Sergiovanni, Thomas J

T.L.Taylor

Description

• cours - matière potentielle : at a time
• cours - matière potentielle : improvement
• expression écrite - matière potentielle : fiction
• cours - matière potentielle : systems
• cours - matière potentielle : controls
• leçon - matière : music - matière potentielle : music
• cours - matière potentielle : p34

1/7 2007-02-11_summary_Richard_DuFour_On_Common_Ground.doc printed: 9/26/2007 DuFour, Richard, Robert Eaker, Rebecca DuFour, On Common Ground: The Power of Professional Learning Communities, Solution Tree, 2005. Roland Barth, Rebecca DuFour, Richard DuFour, Robert Eaker, Barabara Eason Watkins, Michael Fullan, Lawrence Lezotte, Douglas Reeves, Jonathan Saphier, Mike Schmoker, Dennis Sparks, Rick Stiggins.

• heart of effective reform efforts
• focus on attitudes as a barrier to action
• effective schools
• communities from traditional schools p34
• capacity building
• capacity-building
• assessment
• section
• schools
• action
• strategies

Sujets

• Improve
• Fiction
• System
• Thackeray

Informations

• Publié par: usti0
• Nombre de lectures: 26
• Langue: English

Extrait

The Enduring Dead: The Reuse and Recycling of Bodies and Body Parts
Kelly A. Joyce, Ph.D.
Committee on Degrees in Social Studies
Harvard University
Hilles Library
59 Shepard Street
Cambridge, MA 02138
and
John B. Williamson, Ph.D.
Boston College
Department of Sociology
McGuinn Hall
Chestnut Hill, MA 02467-3807
To be published in Handbook of Thanatology: Essays on the Social Study of Death, edited by
Clifton D. Bryant, Newbury Park, CA: Sage, (forthcoming).1
Recycling bodies and body parts is an important social phenomenon that has received
significant attention from social scientists, policy makers, and historians. This body of
scholarship recognizes that the recycling of body parts after death is shaped by cultural beliefs
and social institutions. As Anthony Synnott suggests, “The body is not a ‘given,’ but a social
category with different meanings imposed and developed by every age, and by different sectors
of the population” (Synnott 1993: 23). The literature that examines the reuse of bodies and
body parts illuminates the social categories and meanings that influence how bodies are and have
been recycled.
In this article we examine five areas of body recycling—organ transplantation, medical
school donations, the display of bodies in museums, cannibalism, and cloning—that have been
the focus of academic scholarship. Individuals working on these topics demonstrate how the
reuse of bodies and body parts in medicine, scientific research, food consumption, and art are
shaped by social norms, policies, and institutional practices. This body of work shows that there
is nothing innate or natural about how bodies are viewed or employed after death. Culture and
power intervene at every step of the way.
Organ Transplantation
One of the largest areas of literature on body recycling centers on organ transplantation.
In the United States the demand for organs far exceeds the number of organs that are available.
In the year 2000, for example, approximately 5,000-6,000 people died while waiting for an organ
(Fauber 2001). Recent estimates suggest that cadaveric donation rates in the US remain steady
at 4,500-5,000 per year while the number of patients on transplantation waiting lists continues to
increase significantly. At the end of 1990, for example, there were 20,481 patients on waiting
lists for organs. By 2001, this number had grown to more than 77,000 individuals (Lou 2001: 1).
The escalating difference between supply and demand exists in other countries as well.
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Anthropologists and sociologists have critically examined how scarce resources such as
tissues and organs are allocated. These writers have demonstrated that social hierarchies such as
class and race often influence the distribution of body parts (Fox and Swazey 1992; Kutner
1997; Spielman 1996; Veatch 2000). Despite efforts to make access to transplants equitable,
significant barriers to transplantation surgery still exist.
Class status is one of the primary social factors that shapes the distribution of body parts.
As sociologists Renee Fox and Judith Swazey note, there is a “green screen” i.e. ability to pay,
that influences who will receive organs and tissues in the United States (Fox and Swazey 1992:
75). This bias towards wealthier individuals occurs because Medicare coverage does not
reimburse all transplantation costs. This type of policy places a financial burden on the
individual to cover the remaining costs--one that a low-income patient might not be able to meet.
Similarly, health insurance policies may require patient contributions towards the total cost of
transplantation and follow-up care. As with Medicare policies, this system of reimbursement is
biased towards those who have the extra income to cover these expenses.
In addition to class, race is also a social factor that influences the distribution of organs
and tissues. Kidney transplant data, for example, has shown that blacks are less likely than
whites to be transplant recipients (Kutner 1997: 366-7). Research by a federal Task Force on
Organ Transplantation and the United Network for Organ Sharing (UNOS) as well as others
have shown that “the primary source of the unequal access.. appears to be...in the decisions about
who will be admitted to the waiting list” (Childress 1989: 108). This work suggests that racial
bias shapes who is referred to transplant waiting lists and who is not. Specifically, white patients
are more likely than people of color to be recommended for organ replacement surgery.
This body of literature clearly shows that individuals do not have equal access to
transplantation in the United States. It demonstrates how policies and referral practices reinforce
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social hierarchies, creating economic and racial barriers that limit access to organ replacement
therapies.
In addition to examining the relationship between social inequities and the distribution of
organs and tissues, other scholars have focused on the social factors that may limit donation rates
among individuals (Grubesic 2000; Sanner 2001; Siminoff and Sturm 2000). Margareta
Sanner’s research, for example, demonstrates that individuals who perceive the body as machine
which may need new parts are more likely to donate organs than those who believe in
reincarnation, nature’s will, or the idea that the personality of the donor will influence the
receiver (Sanner 2001: 1495). Other research has shown that there are regional, ethnic, and
religious differences in regards to rates of donation (Grubesic 2000; Siminoff and Sturm 2000;
Yuen et al. 1998). African-Americans tend, for instance, to have lower donation rates than white
Americans. Studies suggest that this difference is related to a concern among African-
Americans that the distribution of organs is unfair. The perception among African-Americans
that most organs will go to wealthy, white individuals provides little incentive for these
individuals to become donors (Siminoff and Sturm 2000: 64-5). Other work has explored why
various regions in the US have different degrees of donation (Grubesic 2000; Evans et al. 1992).
Grubesic’s research on Ohio suggests that class and education are factors that contribute to
geographical variations in donation rates within this state (Grubesic 2000: 1204). States which
allow individuals to become potential donors at the department of motor vehicles also tend to
have higher degrees of donation (Grubesic 2000: 1208). This type of scholarship provides
insight into the social beliefs and policies that may discourage individuals from donating their
organs and tissues after death, and may help policy makers and members of the medical
community find ways to address these concerns so that the number of donations increases.
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The legalization of the sale and purchase of body parts is one topic that continues to
receive substantial attention by policy makers and social scientists. The 1984 National Organ
Transplantation Act (Public Law 98-507) made it a federal crime in the United States to
“knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration
for use in human transplantation if the transfer affects interstate commerce” (Fox and Swazey
1992: 66). Despite this criminalization of the financial exchange of organs, scarcity of organs
has caused social scientists and policy makers to return to the idea of using financial incentives
to increase the number of body parts available. Proponents of legalization advocate a free-
market approach to organ donation, suggesting that provision of financial incentives would
increase the number of organs available (Barnett et al. 1996). Opponents counter this position
by raising concerns about the effects such a policy would have on particular groups of
individuals. Opponents of legalization, for example, argue that such a policy would
disproportionately affect the poor as it would create incentives for low income individuals to sell
organs as way to pay for day to day living costs. In addition, this type of policy would
exacerbate unequal access to organ transplantation as low and middle income individuals would
not be able to purchase organs. Still others express concern that the legalization of the sale of
organs would further commodify the body and thus objectify relationships between individuals
(Joralemon 2000; Sharp 2000). Although there have been no formal moves to change the law in
the United States, the issue of legalization continues to be actively discussed and debated. It is
possible that organ scarcity may cause the ability to legally buy and sell organs to be more
aggressively pursued.
Other social scientists such as Margaret Lock (2001), Eric Feldman (1988), and Mita
Giacomini (1997) have used organ transplantation as a site to think about the way definitions of
death are social constructions. Giacomini, Feldman, and Lock have documented, for example,
45
how diagnoses of death shifted in the US during the 1960s and 1970s from a heart based criteria
to a brain centered understanding of death. This shift benefited those interested in removing
organs as these are still harvestable when the brain death criteria is used. Lock’s work has also
examined the resistance to a brain-death diagnosis of death that occurred in Japan throughout the
1980s and 1990s (Lock 2001; Lock 1996; Lock 1995).