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In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self regulating, yet who are sustained by modern medical practices, destabilize the existing social order in ways that are different from other hybrid forms. [medical anthropology, anthropology of the body, bioethics, personhood, culture/nature dichotomy]
Introduction
The Site
Five blocks from the commercial center of a mid-sized city in California, a specialized unit of a community hospital houses people in some form of long-term or permanent comatose condition. Without higher brain function, they are considered by most to be unaware of themselves and others. They are fed through tubes that allow their bodies to thrive for years. Many are connected to mechanical ventilators (also called artificial respirators) that enable them to breathe; others have tracheostomies to ease their breathing and prevent choking. Many of these individuals are in what is called "persistent vegetative state" (PVS), the result of trauma or degenerative disease; the rest suffer from a variety of other medical conditions, mostly severe or endstage metabolic and neurological disorders or acute injuries resulting in lack of sufficient oxygen to the brain.1 The average stay on this unit, in a comatose condition, is 5 1/2 years, and there are two patients who have been in a vegetative state for 15 and 17 years respectively. About once a year, I was told, there was a "wake-up" patient who was able to leave the unit and go home after extensive...