Paper short abstract:

This presentation explores how the Japanese brain-death diagnostic procedure was formulated in the 1980s-1990s. It considers how various socio-culturally constructed images of trust and national presages were inscribed in medical device vis-a-vis the brain-death diagnostic procedure.

Paper long abstract:

> This presentation explores the ways in which the Japanese brain-death diagnostic procedure was formulated in the 1980s-1990s. From 1968 to the early 1980s, countries such as the UK, USA, and Taiwan had seen the definition of end of life change from cardio-respiratory failure to irreversible deep coma―later termed brain-death; meanwhile the medical authorities of those countries established standardised brain-death diagnostic procedures. These changes derived from the emergence of the clinical application of an automatic artificial ventilator, and of cardiac transplantation. The transplantation procedure requires a surgeon to extract a pumping heart from a donor; the ventilator device allows the cardio-respiratory function of an irreversible deep coma patient to continue despite a total failure in brain function. Therefore, a beating heart could be taken from a brain-dead donor's body for transplantation. In Japan, the medical community attempted to follow these precedents but there arose a controversy as to which medical technology should be applied: electroencephalogram (EEG), auditory brainstem response (ABR), and/or cerebral angiography. Whilst the then leading Japanese neurologists found specific advantages in ABR, their choice was complicated by a confrontation with cultural politics over the value of evidence produced by certain medical devices. It owes much to this situation: British brain-death diagnostic standard adopted none of these; other Euro-American ones adopted either EEG or cerebral angiography Consequently, the Japanese brain-death diagnostic procedure was shaped alongside intensive reflection over not only which medical technology would be more reliable and feasible to confirm brain-death accurately, but also which cultural position should be taken; that is, whether Japan should follow British, US or Swedish practice, or adopt an alternative approach. This study hence shows what significance was articulated and then rearticulated with each medical device (i.e. EEG, ABR and cerebral angiography). Examination of this controversy illuminates how socio-culturally constructed images were inscribed in the usage of each of the medical technologies relevant to the brain-death diagnostic procedure.