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Reimagining Death: a Posthuman Analysis of Life Support and the Concept of Death in The Reimagining death: A posthuman analysis of life support and the concept of death in the intensive care unit by Amanda van Beinum A thesis submitted to the Faculty of Graduate and Postdoctoral Affairs in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sociology Carleton University Ottawa, Ontario ©2021 Amanda van Beinum ABSTRACT Often assumed to be simply the opposite or absence of life, death is in truth a distinctively uncertain category which troubles assumptions about what it means to be alive, and what it means to be human. In this project, I explore what happens to understandings of bodily endings when the “normal human” is de-centered from the concept of death. I take a post-Enlightenment, post-humanist approach in the mode espoused by Rosi Braidotti (2006, 2019) which seeks to move beyond the elite and exclusive category of “human,” as well as to get outside of anthropocentric patterns of thought. This project focuses on shifting definitions and meanings of death in the midst of advanced life-sustaining technologies and against a backdrop of cultural fascination with immortality as represented by the modern intensive care unit. Employing ethnographic methods and concepts from feminist new materialism, and founded on an in-depth understanding of posthuman theory, this work contributes novel analyses of how death happens in technological spaces, and how our understandings of it could be approached differently. I contrast cases of patients sustained on life-support technologies seemingly beyond their desired limits with those of individuals declared to be dead against their beliefs to explore ontological, epistemological, and practical elements presently maintaining the appearance of universal definitions of death. A final analysis of media cases of people who continue to produce life through pregnancy despite being categorized as dead helps to reconfigure assumptions about life, death, and life sustaining technologies into a new understanding of how bodily endings, alongside perceptions of liveliness, are always a particular product of ongoing and unfolding social and technical ii | relations. Ultimately, I suggest that life sustaining technologies and their capacity to promote impressions of vitality allow us to better appreciate how death is already always a part of life, a perhaps unwanted “other” that we might learn to tolerate and accept, a personal ethical threshold of existence with the potential to transport us into different futures. This work expands the application of posthuman theory into the domain of clinical death and demonstrates the added value of posthuman analyses in medical spaces. iii | ACKNOWLEDGEMENTS This dissertation was made possible through the intellectual contributions, commitment of time and energy, and emotional care of many, many people. I am also grateful to organizations such as the Canadian Social Science and Humanities Research Council, the Ontario Graduate Scholarship, Carleton University, and the Department of Sociology and Anthropology for making this work and this degree possible through grants and scholarship funding. A huge thank you is owed to my supportive and engaged committee, who have truly helped to guide the direction and improve the focus of this project. To my supervisor, Carlos Novas, thank you for inspiring me to pursue inquiry in the field of STS and posthumanism, and for our many interesting conversations. Alexis Shotwell, thank you for your guidance and support from the moment I began my PhD journey, for your many life and mind-changing reading suggestions, and for helping me learn how to take control over my own intellectual process. I am grateful also to committee member Reade Davis for sharing an interest in morbid topics of discussion and for pushing me to connect my work more fully to existing academic conversations. This work was also improved through the timely guidance of Simon Kitto, who helped assure me that ethnographic work in an intensive care unit is possible and provided much need resources on how to do so during the planning stages. Over the past five years this committee has fostered an environment which fostered creativity and thinking the unthinkable. Thank you. In the critical care world, I am indebted to Irene Watpool, who first opened the door for me into the fascinating world of tensions and contradiction that makes up the intensive care unit. Thank you for always taking the time to answer my questions, for putting up with my strange ideas, for teaching me how to actually get research done, and for sharing so much of your knowledge, experience, and love of the people and spaces of intensive care with me over the years. I am infinitely grateful to all of the doctors, nurses, and allied health professionals who tolerated my inquisitive presence in clinical spaces, took the time to engage with me in conversation, and made this line of thinking possible. iv | Thank you especially to Michael Hartwick, Aimee Sarti, and Brandi Vanderspank-Wright for supporting this project. I am grateful to Andrew Healey for trusting me as a co-investigator on our survey study, and for honest reflections and insights about difficult cases. Thank you also to all the participants in our study who shared thoughts and reflections during interviews. Sonny Dhanani, Laura Hornby, and Nathan Scales deserve a great deal of credit for getting me interested in the study of death and dying in the first place, for being open to my interdisciplinary shifts over the years, and for always finding ways to support my growth and development. Thank you for being steadfast colleagues, sharp co-authors, and good friends. This work moved forward as it did in part due to the ongoing academic support, administrative assistance, and community building efforts from Darlene Moss, Kim Mitchell, Kimberley Séguin, Paula Whissell, and Stephanie LeBlanc. Friends provided camaraderie, advice, intellectual stimulation, and the mutual support without which the work of graduate school is impossible to sustain. Thank you to Vivianna Boiles-Leonard, Kat Huybregts, Janna Klostermann, Samantha McAleese, Nadine Powell, Mark Ramsay, Mikayla Sherry, Inga Shisko and all of the many other folks who contributed to a sense of community while I was at Carleton. I hope our paths continue to cross in academic and social spaces. The love and support of my family has been critical. I am grateful to my mother Alyson for demonstrating what a life of academic curiosity, pedagogy, and critical engagement looks like, to my father Elmer for teaching me strategies for finding practical solutions to almost any problem, and to my siblings Nicholas and Michaela for continuing to inspire me with the creative and complex technical and artistic work that you do. A special thank you to my grandparents Sybil and Malcom for your unwavering belief in my potential. Finally, no writing, reading, scholarly growth or exploration would have been possible without the love, support, and constant intellectual stimulation provided by my whip-smart, critical, and compassionate life partner, Juliana. Thank you for keeping me both grounded in the moment and dreaming about the future, for now and for always. v | TABLE OF CONTENTS ABSTRACT ..................................................................................................................................... II ACKNOWLEDGEMENTS............................................................................................................... IV TABLE OF CONTENTS ................................................................................................................. VI LIST OF TABLES ........................................................................................................................... IX LIST OF ILLUSTRATIONS.............................................................................................................. X LIST OF APPENDICES .................................................................................................................. XI CHAPTER 1 | INTRODUCTION ...................................................................................................... 1 Why study death? ........................................................................................................................ 1 Project overview .......................................................................................................................... 7 CHAPTER 2 | MAKING AND KNOWING DEATH: PRACTICES OF DEATH AND DYING ........ 11 Death as embodied socio-cultural practice ................................................................................ 15 Death as rational scientific fact .................................................................................................. 26 Challenges to rational scientific death ....................................................................................... 33 Theorizing death amidst present-day complexity ...................................................................... 44 Notes on theoretical approach ................................................................................................... 52 Conclusions ............................................................................................................................... 55 CHAPTER 3 | INTRODUCING THE INTENSIVE CARE UNIT ..................................................... 58 A brief history of medicine, hospitals, and intensive care in North America .............................. 59 Bringing
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