ANTC61 Lecture 10.pdf

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21 Apr 2012
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Biotechnical Embrace
Decreasing traffic fatalities
Trauma units better at preventing onset of brain death
Aging population (decreases pool of viable donors)
Margaret Lock: writes about these factors
Facotrs that account for a shortage of organs
Pool of patients deemed eligible for transplants has expanded
Increased demand due to:
Socially producing a shortage of organs: the metaphor of a shortage of organs is embedded in transplant discourse, and the assumption of
much of this course is that donations have declined. At the same time, demand has increased. The increase for wait time is du e to decrease in
supply and increase in demand. There is an increased rate of live donations (i.e. kidneys) and it has been found that the liv e donors are a better
solution. Organ tourism (i.e. Canadian going to Germany) are becoming more popular
Poverty and indebtness in contexts of social inequality are the 2 main facftors in context of social inequality, lack of soci alized
health care and little regulatory oversight (with the presence of occruptions)
There was little long- term data on donor outcomes, but doctors assured recipients that they would be fine. There was a gender
dynamic in Sotuh India: donors from urban areas are women and donors from rural areas are men. There is a valuation of men's
work and bodies more than women's. This raises the question of who's health in a family member is considered most valuable.
There are zones of belts that have a very high level of kidney donation and this might be on the part of moneylenders
(collateralizing the body's rapport). Most people who were in debt and donated kidneys ended up back in debt.
There is a creation of perceptions by competitiors to make clinics look suspicious and part of a larger conglomearate that le ads to an
arms dealer for example.
Ethical arguments: "win- win" discourse makes it seem like everyone is winning. This discourse admits of a very short frame time
of consideration. It's often not beneficial for donors. Legally since 1994 you're not allowed to sell organs, and organ touri sm was
meant to be curbed. Generally, it had to be donations from family or those who have died (or approved non - kin donors by a
committee). Donating organs was viewed as a highly risky proposition, so a non- family member was preferred (same standard not
applied). Marx's commodity fetishism is similar; creation of commodity does not entitle you to a sense of ownership.
Cohen found a shortage of recipeients, not donors. He also talks about aggressive recruitic tactics, with recepipients not be ing aware
of duration and extent of medical expenses. The ones who need it are too poor to be able to afford organ transplants.
Iran has managed to stamp out illegal organ transfers. Sales are not permitted, but donors are given a gift and guaranteed
medical coverage.
Organ tourism: Scheper- Hughes found that the win- win discourse is inapprorpiate when applied to stepp poverty. Better
regulation is empty rhetoric. The language of rights can mask the suffering. The technology creates a complicated form of
bioexchange that unfold in divergent contexts, and which evade easy generalizations about 'being a boon'.
Lawrence Cohen: How are donors created? What circumstances drive people to conceptualize parts of their body as being for sale?
Bioavailability
While live organ donations are seemed more effective, regular donations are still important. The technology of being able to keep
someone alive has lead to changes in the definition of death (medically and legally). In medieval Europe, there was a fear of being buried
alive. The definition of death has changed from putrefaction to cessation of heartbeat to brain death (a cyborg: being kept a live by a
combo of human dand machine, such as dialysis, artificial heart). There are patients who lose consciousness were called livin g cadavres,
but not brain dead is more common.
Living cadavers become target for procurement. What is the criteria for brain death? Margaret Lock suggested that doctors silently turned
off machines in patient assisted doctors, but post 1978 that changed. We want to prevent doctors from unplugging someone.
Death is a process. Even though a beep may indidicate brain or heart death, the rest of the body does not die immediately. In tensivists
want to make death as far along the spectrum as possible, while transplant experts want it as early as possible.
Finally, a consensus emerged in NA that the "irreversible loss of whole brain function" is the definition of brain death, and some broad
agreement on criteria for determining brain death. Why is this the case? There is actually no consensus on why this time is t he chosen
time; different physicians give different times.
Lock's research show sthat in Japan and NA, there are similar definitions of brain death. However, consequences od diagnosis are
different; brain death and death of a person is not the same.
There has been a shift in the definition of death (i.e. brain stem death), but this can't be separated from supply- demand of organs.
Proponenets of transplantation seek to legally define death as early as possible to increase the likelhhood of success outcomes and to
increase pool of donors to meet the shortage.
"Being as good as dead": are there categories that can be considered effectively dead? (Vegetative stage in The Spirit) In so me quarters,
even the mentally ill have been considered organ.
Any discomfort we may feel at this topic is a social construction itself. There is conflict that is created because of these contradictory
ideas that exist in our dead. Technological advancement leads to the creation of these conflicts. The question that emerges i s what sort of
human life do we value the most.
New definitions of life and death
Anthropological studies of the economy have focused on a dichotomy: gift versus commodity. Gift is associated with smaller sc ale
societies and commodity is associated with complex societies.
Michael Mauss (The Gift): He was trying to answer the question what is about a gift that compels the recipient to give back. The notion
of gift giving creates ties of reciprocity between people (creation of a social bond). In gift economies, the gift is not see n as alienable but
Sociality of organs
Lecture 10
Wednesday, March 16, 2011
2:37 PM
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of gift giving creates ties of reciprocity between people (creation of a social bond). In gift economies, the gift is not see n as alienable but
rather inalienable (you're giving a part of yourself). The recipient has to give back. We've lsot stories, but the gift logic is still there.
Karl Marx (Kapital): Marx says that within capitalist societies, commodities are things that are alienable. This is the basis of capitalism of
a system of production. When we purchase something, we don't feel a link to the person who made it (although fair trade can b e seen as a
gift giving logic injection into capitalism).
However, there is some gift giving logic. For example, life acquires a further meaning when you give your organs (you live th rough
the organ recipieient, the gift of life).
There is some sense on which the organ is not seen as completely separate from the person (a person's characteristics, moral
qualities, etc. might be transferred)
Many recipients note changes in themselves after transplantation, especially the acquisition of qualities of the donor.
Gift and commodities are often seen as opposing logics about the relationship between people and things. We can see both at p lay in
discussions of organ transplantation. Organs are alienable, and medical literature msut resist mystical associations of perso nhood with
organs. Gift giving logic would see organs as a inalienable from the person.
Anonymous gift giving is important to prevent the tyranny of the gift: avoid mystical notions of organs and prevent donor fam ilies from
exerting pressure (my brother gave you his heart, give us money).
Evlauating the success of the organ transplant enterprise solely in terms of an increase in the years of survival- post operation seems
inadequate
Bodies and person
Nature and culture
Death and life
Forms of kinship and relatedness
Commodies and gifts
And are intermeshed with larger processes of politics, soacialty:
Organ transplants blur the boundaries of many fundamental conceptual categories, such as those between:
And can challenge ethical discourses of rights, alturism and autonomy when considered in light of poverty, inequality and
exploitation
ARTs are another set of techs that have received much anthro scruity, for they impact notions of kisnhip.
Within C19 Euro- American model of kinship, the facts of society ewre rooted in "facts of nature": biological descent was assumed as
the essential process determinative of kin relations. Blood and marriage both created kinship.
The idea of blood: lots of communities think about "sharing" blood. Among the Malay, sharing food (i.e. breastmilk) is equal to
sharing blood (two people who shared the same breastmilk would be considered kin)
Strathern pointed out that kinship served to link biological and social domains in Euro- American imagination. The nuclear family came
to be seen as natural. There was also a strong focus on the individual in the Euro- American conception, but this emphasis tends to
misrepresent other forms of relationships. Incest is a common idea, but what is incest is different. Different moderns of con ception
anchor different forms of paternity (in Amazon, a woman will have sex with several men).
The point: diverse practices in relation to kinship structgure different models of relatedness
There are extra- kinship consequences. For example, the legal idea of family is extremely important. Thus, the idea of kinship has social
consequences.
Charis Thompos: her study was about the "dynamic coordination of the technical, scientific, kinship, gender, emotional, legal , politcal
and fianncial aspects of ART clinics". WE can think about kinship/ relatedness as part of a giant web. Thompson talks about d aily
activities in the ART clinic as a culture in the making. The relationships aren't stable (bureaucratic constraints) and the c onstraints don't
lways mesh.
Class: Unlike Israel, where ART is subsidized, ART is done in private clinics in Egypt and so only wealthy women can afford
to reproduced using these techs. Those who can't afford it are being denied, and many argue this is a form of violence.
1.
Knowledge: Welathier patients tend to have a better understanding of the techs, while poorer women had little understanding
of these techs.
2.
Religion: No 3d party donations are allowed in IVF (adulterty), which is different from Israel.
3.
Standards of medical practice: there is a perception of low quality controls and profit motives that makes people wary. Also,
why not spend on public initiatives to counter infertitlity.
4.
Low success rates: Out of 77 cases, only 7 resulted in successful conceptions. In promotions, they give much higher success
rates. People are mislead.
5.
Gender: Men speak about a loss of their sense of masculinity b/c they can't give their children their identity, and a loss of
their patriarchy power (their not fathers of biological children). Men often blame their wives (threats of divorce), which is
paradoxical b/c men seem to be more infertile (environmental factors: lead exposure, kidney failure leading to tract
infections). Women go through all kinds of stress in the process. The powr of the medical imaginary utilizes the hopes of
these women.
6.
Stigma: B/c of the possible connotations of adulterty in using the tech and gender performance, many people are afraid to
share with even their close family members that they're undergoing IVF. It's a burden of secrecy that probably increases costs
(travel further so people don't recognize them). It was decided that the kids would never be told.
7.
There are 8 constraints to to IVF in Egypt:
Marsha Inhorn writes about IVF to Egypt. Muslim women see infetitlity as a crisis in a married woman's identity. IVF leads to great
hopes and also dashes them too. The biomedical model that underlies the tech and popular models don't complexty connect, and this
leads to different degrees of understanding and misunderstanding about the procedure. This raises moral problems for women. T here is
an investment in the "natural" prduciton of fetuses. For a child to be your own, it has to be gestated in the mother's womb. Seeing a child
outside a womb and in a tube is morally problematic. IVF translates to "a baby of the tubes", but its not clear what tubes me ans (fallopian
tubes, test tube, etc.). Some people see this as problematic, but others see only have a surrogate mother or donated sperm as okay (father's
sperm, mother's egg).
Assistive Reproductive Technologies
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(travel further so people don't recognize them). It was decided that the kids would never be told.
"Embodiment": the pressure and the stress affects their physical bodies (when you stop trying, that's when something
happens)
8.
Biotechs like ARTs can't be separated from the context into which they are introudced; they have unintended social effects an d
bring into releif (and exacerbate) social inequalities.
She wrote "Reproducing Jews". She describes some of the complex negotiations that go on. Religious significance is assigned t o
these alienable technologies. A story about a woman getting pregnant in a bathtub is used to justify this tech as not being a dultery.
The complex entaglement of Jewish notions of identity and religious, law, legal notions of rights, community hitsory and pres ent-
day national politicals.
Susan Kahn writes on ARTS in Israel. In Jewish discourse, an infertile woman is extremely problematic b/c society valeus havi ng
progeny. There are many different factors: reflection on the Holocaust, nationalist worries about increasing rates in Arab n ations, etc.
The religious, social and political have come into alignment, and as a result, sperm donation, single motherhood, and surroga te
motherhood are encouraged. Adultery becomes an interesting topic, as does the use of non- Jewish sperm. Mother is the transmitter of
Judaism.
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