Remembering and Disremembering the Dead

Front matter

PALGRAVE HISTORICAL STUDIES IN THE CRIMINAL CORPSE AND ITS AFTERLIFE

Series Editors: Owen Davies Elizabeth T. Hurren + Sarah Tarlow oaloraverpivot

REMEMBERING AND DISREMEMBERING THE DEAD

Preface

In the main, this book is a cross-fertilisation of history and philosophy in the broadest possible sense. Ideas of death, posthumous harm, punishment and redemption germinate in both the conceptual ground of philosophical analysis and the empirical ground of historical case study.

One metaphor for the approach to this book is of germination. At the beginning of this project I had more of a conceptual understanding of death and harm than any sustained appreciation of how that related to any historical contextualisation. However, after spending three years with archaeologists and historians my conceptual training as a philosopher germinated in an appreciation of historical case studies.

Cross-pollination of ideas from history to philosophy chapters and vice versa has led to the germination of an interdisciplinary perspective. That said, each of the chapters also stands alone as either broadly philosophical or historical. This makes the character of the work also appear multidisciplinary in nature.

I cannot make any claims to personally partaking in any serious historical research. I have not visited archives, unearthed any undiscovered and illuminating primary sources. Instead I have stood on the broad shoulders of historians who have inspired me to refashion the lens of philosophical/conceptual inquiry.

Another metaphor that can be used to understand my approach is the fashioning of a varifocal interdisciplinary lens.

So, what is the difference between an ordinary disciplinary lens and a varifocal interdisciplinary lens? A disciplinary lens is pre-ground with a vi PREFACE fixed focal length that illuminates a particular kind of academic territory. The problem with importing a disciplinary lens to a different academic territory altogether is that while it illuminates some things in an unexpected way, it will also distort many other details. I began my foray into a historical case study of posthumous harm and redemption in this way.

By trying to understand the conceptual distortions as well as the illuminated focus, I could sense, not re-grind/grind in order to widen the field of view, steadily increasing over-all illumination and the ability to focus near and far. This gave my lens a varifocal quality: a way of looking both out to the far distance of key conceptual distinctions and the near distance, which added sharp empirical focus to a conceptually informed history.

I would like to thank the criminal corpse team at the School of Archaeology and Ancient History, University of Leicester for providing a philosopher with a different way of seeing. My thanks go out to: Prof. Owen Davies, Prof. Pete King, Prof. Elizabeth Hurren, Dr. Emma Battell Lowman, Dr. Rachel Bennett, Dr. Francesca Matteoni, Dr. Shane McCorristone and Dr. Richard Ward. I would also like to acknowledge all the historians and philosophers who have deeply influenced this work and who appear more formally in the references.

A special thank you goes out to philosopher and historian Jonathan Reé, the archaeologist Sarah Tarlow and the poet Sarah Hymas. Jonathan Reé was encouraging and inspiring in equal measure. Sarah Tarlow believed in this kind of project from the start and was instrumental in bringing in a philosopher with interdisciplinary interests. Sarah Hymas patiently read through the draft with an editorial eye.

Last but not least I would like to thank our funders the Wellcome Trust for funding ‘Harnessing the power of the criminal corpse’ project (Grant No. 095904/Z/11/Z). Without the financial support of a Wellcome Trust Research Fellowship this project is unlikely to have ever materialised.

Leicester, UK Floris Tomasini

CONTENTS l Introduction

Introduction

Abstract The introduction summarises a chapter outline and discusses some of the main concepts used.

Keywords Biological and social death - Posthumous harm Punishment and redemption

Part I of this book—the conceptual groundworks—is philosophically orientated in character. It consists of two themes: a reflection on what and when is death (Chap. 2), followed by a discussion on the possibility of posthumous harm, punishment and redemption (Chap. 3).

Chapter 2 theorises death as a form of change. Biologically speaking, death is a complex change where it is already present as part of the dying process. Death as a process (dying) can be contrasted with death as a state: dead or alive. This work broadens out what we mean by death and its timing. In doing so, it is worth distinguishing social death from biological death.

Social death is understood as a series of narrative changes to the identity of a person that happen as a consequence of real changes to their biology. In absolute terms, social death involves the extinction of someone’s biographical narrative. For example, narrative death in an absolute sense is not only no longer being remembered, but also being extinguished from memory and the historical record altogether.

Social death is also intelligible as a processual change, where significant narrative changes configure and refigure personal identity before

© The Author(s) 2017 l F. Tomasini, Remembering and Disremembering the Dead, and after biological death has taken place. As such, social death is not necessarily co-terminus with death as a biological event. For example, the social death of a person may happen as a result of brain injury, so that while an individual may physically survive a major brain injury, they may no longer be the same person. Indeed, certain brain injuries may lead to the ‘autobiographical’ death of a person, as in the case of those who are left in a permanent vegetative state.

Chapter 3 attempts to understand the harm, punishment and redemption of death. If the ontological and epistemological puzzle of what and when death is becomes the subject of Chap. 2, its normative sense is explored in Chap. 3. When death is has a normative as well as ontological/epistemological dimension. As well as asking the question what and when is death, we can ask the question: what constitutes the harm of death?

Chapter 3 argues that while it is impossible to physically harm or save the dead, it is possible to harm or redeem how we remember them. Looking deeply into the notion of harm, it is possible to distinguish intrinsic from symbolic harm in order to clarify what is meant by this. We can only intrinsically harm human beings that are still living. In this sense it is impossible to harm a corpse. This said, it is possible to symbolically or narratively harm the dead. We can harm:

e the narrative and fidelity of memory;

e the biography of a person that once existed;

e the memory of a person that once existed even though they are still physically alive;

e the memory of a person that no longer exists;

e the symbolic unity of the corpse, whereby dismembering the corpse affects being able to remember the person as they were.

Harming the dead in this way is understood as disremembering the dead, whereas faithfully remembering the dead, as they really were in life, implies redemption. It is this play of words that flags up the significance of the title of this volume. Furthermore, it is possible to conceptually distinguish types of posthumous harm and redemption, which is explored more deeply in Part II.

Part II of this book involves historical case studies—where the conceptual groundworks in Part I cross-pollinate and fertilise in a critical examination of carefully selected case studies where ideas of posthumous

1 INTRODUCTION 3 punishment, harm and pardoning (redemption) are examined in their historical context.

Posthumous punishment involves retribution, by which the narrative of those that once existed is intentionally and deliberately harmed by institution or state. In its most virulent form, posthumous punishment involves a double form of retributive justice in the eighteenth century: hanging criminals (capital punishment) and dismembering the criminal corpse after hanging either by dissection or gibbetting (posthumous punishment). In its less virulent form, posthumous punishment in the twentieth century involves dishonouring the dead without dismemberment. For example, those deliberately executed by firing squad for a variety of military offences in the First World War were intentionally dishonoured as an example to others.

Chapter 4 opens with an examination of capital punishment through the lens of the British Army’s ‘shot-at-dawn’ policy during the First World War. This leads into a historical discussion of the character of retributive justice and posthumous dishonour of those executed by firing squad, and whether or not posthumously pardoning those shot at dawn is at all appropriate today.

If it is possible to symbolically harm the dead, it is also possible to symbolically redeem their memory. This is intelligible in terms of posthumously pardoning those that were punished and dishonoured.

Some historians argue that posthumous pardoning is either unintelligible and or inappropriate because it is an attempt to re-write history. Such historians have not given enough thought as to what a posthumous pardon is good for. Indeed, it is argued that it is perfectly possible, as well as morally appropriate, to re-evaluate the past in the present for good reason; for example, by rehabilitating the identity of those that have been historically dishonoured in the memory of those still living today.

The chapter ends with a long view of the history of capital punishment, posthumous punishment and redemption, examining how these notions have repeated with a difference over time.

Chapter 5 looks into the idea of posthumous harm in the context of the improper removal and retention of children’s organs and tissues at Alder Hey Children’s Hospital in the 1990s. Posthumous harm in this historical context is understood as a failure of institutional trust, where moral blindness to inappropriate post-mortem practices thrived in the late twentieth century. While the effect may be very similar to posthumous punishment in earlier times, the intention and context are not comparable. The supposed intention behind the inappropriate removal and retention of tissues and organs from dead children at Alder Hey was ostensibly motivated to save lives through medical research, even though in reality the institution colluded in perpetrating harm.

The Alder Hey scandal concerns a failure in a system of trust, where clinicians and their managers were wilfully blind to parental anger and grief brought about by inappropriate removal and retention of their dead children’s organs. By outlining two different contexts of understanding Alder Hey and posthumous harm, there is an attempt to provide conceptual clarity as to why posthumous harm mattered at both an institutional level of trust and at a personal level of grief.

To end, there is an attempt at a historical long-view, where ‘organ-snatching’ at Alder Hey is a practice that has certain similarities with, as well as important differences to, ‘body-snatching’ in the Georgian period.

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PART I

Conceptual Groundworks

‘There are three deaths. The first is when the body ceases to function. The second is when the body is consigned to the grave. The third is that moment, sometime in the future, when your name is spoken for the last time.’

David Eagleman, 2010, p. 23.

CHAPTER 2 What and When Is Death?

Abstract This chapter is one of two conceptual chapters that set up the analytical foundation for the remaining empirical case studies which are mainly historical in character. The first chapter focuses on the question: what is death? The secondary question: when death occurs, depends on what we think death is. This chapter addresses a number of questions: What and when is biological death? Can biological death be understood as an absolute state and/or is it partially present in the process of dying? What is social death? When is social death co-terminus with biological death? When is it not? How can we characterise the meaningful similarities and differences between biological and social death? Why should this matter?

Keywords Biological and social death - Real and symbolic change

BIOLOGICAL DEATH

The commonplace notion of death is to characterise it as an end state: being dead. Nevertheless being dead is not the same as the event of death or the dying process (Scarre 2007, p. 5). Biological death can be understood as:

l. A final event. 2. An absolute state (being dead).

© The Author(s) 2017 7 F. Tomasini, Remembering and Disremembering the Dead,

3. Part of the dying process.

Defining Death

The absolute state of being dead is synonymous with the idea of medical death. The definition of being dead, as proposed by the US President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research set up by Ronald Reagan (1981), is when:

...an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. (Leming and Dickinson 2002, p. 43; Scarre 2007, p. 6)

Death: Absolute State, Final Event and Process

The difficulty with the above definition is capturing the irreversible final moment of death. It is worth critically interrogating both clauses of the above definition.

Clause (1) does not accurately capture the timing of the final biological death event. That is to say, irreversible and irreparable damage to heart and lungs will quickly and inevitably lead to entire brain death, but it is not quite synonymous with that final event. There is a time interval in which the brain is dying because of lack of a supply of oxygen-rich blood to keep it alive, at which point the human brain is dying but not yet dead (Scarre 2007, p. 6).

Clause (2) points to the timing of the final event. The certitude around entire (whole) brain death follows from a clinical assessment of total brain failure. However, the assessment of total brain failure has courted controversy.

The neurologist Alan Shewmon is a leading critic of equating total brain failure with human death. Shewmon identified many cases of patients who were diagnosed with total brain failure that nevertheless ended up surviving. Shewmon collected 175 case reports of patients that had survived against the odds, and whose bodies had stabilised long after the period accounted for by current literature on ‘brain death’. The length of patient survival varied from a month to a year and even, in the exceptional Florida Boy Case, 14 years (Rubenstein 2009, pp. 37-38).

In certain cases, therefore, it may be possible to try to artificially sustain a body after so-called total brain failure has been diagnosed. As such, it is possible to distinguish total brain failure from chronic brain death.

Shewmon’s arguments have thrown significant doubt over associating death with total brain failure.

This is illustrated in the famous Florida Boy Case. The boy survived for 14 years in an Intensive Care Unit (ICU) after an initial diagnosis of total brain failure. Following his parents’ wishes, the boy was artificially ventilated, fed and hydrated in hospital, by which time his body had grown, recovered from wounds and even parts of his brain had become replaced ‘by ghost-like tissues’ (McMahan 2002, cited in Scarre 2007, p. 7).

The Florida Boy Case has shown that establishing death may be less about precise diagnosis of the brain state and more about understanding the resilience of the human organism as a whole. In other words, the Florida Boy’s resilience was tied up with what Shewmon calls the organism’s ability to function as an ‘emergent property of the whole’ (Rubenstein 2009, p. 38). This fits with what Aristotle calls ‘entelelchia’, his ancient term for the soul, which has biological connotations with what Joe Sachs has translated as the organism ‘being-at-work-to-stayitself” (cited in Rubenstein 2009, p. 41).

Chronic brain death, where a patient may continue to exist in a permanent vegetative state (PVS), is a notion that only shows up as mattering in the highly advanced technical environment of ICU where specialist clinicians can artificially hold medical death at bay. Arguably then a diagnosis of total brain failure (or indeed chronic brain failure) is:

...perfectly correlated with the permanent cessation of functioning of the organism as a whole because the brain is necessary for the functioning of the organism as a whole. It integrates, generates, interrelates, and controls complex bodily activities. A patient on a ventilator with a totally destroyed brain is merely a group of artificially maintained subsystems since the organism as whole has ceased to function. (Bernat, cited in Rubenstein 2009, p. 36)

To conclude, ‘life’ after extensive brain death is an ambiguous state, one where precise terms are necessary to establish what exactly a human life is constitutive of.

A philosopher that is clear about what bare life entails is Leon Kass. He describes life at its most basic as a ‘series of preconscious needs.’ From Leon Kass’s book The Hungry Soul (1994):

What moves an organism to feed is not merely the sensed and registered presence or absence of a certain chemical or edible being in its environment but the inner needy state of the organism, for which such an absence is a lack, an absence to be overcome and remedied... The organism would not ‘respond’ to perceived food ‘stimuli’ were it not ... ‘appetitive’ being

. internally ordered toward the necessary activities of self-nourishing. (Leon Kass, cited in Rubenstein 2009, p. 43)

As the Florida Boy Case illustrates, the organism as a whole retains a preconscious and ‘inner needy state’ for basic appetitive functions. That is, the need for air, hydration and nutrition. This inner state of neediness is met at the threshold of life in ICU, where the organism is not only maintained but even grows, adding to the illusion of recovery.

What and when is death here? It depends on one’s perspective of life.

From an understanding of bare life, the Florida Boy was a biologically living, growing organism with pre-conscious needs and an inner needy state. From the perspective of a living person, the Florida Boy is likely to have died well before his parents projected their hope on to his recovery.

To elucidate further, patients in the UK, who remain comatose and unresponsive and who have made no significant recovery after 12 months from a serious brain injury of this sort, are categorised as being in permanent vegetative state with a statistically improbable chance of recovery (http: //patient.info/doctor/vegetative-states).

What is surprising in the Florida Boy Case is how he survived in ICU for 14 years. The ambiguity of his state of existence was probably obscured within the ICU environ. Steps may have been taken to establish how he may have fared without a ventilator, establishing whether or not the boy’s brain had the necessary integrative function to sustain autonomous biological life beyond life support. This throws up another distinction: between bare life in the technological setting of intensive care and the bare life of a deeply brain-damaged individual who may survive for years afterwards with constant care from family and social care professionals.

In the case of bare life the patient can be described as already being in a state of ‘techno-death’, where machines, like ventilators, take over from biological sub-systems that have permanently and irreversibly failed.

Some thinkers regard the neurological standard of whole-brain death to be unnecessarily restrictive (e.g., Green and Wikler 1980). Even if a body could survive technologically unaided, ‘neocortical’ (or ‘higher’ brain) death may have occurred anyway, meaning that what remains is a severely mentally and physically disabled individual whose personhood is barely recognisable.

Personhood is characterised by having the mental capacity to be selfaware, communicate with others, and self-create a meaningful life. Once that is gone it is difficult to relate to that human being in the same way. The person who one may once have known has died, presenting the challenge of forming an altogether different relationship with another being. Again the Florida Boy provides an example: while his autobiographical life as a person was over, destroying who he had been, his biographical life was sustained through the narratives of hope his family harboured in his recovery.

Death as Change—A Historical Long-View

The conundrum of understanding biological death is not a new one. It has a long historical root. This is evident in how medical men of the past understood death as both a state and a process.

Hurren (2013a,b) reminds us of the work of Dr Philips. Dr Philips, in a paper given to the Royal Society in 1834 called The Nature of Death describes death in two ways: ‘the name of death’ where ‘sensorial, nervous and muscular systems’ were in the process of shutting down. This is roughly equivalent to what we may understand today as a ‘living death’, inimitable within the process of dying. Philips contrasted this process with a permanent physiological shut down or ‘absolute death’ (e.g., Philips 1834, cited in Hurren 2013a,b).

Moreover, the idea that dying was sometimes reversible was demonstrated through very early resuscitation techniques. Indeed as early as the 1760s, there were mechanical ways to resuscitate dying persons through artificial respiration in the case of drowning. By 1796 the London Humane Society, for example, claimed to have resuscitated over 2000 people (Hurren 2013a).

Our understanding of the state and process of death has greatly evolved, partly as result of a more sophisticated understanding of brain death in the twentieth century, and partly as result of more advanced resuscitation techniques pioneered by Peter Safar’s ABC of cardio-pulmonary resuscitation (CPR), which are now standard practice in emergency medicine (Acierno and Worrell 2007).

Today we have a nuanced understanding of the process of dying, which in its crudest form may be subdivided into roughly six categories:

e Reversible and natural. For example, death may be part of the natural cycle of regenerating the body;

e Irreversible and natural. Death, for example, is part of ageing;

e Reversible and catastrophic. Having a cardiac arrest is reversible, in that the patient can be resuscitated. At this point the patient may be described as clinically but not medically dead;

e Irreversible, catastrophic and unambiguously fatal. Total brain failure that is not redeemable in an ICU environment and is characterised as medical death;

e Irreversible, catastrophic and survivable if technologically aided. Serious brain injury may not necessarily be fatal—persons affected by serious brain injuries survive and sometimes make remarkable recoveries in ICU;

e Irreversible, catastrophic and survivable if technologically unaided. Survivors of major brain injuries that eventually make it out of ICU may be severely mentally and physically disabled requiring life-long support and care. Those who survive the initial crisis and are eventually discharged from ICU and hospital care may have personalities that are barely unrecognisable from before.

A More Conceptual View of Death

On a more conceptual level, death may be theorised in the following ways:

e as a form of change; e asa particular kind of personal identity.

Death as Change

Geatch (1969) distinguishes between Oxford and Cambridge changes, characterising Oxford changes as real changes in the intrinsic nature of things and Cambridge changes as relational changes that happen as a consequence of real changes (e.g., Lowe 2002).

Death therefore, takes on a dual aspect: a biological and social aspect. If biological death can be understood as a real change in the intrinsic matter of biology, then social death, by contrast, is a relational or narrative change that happens as consequence of real changes in the intrinsic nature of biological materiality.

So, if Maud suffers a brain injury and she is left in a permanent vegetative state, then as a consequence of real changes in the intrinsic property of her brain she will have undergone an irreversible form of biological death. Now a real change in the intrinsic integrity of Maud’s brain will result in a relational or narrative change in who we understand Maud to be after her brain injury. Maud might be in a permanent vegetative state (PVS), in which her brain that is responsible for her personality has died before the rest of her body has.

So, implicit in the so-called scientifically neutral language of intrinsic changes in biological properties of her brain, there is also a ‘narrative’ understanding about who remains. In this way social death is already inextricably linked with biological death.

SocIAL DEATH

Social death is a relational or narrative change in the meaning of a human life. It involves a change in the narrative identity of persons that either still exist or have once existed.

Narrative Identity

One way of conceptually fleshing out the difference between social and biological death is to think through two senses of personal identity.

Paul Ricoeur (1992) reminds us that Latin has two meanings for the word identity: identity understood as ‘being the same’ (idem), usually interpreted as the question ‘what am I?’; and ‘oneself as the self-same’ or ‘self-constancy’ (ipse), understood in the question ‘who am I? (e.g., Simms 2003, p. 102).

Now biological death primarily concerns idem identity, where death marks a real change in the intrinsic properties of ‘being the same’ biologically.

Moreover, the death of ‘what I am’ (idem) is inextricably linked to being able to self-configure the story of one’s life. In short, the physical end of ‘what I am’ as a living person spells a particular kind of social death: the autobiographical death of one’s narrative identity.

l4 EF. TOMASINI

Traditional definitions of medical death are unambiguous, describing a final event that leads to the absolute state of being dead—in which case the biological death of a human being (idem identity) is co-terminus with the social death of the person (ipse identity).

The biological death of a person has narrative consequences in how we may configure personal identity. In the most formal terms this involves correct signification. Being dead signifies a corpse, a state of non-being, for which the personal pronoun in the phrase ‘I am (a corpse)’ is no longer correct. A corpse refers to a husk, and a husk is no longer a person that actively possesses a body. Furthermore, physical death has relational consequences for others. My death, for example, would mean that my wife would undergo a relational/narrative change: that is, my wife would become a widow.

Social death concerns our ipse identity—the narrative identity of who we are. While social death is dependent on having existed, it is not necessarily co-terminus with existing as a biological entity.

Real changes in our biology certainly prompt relational changes in how we may configure the narratives of our lives. After a heart attack, for example, there may be a subtle shift in who we understand ourselves to be through what we believe we are realistically capable of doing. This may signal a subtle shift in our personality. Less subtly, brain injury, as argued earlier, can lead to narrative inversions in our clinical status: from a living person that is self-conscious and aware of others, to a living human organism which in PVS is not conscious in this way.

A relational change in the meaning of who a person is has both an existential as well as a biological dimension. The narrative of who we are is existentially anticipated in the face of our physical mortality. We existentially configure the meaning of our lives in anticipation of our physical death. This has a secular and religious dimension.

In secular terms the meaning of our life matters beyond its physical annihilation. For example: we might suffer a serious brain injury that marks our autobiographical death destroying our dignity; we resonably anticipate being respectfully treated and honestly remembered after our physical life has ended.

In spiritual/religious terms we may anticipate who we are and how we might continue in a life hereafter. If one believes that how we treat mortal remains matters for a disembodied life hereafter, then the burial rituals associated with keeping the corpse intact take on a special ‘narrative’ significance.

The narrative identity of the dead is also refigured by others who survive them. The narrative identity of the dead is refigured for good and ill through memory and biography by those who survive the deceased. Informally, we are remembered by family and friends, while formally we may be remembered through the social impact of our past actions. In short, who we are survives our physical death in narratives of remembrance.

Similarity and Difference: Biological Versus Social Death

There are both fundamental similarities as well as underlying differences when comparing social with biological death.

e Biological and social death both involve change.

However, how we understand ‘change’ differs in each case. Biological death involves understanding intrinsic or real changes to the material what-ness of existence, whereas social death involves an understanding of narrative change of who we are.

e Biological and social death depend on an existence condition. Death is unintelligible without ever having existed, or never having changed.

How we interpret the existence condition is different depending on context; that is, it has different meanings in the context of biological and social death. Biological existence primarily concerns changes in the material what-ness of life. In the case of social death however, existence primarily concerns a narrative self-constancy of who-ness over time.

Narrative identity is mot necessarily co-terminus with physical existence; that is, a human being, either existentially anticipates and configures the meaning of who they are beyond their physical annihilation, or their narrative identity changes through its refiguration by others who survive them.

e Biological and social death can be understood as a state or a process. Being dead is a physical state to be contrasted with dying, which is a biological process. In social terms, the absolute state of being dead is the equivalent to being completely forgotten and expunged from the historical record altogether. Moreover, the social equivalent of physically dying is being slowly forgotten, misremembered and, most damagingly of all, being harmfully remembered (disremembered). In this volume the focus is on the process of being disremembered, which is a form of social death.