Death before dying: Mind, body, ethics and the Harvard brain death committee

When does life end? On August 5, 1968, a committee of the Harvard Medical School published criteria for "irreversible coma," ushering in widespread use of the idea of "brain death." Yet brain death was more than an idea. It reflected a constellation of practices and experiences. Just what these were is the subject of this study. And what they were is consequential. Historical characterizations of the motives behind brain death fuel continued controversy about whether to define death via the brain, and about how much the declaration of death is needed for decisions to end care or remove organs.;This study examines the contributions of the authors of the criteria and the interests, practices, resources, and problems that shaped both their work, and criticisms of it. The Harvard Report emerges as a point in time where a certain ordering of work on the management of coma, laboratory paradigms of consciousness, and a considered preference for a contingent, situation-based approach to ethics, were mutually reinforcing in the context of medical practice. The Report was only marginally concerned with protecting transplantation and primarily concerned with reliable measures for taming technologically intensive medical practice. This characterization questions the polarity between the clinical and the ethical that has sustained an historical narrative of bioethics as a needed and inevitable new expertise.;Larger stories better capture negotiations over the variably prized and variably maligned role of medicalization in culture. The Report suggests questioning, rather than underscoring, usual critical assumptions about the institution of medicine and the nature of medical knowledge by pointing to shared historical narratives of which the Report and its critics were a part. Brain death is a story of how consciousness, human agency, the brain, and their relationships with each other, are crucial, dispersed, tools with which to shape the contours of acceptable uses of medicine. But to what do these terms refer and reflect? Themselves shaped by tensions between the need for standardized knowledge and the compelling meanings of circumstance, these terms mediate efforts to maintain the identity, integrity and wholeness of persons in an increasingly strange world.