A Lacanian Perspective on Organ Donation and Transplantation Medicine

Med Health Care and Philos (2014) 17:559–571 DOI 10.1007/s11019-014-9553-1 SCIENTIFIC CONTRIBUTION The donor organ as an ‘object a’: a Lacanian perspective on organ donation and transplantation medicine Hub Zwart Published online: 15 March 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract Bioethical discourse on organ donation covers Keywords Organ donation Á Transplantation medicine Á a wide range of topics, from informed consent procedures Embodiment Á Psychoanalysis Á Jacques Lacan Á Thomas and scarcity issues up to ‘transplant tourism’ and ‘organ Starzl Á Cannibalism trade’. This paper presents a ‘depth ethics’ approach, notably focussing on the tensions, conflicts and ambiguities concerning the status of the human body (as something Introduction which constitutes a whole, while at the same time being a set of replaceable elements or parts). These will be Bioethical discourse on organ donation covers a wide range addressed from a psychoanalytical (Lacanian) angle. First, of topics, from informed consent procedures and scarcity I will outline Lacan’s view on embodiment as such. Sub- issues up to ‘transplant tourism’ and ‘organ trade’. Over the sequently, I will argue that, for organ recipients, the donor past decades, it evolved into a stream of documents of organ becomes what Lacan refers to as an object a, the bewildering proportions, encompassing thousands of ‘partial object’ of desire, the elusive thing we are deprived books, papers, conferences, blogs, consensus meetings, of, apparently beyond our grasp. Within the recipient’s policy reports, media debates and other outlets. Beneath the body an empty space emerges, a kind of ‘vacuole’, once ‘manifest’ level of discourse, a more ‘latent’ dimension can occupied by a faltering organ (now removed). This space be discerned, revolving around issues such as the experi- can only be filled by a ‘gift’ from the other, by an object ence of embodiment, the status of the human body, and the a. Once implanted, however, this implant becomes an notion of bodily integrity. ‘extimate’ object: something both ‘external’ and ‘intimate’, In this paper, these more ‘basic’ issues will be addressed. both ‘embedded’ and ‘foreign’, and which is bound to What I envision is a ‘depth ethics’ (the moral equivalent of a remain an object of concern for quite some time, if not for ‘depth psychology’) focussing on the tensions, conflicts and life. A Lacanian analysis allows us, first of all, to address ambiguities at work in these more latent layers of bioethical the question what organ transplantation has in common discourse, although they evidently influence and co-deter- with other bodily practices involving bodily parts procured mine the viewpoints articulated on the more manifest levels from others, such as cannibalism. But it also reveals the as well. Notably the status of the body (not only as something basic difference between the two, as well as the distance which we ‘have’, but at the same time ‘are’; but notably as between the ‘fragmented body’ of Frankenstein’s ‘mon- something which constitutes a whole, while at the same time ster’—as an aggregate of replaceable parts—and the mul- being a set of elements or parts) is a highly relevant issue in tiple organ recipients (the ‘puzzle people’) of today. this respect. Moreover, these issues will be addressed from a psychoanalytical angle. Notably, the work of Jacques Lacan (1901–1981) will be used to highlight some of the con- H. Zwart (&) tradictions and tensions of bodily existence resurging in the Department of Philosophy, Faculty of Science, Radboud contemporary transplantation debate. University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands This attempt to approach organ donation from a Laca- e-mail: [email protected] nian perspective will cause some eyebrows to frown, I 123 560 H. Zwart guess. To begin with, besides the interpretative difficulties scientific research practices. It is brought to the fore that are raised by the obscurity and idiosyncrasy of his through technology and science: the body as it is being work, Lacan has never systematically addressed topics measured, qualified and quantified with the help of bio- such as organ donation or transplantation medicine himself, medical equipment. Allow me to develop these three reg- so that the idea of ‘applying’ his views to such topics seems isters/dimensions of human bodily experience somewhat a hazardous one indeed. Moreover, Lacan even explicitly further, with the help of a few examples. seems to discard the feasibility of ‘applied psychoanalysis’, In everyday adult life, we are hardly ever directly con- calling it a silly ‘deviation’.1 And yet, as I will demonstrate fronted with the real, fragmented body any more. Rather, in this paper, his work teems with insights that may sig- the fragmented body (‘corps morceleé’) is the body as it is nificantly deepen our understanding of the various ambiv- experienced by very young children during early stages of alences entailed in the transplantation debate, so that it development, although it continues to emerge in the folds would be an intellectual waste to use his work as a resource and margins of bodily experiences later in life.2 The real for academic ‘author studies’ only. Moreover, from a depth body is that which resists our efforts towards idealisation ethics perspective, organ donation is a rather ‘fundamental’ (scientific, artistic, religious, or otherwise) of the human issue. In fact, in one of his seminars, bearing the telling title body: it is the unclean rather than the clean, the damaged D’un Autre a` l’autre (‘‘from an Other to the other’’), Lacan rather than the unviolated, the destitute rather than the approximates the issue rather closely, as I will show (Lacan wholesome, the eerie rather than the familiar body. 2006). Nonetheless, since bioethical quandaries are hardly A first effort to turn the fragmented body into a stable, (if ever) addressed by Lacan directly, a quick introduction coherent unity or whole is brought about by the so-called into his views on embodiment as such seems an indis- mirror stage (Lacan 1966, p. 93 ff.). By recognising their pensable preparatory exercise. Subsequently, I will eluci- image in a mirror, Lacan argues, very young children for date these views with the help of a bodily practice that is the first time learn to see themselves as complete individ- abundantly present in psychoanalytical discourse in gen- uals. This triumph over fragmentation gives rise to an eral, and in Lacan’s writing in particular (and which, like experience of ‘‘jubilation’’. Yet, this newly acquired sense organ donation, involves ‘gifts of the body’), namely sex- of unity is dependent on an external image: the Gestalt or uality and love. Finally, I will consider in what manner and image as reflected in the mirror, and therefore remains to what extent a Lacanian view may facilitate the devel- highly vulnerable and image-dependent (‘imaginary’). opment of a ‘depth ethics’ approach to transplantation The imaginary body can also be encountered, moreover, medicine, supplementing my conceptual analysis with a in works of art, notably in ancient Greek and Roman concrete case study. sculptures (and their neo-classicist equivalents). An artistic rendering of the human body may present it as an integrated unity, as something admirable, stable and whole. The real, the imaginary and the symbolical: Lacan’s Moreover, through various body practices, such as body- understanding of human embodiment building for example, athletes (male or female) may sculpt their bodies into living pieces of art, thus mimicking or Before addressing organ donation proper, the Lacanian mirroring examples (either in marble or in the flesh) pre- understanding of bodily existence in general will be briefly sented by others. Ancient Greek statues were basically the outlined. Lacan distinguishes three realms (or: registers) of statues of athletes or of gods (but that amounted to the bodily experience, three basic ways in which the human same thing, as gods were regarded as athletes and athletes body comes to the fore and may be encountered in various as gods). Moreover, as Lacan explains, statues of human practices, namely the ‘real’, the ‘imaginary’ and the beings, erected alongside major roads in ancient times, ‘symbolical’ body (Cf. Zwart 1998). As far as the real conveyed the idea of humanity: the concept of a human body is concerned, the human body is basically experi- being, with integrity and dignity as its basic normative enced as a fragmented body: a composite aggregate of attributes (Lacan 1981, p. 328; Cf. Zwart 2000). Thus, organs, fluids, processes and products. The imaginary statues of heroes, emperors or other ‘exemplary’ humans body, by contrast, refers to the body as a meaningful whole. (both physically and morally) spread the ancient gospel of Now, the body is envisioned in terms of integrity or human dignity, of humanitas. They incorporated an idea- wholeness, and seen as an integrated unity. Finally, the lised view of what embodied human beings should aspire symbolical body is the body as it emerges in modern to become. These statues were erected alongside public 1 ‘‘Cette de´viation bouffonne que j’espe`re barrer, qui est de´ja` e´taleé 2 ‘‘Die Pathologie lehrt uns [Fa¨lle] kennen, in denen uns Teile des de longues anneés sous le terme de psychanalyse appliqueé’’ (2006, eigenen Ko¨rpers … wie fremd und dem Ich nicht zugeho¨rig p. 66). erscheinen’’ (Freud 1930/1948, pp. 423/4). 123 The donor organ as an ‘object a’ 561 roads by way of ethical propaganda. They functioned like To a certain extent, the ground for this Frankensteinian missionaries in stone, whose silent sermons made a definite experience of embodiment had been prepared by early impact on anonymous masses of travellers and passers-by modern anatomists: notably pioneers such as Vesalius.

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