Not Quite Dead Yet: Perceptions of Death and Spontaneous Return to Life in the Intensive Care Unit

• In Event: Diagnosing Death: Critical STS Perspectives - II

Abstract

The intensive care unit (ICU) is a hospital clinic with a high concentration of artificial life-sustaining technologies and medical expertise. ICUs exist to save and sustain the lives of even the most critically ill and injured patients. Yet despite (or in spite) of its social and technical orientation towards saving life, the ICU is an increasingly common location for death. How is death orchestrated within contexts of life-saving? This tension between life-saving and death-facilitating is foregrounded in instances where the social and technical production of ICU death is interrupted. One example of this type of challenge appears to occur in cases of perceived autoresuscitation (the spontaneous resumption of circulation after a declaration of death), where the patient’s body seems to temporarily refuse the social and technical categorization of death. In this paper, I use a qualitative approach to explore 12 cases of reported autoresuscitation in European and Canadian ICUs. My dataset is comprised of clinical data, written descriptions, and interviews with physicians and nurses who perceived and reported cases of autoresuscitation in the ICU. Using an STS perspective that centers the interactions of technology and knowledge, I describe how each informant perceives death within the socially constructed contexts of life-sustaining technologies. I also consider informants’ perceptions of and reactions to technological artifacts, such as arterial waveforms displayed on monitors, that helped shape understandings of clinical events into observations of autoresuscitation. This project draws attention to how death in the ICU is socially and technically constructed using the technologies of life.

Author

• Amanda van Beinum, Carleton University