An anthropology of death

Townsend Letter for Doctors and Patients, Dec, 2005 by Tim Batchelder

I read a line in an anthropology book once that suggested that all Americans should spend an hour each day meditating on death. The writer argued that we are infatuated with life and in doing so have become intensely afraid of death and only through meditation on death and comfort with it can we truly enjoy life. Other people are more familiar with it. The stories in anthropology are legendary: cultures that drink the bones of their dead in Amazonia. The signs of our infatuation are everywhere: the ends of our lives are consumed with trying to restore our bodies and minds to carry on with trivial tasks. We spend millions on preserving our bodies but then lock ourselves away in nursing homes or apartments divorced from family and friends, from culture and social interaction. We struggle to achieve a physical permanence by imprinting our personal thoughts and memories on silicon chips, which will be obsolete or unreadable by a new machine in a decade. Most of us in modern societies do not realize the experience embedded in our elderly until it is too late and they are gone. Other people emphasize the aging time as one of letting go of trivial things, of passing on artifacts embedded with stories and made to last a thousand years, and of spending the last years in a place where you have always felt most at home. In this column I will examine an anthropology of death and hope to raise some questions about the best way to die.

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Defining Death: Culture and Technology

Stanford anthropologist Barbara Koenig notes that the boundary between life and death is socially created; it cannot be easily ascertained or "read," even by the most sophisticated brain imaging technology. Anthropologists are unlikely to contest such a claim. Others expect a bedrock of certainty, informed either by religious faith or science. Is a patient diagnosed as in a "persistent vegetative state" (PVS) meaningfully alive? Even people legally declared "brain dead" appear closer to sleep than death, as Margaret Lock's compelling ethnographic treatment of the topic--Twice Dead--reveals. Under the narrow legal view, all that matters is a prior proclamation of a "right to die" when in a state of cognitive decline. Yet social personhood need not be defined by biological life. Cryonics is the most extreme boundary clash. Advocates of freezing corpses (or brains) for later reanimation simply redefine their subject's bodies. Steve Bridge, founder of the Alcor Life Extension Foundation notes that what they think they're doing is freezing people who are incorrectly labeled as dead by the medical technology of today. Anthropologists will recognize the cultural theme--striving for immortality--now manifest in technological language, goals and assumptions.

Koenig points out that the rhetoric of "choice" embraced by most advocates of end-of-life reform including living wills and legal documents like the durable power of attorney for health care, have been oversold as the key to reform. Ethnographic studies reveal how the assumptions behind these bioethical practices do not hold up. There is resistance on the part of doctors and patients. Such practices are a well intentioned but failed project in public policy. Well intentioned because based on the highest ideals of respect for individual autonomy, but deeply flawed because of incorrect assumptions about the way people make decisions and of how the health care system is structured. We are not rational calculators balancing length of life against a metric of suffering as though making a choice about mortgage rates or the purchase of a new computer. The notion of choice makes sense within a consumer society dominated by market-driven medicine. Koenig notes that unlike services that purport to extend or save life, end-of-life care is most often a source of costs rather than revenue for hospitals, and advertising a good death conflicts with the bottom line.

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Political Economy of Death

In contrast to American notions of bioscience commerce the people who manage to live the longest are marked by a lack of drive for material and physical wealth. Anthropologists have found that centenarians (people 100 years old or older) are attached to notions of freedom and independence and have rarely worked in corporations. Many have worked on their own. According to sociologist Albert Rosenfeld who conducted interviews with 1200 social security recipients over age 100, they show a marked lack of high ambition, high appreciation for simple experiences and pleasure of life. They live quiet and independent lives. Dr. Stephen Jewett in a 1973 study of New York elderly people age 87 and over noted that they worked in farming and plant nurseries, many owning their own small businesses. Many centenarians are religiously orthodox and are early risers. They rarely visit doctors and use less medication in their lifetime than most elderly use in a week. They also eat diets low in fat, maintain steady weight throughout their life, and have strong grips and good muscle tone but no exercise routine. In Abkhasia, a Russian mountain-village near the Black Sea, large numbers of centenarians survive. The climate is moderate at 55 degrees year-round and the residents are champion tea pickers and grow corn and tomatoes. They consume only 1500 kilocalories of food energy per day and walk an average of 20 miles. According to researcher Dan Georgakas, they dislike being rushed and loathe deadlines, never working to exhaustion. They also consider it impolite to eat quickly or too much. Routines in their lives are linked to biological rhythms. Vegetables are picked just before serving and guests are shown animals before slaughtering. Alexander Leaf, a Harvard Medical School professor, conducted extensive studies of this population in 1972.