, new conceptions of the Last Judgment, and the first attempts (by Masses and other rituals) to guarantee a better life in the next world. In the 1500s attention shifted from the demise of the self to that of the loved one (as family supplants community), and by the nineteenth century death comes to be viewed as simply a staging post toward reunion in the hereafter. Finally, Aries shows why death has become such an unendurable truth in our own century--how it has been nearly banished from our daily lives--and points out what may be done to "re-tame" this secret terror. The richness of Aries's source material and investigative work is breathtaking. While exploring everything from churches, religious rituals, and graveyards (with their often macabre headstones and monuments), to wills and testaments, love letters, literature, paintings, diaries, town plans, crime and sanitation reports, and grave robbing complaints, Aries ranges across Europe to Russia on the one hand and to England and America on the other. As he sorts out the tangled mysteries of our accumulated terrors and beliefs, we come to understand the history--indeed the pathology--of our intellectual and psychological tensions in the face of death. (shrink)

Images are objects of work in the laboratory. On its face, this work is achieved through talk Yet the talk attached to these images makes reference to other images, which are drawn from varcous environments. In this article, four such environments are identified: the domain of laboratory practice; the context of invisible physical reactions; the future image as it will appear in publication; and the domain of case precedents and reference scenarios from the field. The work of image analysis brings (...) the outside of the image into it and takes the inside out. Thus it can be seen that images are not just taken, they are designed and made. (shrink)

There are three components to boundary objects as outlined in the original 1989 article. Interpretive flexibility, the structure of informatic and work process needs and arrangements, and, finally, the dynamic between ill-structured and more tailored uses of the objects. Much of the use of the concept has concentrated on the aspect of interpretive flexibility and has often mistaken or conflated this flexibility with the process of tacking back-and-forth between the ill-structured and well-structured aspects of the arrangements. Boundary objects are not (...) useful at just any level of scale or without full consideration of the entire model. The article discusses these aspects of the architecture of boundary objects and includes a discussion of one of the ways that boundary objects appeared as a concept in earlier work done by Star. It concludes with methodological considerations about how to study the system of boundary objects and infrastructure. (shrink)

We all know that we have and are our bodies. But might it be possible to leave this common place? In the present article we try to do this by attending to the way we do our bodies. The site where we look for such action is that of handling the hypoglycaemias that sometimes happen to people with diabetes. In this site it appears that the body, active in measuring, feeling and countering hypoglycaemias is not a bounded whole: its boundaries (...) leak. Bits and pieces of the outside get incorporated within the active body; while the centre of some bodily activities is beyond the skin. The body thus enacted is not self-evidently coherent either. There are tensions between the body’s organs; between the control under which we put our bodies and the erratic character of their behaviour; and between the various needs and desires single bodies somehow try to combine. Thus to say that a body is a whole, or so we conclude, skips over a lot of work. One does not hang together as a matter of course: keeping oneself together is something the embodied person needs to do. The person who fails to do so dies. (shrink)

Maps the future of phenomenological thought, accounting for how technology expands our means of experiencing the world.

Although established in the law and current practice, the determination of death according to neurological criteria continues to be controversial. Some scholars have advocated return to the traditional circulatory and respiratory criteria for determining death because individuals diagnosed as ‘brain dead’ display an extensive range of integrated biological functioning with the aid of mechanical ventilation. Others have attempted to refute this stance by appealing to the analogy between decapitation and brain death. Since a decapitated animal is obviously dead, and ‘brain (...) death’ represents physiological decapitation, brain dead individuals must be dead. In this article we refute this ‘decapitation gambit.’ We argue that decapitated animals are not necessarily dead, and that, moreover, the analogy between decapitation and the clinical syndrome of brain death is flawed. (shrink)

This article analyzes how the medical gaze made possible by MRI operates in radiological laboratories. It argues that although computer-assisted medical imaging technologies such as MRI shift radiological analysis to the realm of cyborg visuality, radiological analysis continues to depend on visualization produced by other technologies and diagnostic inputs. In the radiological laboratory, MRI is used to produce diverse sets of images of the internal parts of the body to zero in and visually extract the pathology. Visual extraction of pathology (...) becomes possible, however, because of the visual training of the radiologists in understanding and interpreting anatomic details of the whole body. These two levels of viewing constitute the bifocal vision of the radiologists. To make these levels of viewing work complementarily, the body, as it is presented in the body atlases, is made notational. (shrink)

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

The dead donor rule—that persons must be dead before their organs are taken—is a central part of the moral framework underlying organ procurement. Efforts to increase the pool of transplantable organs have been forced either to redefine death (e.g., anencephaly) or take advantage of ambiguities in the current definition of death (e.g., the Pittsburgh protocol). Society's growing acceptance of circumstances in which health care professionals can hasten a patient's death also may weaken the symbolic importance of the dead donor rule. (...) We consider the implications of these efforts to continually revise the line between life and death and ask whether it would be preferable to abandon the dead donor rule and rely entirely on informed consent as a safeguard against abuse. (shrink)

This article introduces the special issue on middle-range theory in science and technology studies, providing the background to its production and reviewing different notions of “middle.” It begins with Merton's ideas about middle-range theory as a way of moving beyond the production of either descriptions or theories of everything. Instead of seeing the middle as the space between the theoretical imagination and the detailed depiction of everyday practices, the authors outline three ways of thinking about the middle range: as an (...) adjective, the closest to Merton's conception; as a noun, the liminal place between theories, audiences, and levels; and as a verb, a process, a means of making connections across time, discipline, community, and place. A summary of each of the articles in this special issue is provided, preceding a call for further discussion about the role of case studies and the nature of the middle in STS. (shrink)

This article addresses the need to problematize “cases” in science and technology studies work, as a middle-range theory issue. The focus is not on any one case study per se, but on why case studies exist and endure in STS. Case studies are part of a specific problematization in the field. We therefore explore relations between motivation for the use of cases, their constitution, and ways they can be invoked to make particular kinds of arguments in STS. We set out (...) to examine the case as an object that links together research practices, intellectual debates, and programmatic concerns in our own work. Based on our experiences and on this reflection on the links between cases and questions in STS, we propose a number of casemaking strategies that shift and enrich the deployment of ethnographic cases as an epistemic tool in STS. (shrink)

This article describes the work of negotiating and reinterpreting "standard" protocols and criteria at the level of local practice, using the example of the procurement of human cadaver organs for transplantation. The tension between efforts to starulardize and globalize biomedical science, on the one hand, and fitting these efforts into everyday practices and understandings of practitioners, on the other, results in new constructions of medical knowledge about bodies and persons.

The traditional Western understanding of life and death as a strict dichotomy is challenged by a more descriptively accurate model of life's progressive cessation. Dying can be defined by a bounded zone of residual states of life that fits better with moral intuition and more sensitively guides action toward the dying.