Late twentieth century medicine still accepts as its ultimate aim the ideal set for it by such figures as Pavlov, Dastre, and Metchnikoff in the first years of the [20th] century: the perpetual maintenance of the human organism as a maximally efficient machine, and the indefinite postponement of the ‘accident’ of death. Given this aim, it is clear that ‘the medical ideal, ever more closely approximated, must be bodily immortality.’ Such an ideal is not normally expressed in explicit terms, however. Rather than calling for the prevention of all deaths, one speaks, for example, of seeking to achieve ‘further reductions in premature deaths’; but this more cautious formulation only thinly disguises the demand for immortality, since ‘it often seems doubtful from our words and deeds that we ever regard any particular death as other than premature, a failure of today’s medicine, hopefully avoidable by tomorrow’s.
The twentieth-century medical opposition between life and death, then, is one that reduces death once again to a kind of nullity, but not the nullity resulting from privation of something positive. Death is now a nullity not because of the loss of something internal to life, but because it is the failure of something external to life, the perpetual maintenance service of modern medicine. The consequences of this outlook can be seen in medical judgements about death and dying, for in practice ‘[d]ying is defined…in terms of the actions—or failed actions—of the physicians. In keeping with the predominant technical bias of biomedicine, “dying” becomes a cultural metaphor which symbolizes treatment failure. Already, at the beginning of the century, Dastre has argued that when a physician ‘declares that any particular person is dead, it is less a judgement of fact that he utters than a prognostication’ that nothing he could do would restore the dying person to life. Observations of medical residents in a contemporary hospital have shown a similar attitude…
In earlier times, anxiety over the diagnosis of death was motivated by the fear of premature burial. In an age of organ transplants, concern was to become focused instead on the fear of premature dismemberment. To introduce cessation of brain functions as the criterion of death, in place of the traditional reliance upon the cessation of heart and lung functions, conjured up visions of the comatose but still breathing, albeit mechanically supported, patients being vivisected by overzealous surgeons in their haste to obtain transplantable spare parts. That the patient could be regarded by opponentsof the brain death criterion as ‘alive’ despite being totally dependent upon artificial support systems for heart, lung, and other vital functions, did not merely reflect lingering nostalgia for the traditional heart-lung definition of death. It also reflected, more importantly, widespread acceptance of the living human body’s dependence upon medical technology as a perfectly natural and indeed intrinsic feature of ‘life’ itself.
As the definition of the brain-death criterion makes clear, in contemporary medicine dying and death are neither a part of life as in the nineteenth century nor the absence of life as in earlier ages. Today, a comatose patient today whose whole loss of spontaneous brain functions is irreversible by existing resuscitation techniques is ‘dead’. Another comatose patient tomorrow, in exactly the same physiological state as the first was today, is ‘not dead’ if in the meantime a new resuscitation technique has been introduced that can be used to reverse the coma, the criterion of death is technological rather than biological.
For modern medicine, then, life is not the opposite of death as the active is the opposite of the inert, for the same level of organic activity/inactivity can count as death at one time and life at another, according to the state of medical technology. Nor is life the opposite of death as the natural is the opposite of the artificial, for the greater capacity medicine has to intervene technologically in the production and maintenance of life, the less sense it makes to characterize life or death as natural. In the twentieth century, both life and death fall under the aegis of a perpetual maintenance programme; their relationship must now be understood as the opposition between self-declared successes and ‘accidental’ failures of a single technological project.
-Ideas of Life and Death by W. R. Albury, From the Companion Encyclopedia of the History of Medicine by William F. Bynum, Roy Porter