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Linda F Hogle, New Brunswick, Rutgers University Press, 1999, 241 pages, US$22.00 (pb).
Drawing upon the disciplines of bioethics, anthropology and politics, Linda F Hogle examines the use of human body parts for transplantation and research in modern Germany. She focuses on German attitudes to organ transplantation and the fears expressed by doctors and the public regarding utilitarian justification of the use of body parts taken from the vulnerable to benefit others.
In modern Germany, argues Hogle, organ transplantation and practices relating to the use of human body parts have developed under the shadow of the history of medicine during National Socialism. This can be seen in the recent controversy over brain death, where the spectre of “lives not worth living” has been invoked in the context of decisions to declare death and authorise removal of body parts. Ethical tensions were also revealed following the unification of East and West Germany: the former Eastern state regarded human bodies as state property and the Western state endorsed the opportunities for profit-based medicine.
In the first part of the book Hogle discusses various cultural meanings of “the body” in German history, including an account of how the body has been handled at death, various uses of the body, (where she points out that the use of bodies and their parts for healing is not a new phenomenon), German funeral customs, and the unique history of the body under National Socialism. This is followed by a discussion of legal notions of bodily integrity and new ways of regarding the relationships between the body, technology, and the state. All of this provides a backdrop to an examination of the link between the social and political aspects of organ transplantation and its scientific and technical aspects, which is covered in part two.
The second part provides an in-depth study of procedures for the management of donors and distribution of cadaveric organs throughout Europe, drawing attention to the way regional political differences within Germany affect the procurement of organs and the medical profession's response to the public debate on transplantation. In this context Hogle recounts how the media in Germany provided sensational coverage of medical scandals during the past decade. First, was the Erlangen experiment in 1992, involving the postmortem ventilation of a woman in order to preserve the life of her fetus. The fetus aborted after six weeks, but during this time confusion reigned over the meaning and diagnosis of brain death, and the incident evoked memories of Nazi medical experiments. The second scandal followed media revelations in 1994 concerning the routine selling of tissues from cadavers in hospitals, which intensified public distrust of doctors and a general feeling of powerlessness in the face of big industry, the state and the medical profession. Under headlines such as “Plundering the dead”, the media published photographs of piles of bones, artificial hip joints and large containers of human brains, resembling the piles of human hair, bones, etc, displayed when the concentration camps were liberated. The third scandal recounted by Hogle involved revelations about the use of human cadavers as crash test dummies, which was sensationally reported in 1998. Each scandal emerged with a barrage of media coverage. According to Hogle, reaction to these stories was informed and influenced by the history and memory of National Socialism and it is partly this history and memory that has been responsible for the decrease in organ donation, in Germany, by relatives throughout the 1990s, which contrasts with other European countries and the US. Throughout her extensive surveys and interviews with German medical personnel, Hogle notes, however, that the essential characteristic of German organ procurement practices is the “need to preserve an image of not violating the dead” (page196).
This is an extremely well researched book and is one of the first serious attempts to understand the complex varations in ethical attitudes to the dying and the newly dead in contemporary Europe.