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Death Is That Man Taking Names

Death Is That Man Taking Names: Intersections of American Medicine, Law, and Culture

Copyright Date: 2002
Edition: 1
Pages: 232
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  • Book Info
    Death Is That Man Taking Names
    Book Description:

    The American culture of death changed radically in the 1970s. For terminal illnesses, hidden decisions by physicians were rejected in favor of rational self-control by patients asserting their "right to die"-initially by refusing medical treatment and more recently by physician-assisted suicide. This new claim rested on two seemingly irrefutable propositions: first, that death can be a positive good for individuals whose suffering has become intolerable; and second, that death is an inevitable and therefore morally neutral biological event.Death Is That Man Taking Namessuggests, however, that a contrary attitude persists in our culture-that death is inherently evil, not just in practical but also in moral terms. The new ethos of rational self-control cannot refute but can only unsuccessfully try to suppress this contrary attitude. The inevitable failure of this suppressive effort provokes ambivalence and clouds rational judgment in many people's minds and paradoxically leads to inflictions of terrible suffering on terminally ill people. Judicial reforms in the 1970s of abortion and capital punishment were driven by similarly high valuations of rationality and public decision-making-rejecting physician control over abortion in favor of individual self-control by pregnant women and subjecting unsupervised jury decisions for capital punishment to supposed rationally guided supervision by judges. These reforms also attempt to suppress persistently ambivalent attitudes toward death, and are therefore prone to inflicting unjustified suffering on pregnant women and death-sentenced prisoners. In this profound and subtle account of psychological and social forces underlying American cultural attitudes toward death, Robert A. Burt maintains that unacknowledged ambivalence is likely to undermine the beneficent goals of post-1970s reforms and harm the very people these changes were intended to help.

    eISBN: 978-0-520-93146-6
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
    Daniel M. Fox and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed national foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. The Fund makes available the results of its work in meetings with decision-makers, reports, articles, and books.

    This is the seventh of the series of California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the Press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.

    Robert Burt contributes to more effective policy for the care of persons who are near death...

    (pp. xi-xii)
    (pp. 1-26)

    As a man going round taking names, death appears threatening, uncontrollable, robbing the living of their identity and leaving pain in his wake. There is no comfort in this vision, and American culture has not embraced it. We have sought comfort by imagining death in another format: a different man taking names, one might say—a man administering a checklist of rationalized criteria for admitting death. “Has Mr. G—voluntarily agreed to disconnect his respirator?” “Did the unconscious patient in 216, when he was mentally competent, fill out an advance directive about terminating life-prolonging treatment?”

    This new format is intended...

  6. CHAPTER TWO HIDDEN DEATH I Walk through Shadows
    (pp. 27-46)

    In 1947, a three-judge panel of the United States Court of Appeals for the Second Circuit rendered a decision that can be understood as both an early expression and a wise rejection of the reform impulse that was to erupt twenty years later into the dominant contemporary agenda for the dispensing of death. The three judges were Learned Hand, Augustus Hand, and Jerome Frank—today generally considered the most distinguished panel of American judges ever assembled in one courtroom. By my account of this decision, Learned Hand emerges as the role model whom I would commend for avoiding the seductions...

  7. CHAPTER THREE DEATH AT WAR In the Presence of My Enemies
    (pp. 47-66)

    From the end of the Civil War until the mid-twentieth century, an undeclared state of warfare existed between the “mentally normal” community and people with mental retardation or mental illness, between Whites and Blacks, and between the “living” and the “dying.” These hostilities were masked, and open aggression thereby somewhat contained, by increasingly rigid social and geographic segregation restricting or even (beginning in the nineteenth century for the “mentally abnormal” and in the twentieth century for the “dying”) entirely eliminating face-to-face interactions. In all of these relations, the dominant party was clear; yet those who were “normal / White /...

  8. CHAPTER FOUR JUDGES AND DEATH Lead Me in Paths of Righteousness
    (pp. 67-86)

    The underlying elements in our shifting cultural attitude toward death—the loss of faith in traditional caretakers and the emergence of individual self-control as a preferred alternative to the old ethos—were revealed with special vividness in two court cases in the 1970s: theQuinlandecision in the New Jersey state courts and the U.S. Supreme Court’s decision inRoe v. Wade.Closer attention to the decision-making process in those two cases will illuminate these elements and point us toward an appreciation of the essential weakness, the pathos, of the self determination ideal as an adequate alternative, as an imagined...

    (pp. 87-105)

    If it is true that an underlying cultural attitude about death’s inherent wrongfulness has fueled past medical abuses against dying patients, the reformist move to patient self-determination would not be a reliable corrective, because dying people themselves would be prone to mirror the relentless hostility of their physicians. The stage would thus be set for reiteration of past abuses, embraced by patients in collaboration with physicians. There is, moreover, a further element in medical practice that gives added impetus to this malign possibility. Physicians’ mistreatment of dying patients has arisen not simply from their condemnatory attitudes toward death but also...

    (pp. 106-122)

    Dying people, their families, and their physicians are all vulnerable to unruly psychological forces unleashed by the imminent prospect of death. The success of the contemporary reformist claim that death can be subject to rational control depends on the capacity of vulnerable people to tame these unruly forces. The reformist claim, moreover, rests not simply on the possibility of individual self-control by dying people and their families and physicians but also on the capacity of formal institutional actors—judicial or administrative agency regulators—to exert rationalized bureaucratic control to protect dying people against previous patterns of social and medical abuse....

  11. CHAPTER SEVEN THE DEATH PENALTY Surely Goodness and Mercy Shall Follow
    (pp. 123-156)

    The death penalty is the paradigmatic expression of officially sanctioned involuntary killing. There is, moreover, no pretense of mercy; it is intended as punishment, even though constitutional norms against “cruel and unusual punishment” restrain its administration. We can nonetheless discern important lessons from American efforts during the past thirty years to ensure the “rationality” and “fairness” of capital punishment that provide guidance for thinking about the administration of death more generally. The lessons emerge from the following themes that have been explored in previous chapters: that death conveys an inherent aura of wrongdoing, in persistent counterpoint to claims for its...

    (pp. 157-186)

    Our publicly proclaimed motives are impeccable: the death penalty must be administered without arbitrariness, without discrimination against racial minorities or poor people, and only with the most intense scrutiny by impartial judges to assure that the entire enterprise is beyond reproach. This was the explicit commitment that the United States Supreme Court first made in 1972. The reality is, however, far distant from this ideal—and the Court itself, beginning in the early 1980s, adopted one measure after another to ensure that this ugly reality would remain hidden from public view. The dynamic could not be clearer: a public commitment...

  13. NOTES
    (pp. 187-218)
  14. INDEX
    (pp. 219-221)
  15. Back Matter
    (pp. 222-222)