Life Studies Blog (Old)

December 24, 2004

Brain death, Discipline & Punish, Foucault, Michel, panopticon (by M)

One of the most important characteristics of Chapter 2 of Brain Dead Person is that the function of "intensive care unit" is discussed in terms of ethics. This was because I believed that the creation of a "brain dead person" is closely connected to the function of "intensive care unit" in a hospital.

In this chapter I discussed that an intensive care unit looks like a "panopticon" that was described by J. Bentham, and later by Michel Foucault in his "Discipline & Punish : The Birth of the Prison."

I wrote in my book as follows:

"The beds have been separated with walls or curtains between them. Fellow patients have had their lines of sight entirely cut off. However, it has been made possible to see all of the patients from the nurses’ station in the very center. Here the intense gaze of those supervising falls on all those being supervised. This one central watchtower is designed to allow supervision of many small rooms from one place.
This looks incredibly similar to the structure of the modern European thinker Jeremy Bentham’s “Panopticon” -- a design for a prison. This was designed so that all the movements of the inmates could be seen from a central watchtower. The ICU is at the forefront of contemporary medicine, which started in Europe, and so it is of deep significance that the model of the Panopticon reappears here. Perhaps only a modern gaze fills the ICU. " (See this page)

When this book was published in 1989, some critics said that this idea was very interesting. Do you have any comments about the above idea?

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2 Comments:

  • Brain death is an ambiguous situation, because the concept of brain death does not express an “absolute” fact. Brain death is only a scientific fact, limited by the contingences of contemporary medicine. (Western-rooted) contemporary medicine is ruled by the mechanistic, compartementalized and utilitarian approach towards human’s being, instead of taking this being as a psycho-somatic whole. Therefore all of its scientific facts carry the defects of this approach.
    Also there are the problems created by the objectifying gaze that is rooted from the modern scientific understanding, which is meant to control more than to comprehend and communicate. The observer never aims to open his/her being to the other, whom (s)he observes, but rather treats the observed as a machine with a certain mechanism to be resolved in order to be manipulated. This gaze is also evident in contemporary medicine.
    In Fouccault’s book “The Birth of The Prison”, In the third chapter, “Discipline” the dormitory of a boarding school is described in a quotation. “Sleep is the image of death, dormitory is the image of cemetery… in the dormitory the beds are placed in such a way and they are seperated with curtains so that the people lying in the dormitory can go to bed and get up without seeing eachother.” This reminds us of the placing of the beds in the ICU. Foucault emphasizes that the same functional design is common in factories, schools, prisons, as well as hospitals. The same principles are valid in all of those modern institutions: enclosure, isolation of the individual, surveillance, classification, etc. The authorities in these institutions can see the individual (as the “object” of knowledge) without being seen, and the individual is detached from his/her past, personal relations and the fellow beings around in the institution, for the sake of only fulfilling the aims of the institution. In the ICU of the hospitals, the aim is to save the individual’s life but when brain death occurs, we see this aim is not achieved, despite all the modern methods applied. This is because a living being can not be approached and manipulated like the machines. A revolution in the perception of living beings seems to be essential. Living beings are not machines. Supporting their life “functions” and watching them with an objectifying gaze is not enough to keep them alive. The gaze that is aimed at controlling, should be changed with the means of comprehension and communication. These means can not be limited to the equipment and machinery necessary for monitoring and physiologically supporting the patient. We must understand that the human being is a psycho-somatic whole and we must pay attention to the probable phenomenon ascribable to this whole that can not be observed and controlled by means of modern medical equipment. There are some approaches by neurologists that take this fact into account. For example, in Columbia Univarsity, College of Physicians and Surgeons, it is accepted that alternative methods for helping a patient in coma can be used:
    “Although nobody knows for sure, it is possible that patients in coma can respond to the presence of loved ones at the bedside. A familiar voice or touch may have a calming or reassuring effect on the patient, and certainly can't hurt. We encourage as much bedside contact between the patient and family members as is possible, as long as it does not interfere with medical care. Playing a patient's favorite music may also be helpful.” (http://cpmcnet.columbia.edu/dept/neuro-icu/patient_info.html)
    In some other institutions it is also accepted that meaningful stimuli, that have emotional significance to the patient, such as perfume, pictures, reading etc. are usually more likely to elicit responses. (http://calder.med.miami.edu/pointis/tbifam/coma2.html)
    There are some reported cases, when the patient in coma responds to music. (http://www.uwec.edu/rasarla/research/litandgoals/Other/coma.htm)
    All of these approaches are different from the mechanistic “panopticon” approach towards the patient. It is also different from some physicians’approach who call the patients in coma as “vegetable” or “cabbage” in English speaking countries.

    By Blogger icono-clast, at 8:17 AM, December 29, 2004  

  • Thanks icono-clast. It is important to understand that a brain dead person is not a mere "object". As I showed in my paper Current Debate on the Ethical Issues of Brain Death, in some cases a brain dead person's heart continue beating more than a year. This is contradictory to lay persons' intuition about "brain death". Some family members report that when they enter the ICU they sometimes see the blood pressure of the brain dead son/daughter rise. This is a mystery to modern medicine, so physicians tend to think it a mere coincidence. Some family members talk about a kind of nonverbal communications they experienced between the brain dead patient and them. I discussed this topic in Life Studies Approaches to Bioethics. I will translate this part in the future.

    By Blogger Masahiro_Morioka, at 8:09 PM, December 29, 2004  

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