- Email: [email protected]
Rethinking our criteria for death
DISSECTING ROOM
have a lasting effect. In the USA and Europe, where medical hegemony is said to be more powerful, adverse publicity and worries about the source of organs seem to have been suppressed in favour of “focussing on the heroics of this technology”. Lock’s concluding plea that the term brain death should be dropped is entirely consistent with the evidence she has so painstakingly accumulated. However, Lock mars her admirable contribution to this subject with her suggestion that death of the “person” should be certified when consciousness and the ability to breathe have been lost permanently. This is surprising in view of the philosophical and scientific difficulties associated with any such concept and its diagnostic implications. Perhaps her enthusiasm for transplantation—she was a signatory to an article in this journal, in 1997, that mooted the acceleration of death in patients in a “permanent” vegetative state so that their organs might be available for transplantation—place her among those who put that interest before objective consideration of the facts?
Rethinking our criteria for death Twice Dead: Organ Transplants and the Reinvention of Death Margaret Lock. Berkeley: University of California Press, 2002. Pp 429. $24.95. ISBN 0 520 22814 6. his book may well drive the final nail into brain death’s coffin. It makes it abundantly clear that the ill-defined clinical state known by that name is not death and that its misrepresentation as such was solely for the purpose of avoiding the legal difficulties otherwise attendant upon the removal of organs from the dying. Most impressive, to the medical reader, are the candid views of those involved in the care of the so-called brain dead, and in the removal of their organs, which Margaret Lock obtained by personal interview. Physicians, specialists in intensive care, and surgeons admit to their difficulties in regarding these patients as dead. Some say explicitly that real death occurs when the heart stops. Hence the title of this remarkable book. Lock is especially interested in the different reception that the attempt to redefine death in terms of the loss of brain functions has had in Japan, as opposed to its seemingly ready acceptance in the USA and Europe. As others
T
have noted, the redefinition of death for transplant purposes seems to have been foisted upon the professions and public without informed debate. There is, accordingly, “nothing like a public consensus” even now. In these western countries, it may be that “the seductive metaphor of the gift of life” has led to the “studious” avoidance of reflection on how exactly the organs are procured. And the absence of legal and religious objection may have been an important factor. In Japan, the lawyers are still opposed to the confusion of brain death with death itself. Japanese transplant law preserves the distinction, allowing the diagnosis of brain death—which involves the acknowledged danger of the crucial apnoea test—only for the specific purpose of organ procurement in cases where the patient has registered a wish to donate organs and the relatives agree. Medical opposition in Japan is based on cultural differences as well as scientific grounds. Some well publicised early misadventures in transplantation may
David W Evans e-mail : [email protected]
An artist’s odyssey Imaging Ulysses: Richard Hamilton’s Illustrations to James Joyce An exhibition at the Irish Museum of Modern Art, Dublin, Ireland, showing until Sept 15, 2002. Imaging James Joyce’s Ulysses Stephen Coppel. London: British Council, 2002. Pp 156. £19.95. ISBN 0 863 55474 1.
R
imaging. Hamilton has completed illustrations for seven of the novel’s episodes, which the exhibition presents in sequence. The works reveal how he develops his final images from preparatory drawings and a successive prints.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Richard Hamilton, Bronze by Gold (1987)
THE LANCET • Vol 360 • July 13, 2002 • www.thelancet.com
British Museum © Richard Hamilton
ichard Hamilton was pivotal in the development of British Pop Art in the late 1950s. This illuminating exhibition, however, records his achievement in illustrating Ulysses, James Joyce’s complex and experimental novel. The publication of Ulysses in 1922, privately in Paris, was a landmark in 20th-century literature. The colours used on the first edition cover—white letters on a blue background—symbolised islands in the Aegean Sea. But one cannot judge a book by its cover alone. Ulysses’ kaleidoscopic text—made up of 18 episodes, written in varied and experimental styles, notably the interior monologues—challenged its illustrators. Henri Matisse based his interpretation on Homer rather than Joyce, in a 1935 edition. Hamilton began illustrating Ulysses in the late 1940s, but in 1950 he put the project aside until the 1980s. His strategy has been “to make a pictorial equivalent of Joyce’s stylistic leaps”. In doing so, he has used various printmaking techniques alongside computer
Hamilton’s first attempt at illustrating Leopold Bloom’s anticipation of a warm bath in the Lotus-Eaters episode was a side-on view. But he rejected that idea when he realised that Joyce’s specific phrase, “He foresaw his pale body reclined in it at full”, demanded an interior perspective. So for the print He Foresaw his Pale Body (1990), Hamilton used a vertical view, inverting and foreshortening Bloom’s body to correlate visually with his mental anticipation of his bath. Bronze by Gold (1987) is taken from the Sirens episode, where Joyce likens Homer’s sirens to two Dublin barmaids, luring men to drink at their counter. The cool eroticism of Hamilton’s illustration echoes the erotic connotations of the “beerpull”, evoked in Joyce’s prose: “On the smooth jutting beerpull laid Lydia hand lightly, plumply, leave it to my hands.” “I like to think that the route my venture has taken was served by happy chance”, says Hamilton. “The illustrations became a group of independent prints having their inspiration in Joyce— not bound to the words in a straightbook-jacket, but free to speak for themselves about the experience of learning ways to make images from a master of language.” Colin Martin 32 Woodstock Road, London W4 1UF, UK
179
For personal use. Only reproduce with permission from The Lancet Publishing Group.
have a lasting effect. In the USA and Europe, where medical hegemony is said to be more powerful, adverse publicity and worries about the source of organs seem to have been suppressed in favour of “focussing on the heroics of this technology”. Lock’s concluding plea that the term brain death should be dropped is entirely consistent with the evidence she has so painstakingly accumulated. However, Lock mars her admirable contribution to this subject with her suggestion that death of the “person” should be certified when consciousness and the ability to breathe have been lost permanently. This is surprising in view of the philosophical and scientific difficulties associated with any such concept and its diagnostic implications. Perhaps her enthusiasm for transplantation—she was a signatory to an article in this journal, in 1997, that mooted the acceleration of death in patients in a “permanent” vegetative state so that their organs might be available for transplantation—place her among those who put that interest before objective consideration of the facts?
Rethinking our criteria for death Twice Dead: Organ Transplants and the Reinvention of Death Margaret Lock. Berkeley: University of California Press, 2002. Pp 429. $24.95. ISBN 0 520 22814 6. his book may well drive the final nail into brain death’s coffin. It makes it abundantly clear that the ill-defined clinical state known by that name is not death and that its misrepresentation as such was solely for the purpose of avoiding the legal difficulties otherwise attendant upon the removal of organs from the dying. Most impressive, to the medical reader, are the candid views of those involved in the care of the so-called brain dead, and in the removal of their organs, which Margaret Lock obtained by personal interview. Physicians, specialists in intensive care, and surgeons admit to their difficulties in regarding these patients as dead. Some say explicitly that real death occurs when the heart stops. Hence the title of this remarkable book. Lock is especially interested in the different reception that the attempt to redefine death in terms of the loss of brain functions has had in Japan, as opposed to its seemingly ready acceptance in the USA and Europe. As others
T
have noted, the redefinition of death for transplant purposes seems to have been foisted upon the professions and public without informed debate. There is, accordingly, “nothing like a public consensus” even now. In these western countries, it may be that “the seductive metaphor of the gift of life” has led to the “studious” avoidance of reflection on how exactly the organs are procured. And the absence of legal and religious objection may have been an important factor. In Japan, the lawyers are still opposed to the confusion of brain death with death itself. Japanese transplant law preserves the distinction, allowing the diagnosis of brain death—which involves the acknowledged danger of the crucial apnoea test—only for the specific purpose of organ procurement in cases where the patient has registered a wish to donate organs and the relatives agree. Medical opposition in Japan is based on cultural differences as well as scientific grounds. Some well publicised early misadventures in transplantation may
David W Evans e-mail : [email protected]
An artist’s odyssey Imaging Ulysses: Richard Hamilton’s Illustrations to James Joyce An exhibition at the Irish Museum of Modern Art, Dublin, Ireland, showing until Sept 15, 2002. Imaging James Joyce’s Ulysses Stephen Coppel. London: British Council, 2002. Pp 156. £19.95. ISBN 0 863 55474 1.
R
imaging. Hamilton has completed illustrations for seven of the novel’s episodes, which the exhibition presents in sequence. The works reveal how he develops his final images from preparatory drawings and a successive prints.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Richard Hamilton, Bronze by Gold (1987)
THE LANCET • Vol 360 • July 13, 2002 • www.thelancet.com
British Museum © Richard Hamilton
ichard Hamilton was pivotal in the development of British Pop Art in the late 1950s. This illuminating exhibition, however, records his achievement in illustrating Ulysses, James Joyce’s complex and experimental novel. The publication of Ulysses in 1922, privately in Paris, was a landmark in 20th-century literature. The colours used on the first edition cover—white letters on a blue background—symbolised islands in the Aegean Sea. But one cannot judge a book by its cover alone. Ulysses’ kaleidoscopic text—made up of 18 episodes, written in varied and experimental styles, notably the interior monologues—challenged its illustrators. Henri Matisse based his interpretation on Homer rather than Joyce, in a 1935 edition. Hamilton began illustrating Ulysses in the late 1940s, but in 1950 he put the project aside until the 1980s. His strategy has been “to make a pictorial equivalent of Joyce’s stylistic leaps”. In doing so, he has used various printmaking techniques alongside computer
Hamilton’s first attempt at illustrating Leopold Bloom’s anticipation of a warm bath in the Lotus-Eaters episode was a side-on view. But he rejected that idea when he realised that Joyce’s specific phrase, “He foresaw his pale body reclined in it at full”, demanded an interior perspective. So for the print He Foresaw his Pale Body (1990), Hamilton used a vertical view, inverting and foreshortening Bloom’s body to correlate visually with his mental anticipation of his bath. Bronze by Gold (1987) is taken from the Sirens episode, where Joyce likens Homer’s sirens to two Dublin barmaids, luring men to drink at their counter. The cool eroticism of Hamilton’s illustration echoes the erotic connotations of the “beerpull”, evoked in Joyce’s prose: “On the smooth jutting beerpull laid Lydia hand lightly, plumply, leave it to my hands.” “I like to think that the route my venture has taken was served by happy chance”, says Hamilton. “The illustrations became a group of independent prints having their inspiration in Joyce— not bound to the words in a straightbook-jacket, but free to speak for themselves about the experience of learning ways to make images from a master of language.” Colin Martin 32 Woodstock Road, London W4 1UF, UK
179
For personal use. Only reproduce with permission from The Lancet Publishing Group.