Notes on the book “Twice Dead” by Margaret Lock

This book presents an extensive review of the history and development of one of the most controversial medical practices – organ transplants. In fact, it would be fair to say that the book is not really about organ transplants but about the reinvention of death in the relatively new term “brain death”. Lock describes the making of this term, it’s popularization, the debates that surround it, and its cultural impact.

Having worked for another project in Japan, Lock had an opportunity to research the issue of brain death there. This book provides a sort of comparison between the way the topic is approached in North America and in Japan. We learn that while in North America the use of brain dead patients for organ donation have become quite routinized, in Japan the concept of brain death had only been recognized quite recently (in 1997), even though the technological advances of the country could have permitted the complex procedures long before.

The author takes us through the various cultural and political reasons behind the differences in the way North America and Japan approached the subject. The most important reason for the many disputes around brain death is the fact that such vital questions as whether death is an event or a process, and where exactly is it located, remain unanswered. In the Western cultures it is largely believed that death can be located in the brain, and that consciousness is what what makes an individual recognizably alive and fully a person. In Japan, though, death is not located in the brain, nor is the essence or identity of a person. We find that many questions remain unanswered, which makes the debate over the whole idea of brain death active, especially in regards to organ transplantation.

The book “Twice Dead” rose many important question, which we usually don’t consider in our every day life. Likewise, when the author showed a part of the documentary about organ transplants to American public, they have been shocked, admitting that they had never thought about where exactly the organs for transplant came from. I must admit that I also never previously considered the idea of brain death and the moral and ethical questions that stand behind it. Apart from the idea of brain death itself, the author makes us rethink our own criteria for death. 

Another issue that I found extremely important is how the generally accepted idea of brain death is connected to the “business” of organ transplants. We are shown so many details that sort of play with our perception of reality and often make us lose our own ground, as, for example, when faced with doctor’s opinion. 

While in North America the doctors’ words are respected and accepted, in Japan the situation is a bit different; but here another factor plays a role – it is the dehumanisation of the patients in the ICU. Some Japanese philosophers argue that when relatives find their loved ones connected to different tubes and machines they may feel somewhat disoriented and lose the sense of intuition that would normally guide them in making decisions. 

Dehumanisation and standardisation of the patients with no brain activity brings them into the category of “living cadavers” – the term often used throughout the book. Of course, if a patient is viewed as a living cadaver, it is much easier to make decisions on taking his organs for transplants; yet at the same time, these patients are being stripped of their social rights. 

I couldn’t agree more with the author when she says that the fact that North America had so easily accepted the idea of brain death and its’ meaning as the end of life of a person decade ago, and Japan still has not found a consensus on the subject, should actually raise not an apparent question of “why the Japanese don’t agree?”, but rather the less obvious question of how come North America has agreed with the new concept of death so easily? The book explores  the boundaries between nature and culture, life and death, self and other, person and body, but still does not provide an answer to this vital philosophical question. 

We see that there are many “obstacles” to achieving a total agreement on the subject of brain death, such as the unanswered questions mentioned above. Because the issue is tied to extremely sensible subjects of life and death, it can never be resolved solely by biological measures, but will be always interconnected with philosophical and cultural views.

 In Japan Shinto scholars are split into whether or not organ donation is permissible. While some of them consider donation of the organs of the brain-dead body a community service, majority of the scholars oppose all organ transplantation as this type of procedure “injures there relationship between the ancestor and their kin”.(1) Lock points out that in several countries a few clinicians (mostly neurologists), legal commentators, and philosophers have argued that irreversible brain damage should not be thought of as biological death, but it nevertheless represents the end of meaningful life.

Here I would pose the question – who is to determine whether the life is meaningful or not? Who assigns meaning in this kind of settings? How can we, the little beings on the surface of one tiny planet in the middle of immeasurable Universe, permit ourselves to decided whether one’s life has meaning or not? I find myself agreeing with the point of view of Melanie Phillips presented in the book. She argues that because consciousness remains a mystery and cannot be “tested”, there is no scientific of philosophical basis for saying that brain death is death. 

I must add, though, that I appreciated the way Lock inserted real-life stories throughout the book for it worked as a sort of reality call, showing that this is not just statistics, numbers, ideas, politics… but it is people’s lives we are talking about, as donors and as recipients. I would like to point out that we all tend to reason in different modalities when we are simply reflecting upon an issue that exists somewhere outside of our personal interest, and when it becomes vital for our own personal situations. Thus, I can not predict how I would be talking if it were my child who needed an organ transplant. For this reason I am left only to acknowledge the complexity of the subject without really permitting myself to “take sides”.