DEATH

I was saddened to hear of the death of French philosopher-journalist André Gorz and of his wife Dorine. In his youth, Gorz was a follower of Jean-Paul Sartre and he later went on to help found Le Nouvel Observateur, a socialist news magazine. He was also a leading proponent of Ecology and supported the development of green politics in France. His last book was a love letter to his wife and life-long companion, Dorine, who was ill with a degenerative disease. I had met the couple in France in my student days and keep a lovely memory of them both.



I have translated the entry for Death in the recently published Dictionary of the Body, (Presses universitaires de France, 2007). It is signed by Pascal Hintermeyer of the University of Strasbourg. The ever-meticulous Gorz would have approved.

DEATH

Death constitutes an inexorable limit for bodily existence and for consciousness. Taking hold of the body, it condemns it to irremediable decomposition thus breaking its unity and continuity, destroys its regulatory mechanisms and necessary functions, disperses its components. It can thus be considered, to quote Hegel,
a "natural analysis"separating elements that formerly constituted an organism. Viewed in this manner, death is the destiny of every living being which remains as such so long as it resists its power. It is characteristic of man to be conscious of this necessity all the while opposing it. As much as the use of language or the manipulation of tools, humanity constitutes itself with taking responsibility for the dead. Fear of death is also one of the things which pushes men to assemble, come in aid one of the other and form associations. Certainly they never succeed in suppressing death, which remains the ultimate scandal of existence as well as the paradigm for all that which is limiting. Nor do they know how to pierce its mystery for no subject can experience it personally without ceasing to exist. But efforts made to differ death and the gains thus attained have changed its definition and the signs by which it is recognized. They have also brought to light that relationships to death are variable and marked by diversity with respect to usages, representations and attitudes. Those that serve to hide death have come in contemporary society to raise numerous questions.
Since the early 19Thu century, medicine has viewed life as an organized effort to fend off the menaces of death. Bichat's maxim states it explicitly: "life is the totality of those functions which resist death". The criteria which identify it have been displaced. Thus life has been successively associated with breath, the heart and the brain. Today, one accents the relationship between these three terms, with a marked emphasis on the third. Thus, since the end of the 1960s, in France, death is considered from a rule-defined point of view to be an irreversible loss of cerebral activity, as can be ascertained by a persistent uninterrupted null encephilographic reading, with the added condition that the subject has not absorbed depression-causing drugs and is not in a hypothermic condition of less than 32 degrees C. At this time, it is only when the electrical activity of the brain has ceased that it becomes, in terms of the law, possible to give up resistance to death.
Death has thus become an inverse to techniques of re-animation and life-support, which have known considerable improvement. These techniques permit pushing back, more and more, the limit between life and death. Medicine is capable of sustaining vegetative existence by irrigating the brain, even when this means artificially sustaining breathing and heart function, and this for a long period. It thus applies the consequences of an enlarged definition of life, identified with cerebral activity. It goes beyond this as well in sustaining life notwithstanding irreversible cerebral damage. One thus speaks of persistent vegetative states. Some of these can go on for years. Where it is now technically possible to prolong life beyond its official enlarged definition, one also sees a cleavage with collective opinion. For most men, life is characterized by consciousness and sensibility, the capacity to communicate and act. Yet in an increasing number of cases, it no longer satisfies to these conditions. One can be alive today without knowing it, thanks to the genius of science and technique in the service of the will to restrict the strong-arm of death.
Contemporary life extension can also take the form of situations where a body given to death can heal or sustain a faulty organism. Organ transplant opens the possibility of transforming violent death into the consolidation of life elsewhere. Death is here at the origin of a supplement of existence. And he who dies can hope to not die altogether but lives on through an other who is ultimately beholden to him. The condition to such achievements is the possibility to sustain life in those from whom transplants are taken. These actions have also to be other than homicide. This double constraint is at the origin of changes in the legal definition of death in the 1960s, dispositions centering on cerebral death making transplants possible. This utilitarian approach also supposes that it is possible to accelerate or retard the passage toward death. Organ transplants have become quite common as today some 20 000 people in France are beneficiaries of transplanted organs and many thousand more await them.
Asclepius had tried to re-animate the dead and had been chastised by Zeus. Modernity hopes to make the living out of the dead. In 1818 M. Shelley imagines a Dr Frankenstein creating a living being out of pieces of cadavers. While such
fantasies remain beyond reach, multiple transplants are possible from the same source donor. Such multiple removals have made of the dead sources of life and wealth. Eye tissue transplants number 2 500 per year and are the object of heavy demand. Many hospital teams also make bone tissue removals. To this activity one needs to add those on more or less important sources of articulations,ligaments, heart valves, heart vessels(arteries and veins), tendons, cartilage and nerves.
Death turns the body into a well-frequented store. It is stock-full not only of noble and desired parts, those organs amenable to a new connexion to fragile living beings which will thus find themselves consolidated, but also quantities of materials, accessories and components which are objects with various uses. Certainly, the scruples of families still often put the brakes to such possibilities. But specialists warn us that excessive restrictions only serve to displace the problem toward countries ready to move beyond our sensibilities to impose themselves in these new spheres of activity and satisfy a sustained demand.
Current possibilities to find profit in death are accompanied by a fundamental evolution of the latter. Not only does it occur today at a statistically more advanced age than in the past, but it also appears, to care-givers, volunteers and loved ones who are called upon to live with it, less of an event and more of a process made official by the actual passing-away. This passing-away occurs after prolonged periods of treatment which often entail a long involvement with specialized services, with a succession of events culminating in a phase of agony. Earlier , it is prepared by stages of aging and pathological episodes which alter the look and functioning of the organism. Death thus takes on the task of being the truth of the body, of provoking its transformations, at least for an attentive and penetrating observer as Cocteau who, looking in a mirror, could see the work of death.
The immediate causes of death have also changed: while in traditional societies one frequently found infectious diseases, today we have cancers, degenerative and cardio-vascular ailments identified as the causes of death. Yet we still find inequalities with respect to death: these show up between sexes, professions and regions, between rich and poor countries, and more pointedly, among those members of the latter who benefit from the advances of medicine and those who have little access. As well attitudes, meanings and usages associated with it end up being quite different while revealing how men confront this mysterious force which opposes their will to power and eternity.
Shedding light on the relationship between men and death, studies on this subject were considerably developed and renewed during the 1970s. One thus sees the coming to fruition of numerous research projects which culminate in the publication of essential historical, anthropological and sociological works. These have considerably re-shaped our understanding, until then dominated by two points of view, that of bio-medical sciences on the one hand, that of philosophical, psychological and religious reflection on the other. From the totality of works on death accomplished recently in the domain of the human and social sciences one finds two recurrent ideas. First, that of diversity in representations and responses to death. Thus it becomes less possible to identify it as a stable phenomena, always identical to itself, as one measures significant differences in space and time. As is the case with other physical dimensions of existence ( the body, illness, sexuality, food-taking for example), questioning a unitary conception of human nature opens a vast research domain. Becoming conscious of the relativity of beliefs and usages concerning death leads to another essential idea, that of the uniqueness of the modern relationship to death, very different from that which one finds in traditional societies. In traditional societies, death is a familiar presence and occurs in familiar circumstances: men prepare themselves for it by observances which involve an important part of the collectivity. In contrast, in modern societies, death is a stranger: it is considered an absurdity or an injustice; it is lived through at low volume and only gives place to brief and discrete collective manifestations.
Societies work hard at humanizing death, with a remarkable perseverance. Collective commitment to death has shown itself to be particularly intense. First we have the care given to those at the end of their lives and to the bodies of the dead. Follows funereal ceremonies of increasing effect, banquets and offerings in honor of the dead, dispositions taken to protect them and perpetuate their memory. Certain civilizations have given more importance to their monuments and tombs than the dwelling places of the living, which has turned out to be helpful for us who have access to them through the honors they conferred on their dead. The world would be a much poorer place if one took away the wealth, constructs and works which men have erected for the dead. These expenses were, of course, not sensible in their own time with respect to economic rationality. But they give an idea of the efforts, privations and sacrifices men are willing to undertake to die well.
In all civilizations, a cadaver is a problem. The period during which flesh putrefies is felt to be dangerous. It is marked by rituals and restrictions. These end when the transitory phase of decomposition is considered over. The deceased then has access to a stable and irreversible state, and has a definite status which allows one to be in a positive relation to it. The precautions which have prevailed until then can be considered so many expressions of solicitude which serve to show the refusal of complete disappearance.


Abandoned Rituals


Contemporary society has abandoned or reduced rituals inherited form the past. It yet shares with the past a tendency to euphemism which marks, today as in the past, the representations and practices linked to death. It is notably seen as an absence, a lesser form of existence or a modality of survival. The identification of death with absence is revealed in many a term we use to refer to evoke the fact of dying; to disappear, to pass away, to take one's leave, etc. Etymologically, to decease is also to pass away. And when we say of a dead person that he passed away or was called to God, it is yet to an absence we are referring. Death also appears as an attenuated form of existence, a kind of slower life, which also has needs, which are less. Thus offerings to the dead are things useful to the living, but in much lesser quantities. Again, Thanatos is the brother of Hypnos. Many traits are prominent in this linkage, in particular the association between death and rest or peace. Such a slowed down existence is suggested by various images, such as that of a fountain of water in a slow and indefinite stream or of a plant alive yet incapable of sensation or movement. These images are the preferred decors offered to those come for a funereal visit. In a third type of representation, death appears as an other and mysterious form of presence in the world. Letting go of the heaviness of the body, emphasis is on the survival of an essential part of being, in particular through a double or soul. There are many beliefs on the persistence of spiritual forces beyond death. Materialist ideas even form an echo, as that of the continuation of matter through incessant change of form, in a nature when nothing is ever lost. However the post-mortem existence of an individual may play out, men associate it with the memory they have of the person, and of the importance this person had in their eyes. All these representations have the one thing in common, that of preserving continuity beyond the end of life.
Modernity accentuates the tendency to euphemism by engaging in a hiding of death for which there are multiple signs. This is manifest in avoidance behaviors which persist even up to the bedside of the dying and to the interactions which then form between and family and care-givers, each pretending not to notice that the end is imminent, in order to spare the sensibility or "morale" of the other, but thus taking the risk of stopping authentic communication in these decisive moments. Once the person is deceased, prevails a more or less accented sense of trivialisation. Ceremonies are made simple, often for an intimate group. One wears mourning less and less, or for shorter periods. Grief makes everyone uneasy, the announcement of a death leaving many speechless: conventional expressions of grief, for example offering one's sympathy , sound false, there seem no alternatives, and in search of sincerity and spontaneity many take refuge in silence, or a not-saying,also difficult to sustain, so much so that one avoids the grief-stricken altogether even though the latter may try to appear strong or move on.
Occultation is also present in attitudes toward the deceased. The sight of a cadaver is said to be stressful, and the body is rapidly taken out of the death room. It is given over to thanaxopractice which attempts to make the deceased "presentable" or remove what is less attractive about death. Ceremonies for loved ones are made shorter, from lying in wait to visits from acquaintances, and children are generally excluded. In short, today there is very little contact left between the dead and the living. Outside of wars, catastrophes or accidents, the direct experience of death has become rare. The reverse to this lack of awareness is a keen interest for mediated and media-delivered views of death. It breeds a certain form of voyeurism. And imagination looses itself in what is no longer accessible to experience.
In avoiding death or in setting it aside, modernity distances itself from other societies and puts itself on a false footing with respect to an essential aspect of human experience. This novel situation is for Ariès, that where death finds itself forbidden, deformed, made savage(Ariès,1976). For L.-V. Thomas(1975), it is characterized by feelings of embarrassment, marginalisation, denial. Elias also defines it as an impoverishment since it is based on the socialization, deritualizatiion, deformalization (1987). These convergent analysis carry a disquieting consequence, to which E. Morin(1970), in the footsteps of Durkheim and Halbwachs, has already attracted attention ; increasing individualisation makes man more fragile in the face of death, such that it is no longer circumscribed, and risks becoming overwhelming and impossible to look beyond.


A New Perspective on Death


One quarter of a century later, in view of the researches that have been carried out since then, are these apprehensions and conclusions still pertinent?
The answer to this decisive question seems to be qualified. On the one hand, the underlying tendencies used to establish the diagnostic are if anything stronger than ever. Thus urbanization, individualization or the will to master adversity through science, technique and politics are still very pregnant today. On the other hand, the relationship to death has changed since the 1970s. The warnings of those who have studied the question have at least been partially headed and have generated a certain stock-taking with respect to avoidance attitudes with respect to death. Our societies are, at least to some extent, capable of reflexion. They have also been forced to face, since the beginnings of the 1980s, unforeseen developments and new risks such as AIDS. This kind of pathology took the health system unawares and brought forth the fact that death could strike where one one couldn't foresee, could attack the young. At the same time that doubts sets in that we are forcing death toward a temporal retreat, we are faced with multiple problems coming out of prolonged life spans and the aging of the population.
We thus see a resurgent of interest in death as we enter a new millenium. It concerns as well the conditions on which life should end. We are afraid to live through, too weak to protest, a degrading end. We are afraid that the progress of science might turn against us. The possibility of our lives ending in a hyper-technologized no man's land , but dehumanized, fuels qualitative demands surrounding death. This does not mean that we wish to return to the situation prior to the 1970s or that death should once again occupy the place it used to in daily life. We no longer have the resources which traditional societies used to have in this situation. But we are also not committed to the view that one should die as old as possible, waiting ofr medicine to give us even more time, if not save us altogether. We are not satisfied with a supplement of time granted by science and technique. We want a qualitative investment, and a human face. But we are not sure on how to ensure this. Our relation to death is thus in a phase of careful movement as are witness current debates on euthanasia and care to the dying.