University of Pennsylvania ScholarlyCommons Dissertations (ASC) Annenberg School for Communication 1979 Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea Leslie Ann Rado Follow this and additional works at: https://repository.upenn.edu/dissertations_asc Part of the Communication Commons Recommended Citation Rado, Leslie Ann, "Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea" (1979). Dissertations (ASC). 12. https://repository.upenn.edu/dissertations_asc/12 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/dissertations_asc/12 For more information, please contact [email protected]. Communication, Social Organization and the Redefinition of Death A Case Study in the Institutionalization of an Idea Abstract One of the problems of most interest to students of communication is the analysis and conceptualization of the social processes by which our common notions of what exists, what is important and what is legitimate are shaped. These notions are social and cultural meanings -- values, norms, practices -- the stuff of social and cultural reality, and they are sometimes most manifest and perceptible when they are changing. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Department Communication First Advisor Larry Gross Subject Categories Communication This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/dissertations_asc/12 COMMUNICATION, SOCIAL ORGANIZATION AND THE REDEFINITION OF DEATH A CASE STUDY IN THE INSTITUTIONALIZATION OF AN IDEA Leslie Ann Rado A DISSERTATION in COMMUNI CATIONS Presented to the Graduate Faculties of the University of Pennsylvania in Partial Ful fillment of the Requirements for the Degree of Doctor of Philosophy. 1979 Graduate Group Chairperson ANNENBERG P 002 1979 R131 --~.- -. .:.. o COPYRIGHT Leslie Ann Rado 1979 TO THE MEMORY OF MY GRANDMOTHER MABEL FLORENCE LEE Who told me just of often enough, "Me name is tough, and I lives on Tough Street. The further down ye go, the tougher it gets, and I lives in the very last house." iii ACKNOHLEDGEMENTS Hith no halting prose either claiming or disclaiming the agonies of writing acknowledgements or dissertations -- the agonies of both are widely recognized -- I take this opportunity to express my deep appreciation to those who helped make this effort less agonizing and less solitary than it might have been. None of this would have been possible without the financial as­ sistance awarded me by the Russell Sage Foundation. Special thanks are due Diana Crane who introduced my project and me to the Foundation. Thanks go secondly to those men who took time from their highly active schedul es to participate in this study. Special thanks are ex­ tended to those who offered suggestions, sent me their offprints, and allowed me access to their personal files. Their willingness to participate in a social analysis of their efforts and social contacts was clearly essential to the success of this study. Several gave con­ tinual access and spent more time helping me than participation in the study demanded: Robert Veatch of the Hastings Center; Alexander Capron of the University of Pennsylvania Law School; Leon Kass, then of the Kennedy Institute of Bioethics and now of the University of Chicago; Don Harper Mills of Los Angeles; Hannibal Hamlin, William Curran, the late Henry Beecher, and E. P. Richardson, all of Harvard University. iv It was only through Diana Crane's efforts and helpful advice that I was able to conduct such a successful survey. And I would never have winded my way.through any of the complexities and frustra­ tions of network analysis without the assistance of Michael Eeley, Klaus Krippendorf, Charles Kadushin, and especially Geoffrey Greene. The several people who at one time or another were members of my doctoral committee contributed to the project in different ways. The late Sol Worth offered several helpful criticisms of my plan of attack at the outset of this study. Virginia Ingersoll consistedly encouraged me both on the east .and west coasts. Ray Birdwhistell warned me (once more) not to come - a-cropper, a state of bei ng to which I came perilously close over the years. Robert Hornik, who joined by re­ quest e£ the last minute, made several incisive criticisms which helped enlarge the significance of the project. Renee Fox graciously offered the resources of the Sociology Department of the University of Pennsylvania for conducting the survey. Our occasional but al- ways exciting talks guided my sights in conducting this study. The study became manageable and viable through Diana Crane's ex- cellent advice and her gentle insi~tence that I keep on the track. We may have exceeded known records for discussing dissertation matters in and from different locales, mostofwhich beginwith the letter "P": Philadelphia, Paris, Princeton, Portland, West Lafayette and Boston. My friend and intellectual guide (not to mention doctoral com­ mittee chair), Larry Gross, deserves special mention. Throughout my graduate career at Penn, his timely suggestions {e.g., "Why don't you look into a course offered in Sociology this fall, the sociology of v culture? A di ssertati on mi ght come out of it.") made all the di f­ ference. He consistently allowed me the freedom to pursue my intel­ lectural interests and connected me to avenues and ideas which gave those interests shape. I was reminded throughout the five years of concern with this project that there were myriads of occupations for my time and con­ cern other than death (and liquid brains) by my close friend, Barbara ,/ Jean Safriet. Her support and encouragement, not to mention fi ne editorial assistance, made all stages of this project less painful than they would otherwise have been. And last, but by no means least, I thank my family. My aunt, Edith Lee, always had time to encourage my effoy'ts, And deep grati- tude is extended to my parents, Doris Everts and Edgar Rad~ who each in different ways made this achievement possible. vi TABLE OF CONTENTS Chapter 1. INTRODUCTION ...... The Institutionalization of the Redefinition of Death . 3 Motives and Goals 4 Conceptual Frameworks 6 The Basic Conceptual Problem 13 Apologia: The Relations of this Study to Other Research 14 Preview 16 Endnotes 19 2. CONDUCT: DEFINITIONS, INSTRUMENTS AND ANALYSES 21 Locating the Definers 21 Operational Defi ni ti ons 22 Contacting the Definers: The Survey 23 Contacting the Definers: The Interviews 32 Managing the Articles: Content Analysis 33 Contacting the Policy-Makers 36 Data Analysis 37 The Rest to Come 38 vi i Chapter Page Endnotes . 40 3. THE HISTORY OF THE REDEFINITION OF DEATH FROM RESEARCH TO STATUTORY DEFINITION . 41 The Development of Life Supporting Technologies and the Role of the Anesthesiologist in Defining Death ............... 43 The Electroencephalograph and the Determination of "Brain Death" ............. 45 Legal Ambiguities and the Definition of Death 46 American EEG Research and Redefining Death 48 Early Cadaver Organ Transplantation 50 The Ciba Symposium: Ethics in Medical Progress 52 The Defi ni ti on of Death and Euthanas i a 54 Modern Concern Over Premature Burial 58 The "Replaceable Muscle" 59 The Harvard Committee 61 1968 . 73 Enter Ethics and the Hastings Center 76 The First Statutory Definition of Death - Kansas, 1970 . ... 88 Maryland Takes the Second Step - 1972 96 From Whole Brain to Neocortical Death 97 A Neurologist Challenges the Redefinition of Death ... 100 The Hasti ngs Criti que of the Kansas Statute . 102 The Hastings Critique of the Harvard Report 107 Tucker v. Lower 110 vi i i Chapter Whose Issue is the Definition of Death? . 113 Vi rgi ni a Res ponds With a Statute 115 Cerebral Angiography . 118 New Mexico Enacts a Statute . 119 The Alaska Statute - What Happened? 122 Trans pl ant Troubl e and the Law i n Cal iforni a 122 The AMA Stand on the Issue as of 1974 129 The ABA Recommends a Statute 129 The NINDS Collaborative Study: The State of the Art of Diagnosing Brain Death in 1975 130 Endnotes . 134 4. THE CULTURAL DEFINERS: WHO THEY ARE 136 Work and Discipline. 136 Origin of Involvement with Redefining Death 140 Organizational Affiliation 145 Academic Affiliation and Geographical Locale 146 Cultural Location: Religion, Religiosity and Professional Generation ........ 148 5. COMMUNICATION ACTIVITIES IN CULTURAL DEFINING 152 The Professional Journal 153 Symposium, Conference and Panel Participation 160 Mass Media Discussions 162 6. SOCIAL ORGANIZATION AMONG CULTURAL DEFINERS 167 Assumptions Concerning the Concepts of "Network", "Communication" and "Social Relationship" 169 The Four Ti es . 175 ix Chapter Page The Structure of Soci a1 Ties Among the Definers 181 Comparison With Other Network Populations 201 Summary . 203 Endnotes 206 7. CONCEPTUAL APPROACH: ARTICLE CONTENT 207 The Content Analysis Scheme .... 207 Results of the Clustering Analysis: The Dyi ng Patient vs. the Common Good ... 238 Conceptual Approach and Social Organization 247 Endnotes 259 8. THE POLICY-MAKERS AND DEFINER/POLICY-MAKER INTERACTION . 260 The Policy-Makers: Who They Are 260 Definer/Policy-Maker Interaction 262 9. THE DYNAMICS OF INSTITUTIONALIZATION 265 Stage I: Medical Evolution .... 265 The Plot Thickens: Conceptual and Ethical Development 268 The Importance of Committee Organization 273 Defining as Diffusion 275 The Power to De fi ne . 280 Stage II: The Evolution of Policy 283 Evolutionary Stages in the Career of an Idea 285 Defining and Policy-Making Compared 286 What Prohibited Consensus? 289 Endnotes . 292 x Chapter Page 10. CONCLUSION: SUMMARY, EPILOGUE AND RECOMMENDATIONS 293 In Sum •• 293 Epil ogue: The Issue Since 1974 301 Concl usi ons 312 Endnotes 328 APPENDICES A 330 B 337 C 348 D 350 INDEX 356 SUPPLEMENTARY BIBLIOGRAPHY ONTHE REDEFINITION OF DEATH 358 BIBLIOGRAPHY .................... 367 xi --- LIST OF TABLES Tabl e Page 1. Universities Where Respondents Obtained Their Terminal Degrees.......................................... 147 2. Discipline by Religious Affiliation in Rounded Percentages ..................•...........................