Abstract
Honor walks are ceremonies that purportedly honor organ donors as they make their final journey from the ICU to the OR. In this paper, we draw on Ronald Grimes’ work in ritual studies to examine honor walks as ceremonial rituals that display medico-technological power in a symbolic social drama (Grimes, 1982). We argue that while honor walks claim to honor organ donors, ceremonies cannot primarily honor donors, but can only honor donation itself. Honor walks promote the quasi-religious idea of donation as a “good death,” and mask the ambiguity and discomfort inherent in organ donation to promote greater acceptance by the medical community. While some goods may be achieved through honor walks, particularly for donor families, it is still important to examine the negative work done by this practice.
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Notes
While harm doesn’t need to be empirically demonstrated in order to be real, at least some witnesses report that the honor walk experience is powerfully negative. Because honor walks take place in public areas of hospitals, uninvolved patients and families cannot help but experience the large displays, and some families have even participated in honor walks for unrelated patients. At one author’s university, the hospital ethics committee has recently been consulted by a group of families because of concerns that their loved ones, who were not organ donors and therefore not offered an honor walk, were less valued by the medical team than patients who were offered an honor walk. The voices of bereaved families who only peripherally experienced the honor walks of unrelated patients cannot be ignored. The un-honored families provide critical insights into the full picture of the ritual work being done during an honor walk in the halls of a hospital. We believe further qualitative empirical data in this area may be worth pursuing.
Concerns have been raised at one author’s institution that OPOs have been witnessed using honor walks as an inducement during the organ donation consent process. This behavior demonstrates a larger problem with the consent process than the ritual itself, but is worth noting as it provides some contextual nuance to the work being done by the ritual.
Grimes encourages the use of these categories to make sense of rituals in Beginnings in Ritual Studies (1982).
The honor walk will begin just before death if the donation will occur after circulatory determination of death; in this case, the ventilator will be removed in the OR and organ retrieval will take place 2–5 minutes after determination of death. The honor walk will be shortly after death if the donor is declared dead by neurologic criteria.
See also the three volumes of The Philosophy of Symbolic Forms (New Haven, CT: Yale University Press, 1955). Originally published as Philosophie der symbolischen Formen. Erster Teil: Die Sprache. Berlin: Bruno Cassirer, 1923, Philosophie der symbolischen Formen. Erster Teil: Die Sprache. Berlin: Bruno Cassirer, 1925, and Philosophie der symbolischen Formen. Dritter Teil: Phänomenologie der Erkenntnis. Berlin: Bruno Cassirer, 1929.
Another example of “magic” in medicine is Carl Simonton’s use of imagery in cancer therapy. His patients are guided to envision their cancer as soft and dissolvable. Simonton and other physicians may be able to propose physiologic mechanisms by which this approach might helpfully augment standard cancer therapy, but to patients who benefit from this technique, guided imagery that bolsters their treatment likely appears quite magical.
The person-affecting view suggests that, for harm to occur, it must occur to someone. One interpretation of this position is that harm cannot occur after a person has died. We note again that honor walks may involve living patients, in the case of donation after circulatory determination of death. But more importantly, in the context of this paper, we believe the strong obligations that physicians owe their patients can extend after their death, and this justifies the use of the word “harm”. This is the same type of harm we seek to avoid by barring trainees from practicing procedures on recently deceased patients.
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Drs. Malone and Bishop generated the initial argument for this paper. All authors contributed to drafting and revision, and all agreed to the final paper. Drs. Malone and Mason contributed equally to the paper and should be considered co-first authors.
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Malone, J.R., Mason, J. & Bishop, J.P. Ritual and Power in Medicine: Questioning Honor Walks in Organ Donation. HEC Forum (2024). https://doi.org/10.1007/s10730-024-09525-6
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DOI: https://doi.org/10.1007/s10730-024-09525-6