Enacting death in the intensive care unit: medical technology and the multiple ontologies of death

This article explores various ways health personnel enact death in connection with mechanical ventilation treatment withdrawal in the intensive care unit (ICU) at Trondheim University Hospital. The main focus is on sedated terminal patients who undergo mechanical ventilator treatment withdrawal and relatives' presence at this time. Mol's (2002) praxiographic orientation of the actor-network approach is followed while exploring this medical practice. Utilizing this interdisciplinary science and technology studies approach this article describes what Timmermans and Berg (2003) have called ' technology-in-practice'. Thus the main focus of the analysis is on medical interventions, and enactments of death within medical practice. The article argues against a 'social essentialist' approach to medical technology, which views technology as a passive force empowered by social relations. It explores how various enactments of death are intrinsically linked with and shaped by the use of medical technology within clinical practice. A praxiographic inquiry into how death is enacted carefully takes notice of how medical practice and techniques make death audible, tangible, visible, knowable and real. Mol's praxiographic approach also enables a description of how the multiple enactments of death connect within end-of-life care through various forms of coordination. This article is based on interviews with 28 nurses and two physicians in a Norwegian intensive care unit.