Phenomenology of Implantation: The Liminal Body and the Implantable Cardioverter Defibrillator

Abstract

To prevent sudden cardiac death as a result of fatal arrhythmias, over 1155 implantable cardioverter defibrillators (ICD) were implanted in Australians, in 2001. This represents an increase of 125% in the number of ICDs used in Australia since the previous survey, conducted in 1997. This rapidly expanding biotechnology remains poorly understood by recipients, their family members and by health professionals. Studies of both the effectiveness of ICDs, and their acceptability to patients, have provided equivocal results. Insufficient in-depth research exists to provide direction to health professionals involved in ICD implantation or to provide assistance to recipients and their family members in their decision-making. This study focused on the phenomenon of implantation of a person's heart with a permanent bioelectronic ICD. Implantation was explored through the existential perspectives of participants from four groups: recipients of ICDs, family members of recipients; cardiac nurses and paramedical personnel; and cardiologists. Hermeneutical phenomenology was considered an appropriate methodology through which to explore the research question because of the humanistic approach that locates implantation within the context of the human Being. Methods of inquiry included unstructured in-depth dialogue, thematic analysis of participants' lived-through experience, and interpretation by drawing on literature, poetry, art, and idiomatic usage of words relating to the heart. Six themes emerged from the dialogue of the key players in heart implantation with an ICD: implantation as body-liminality; implantation as body-temporality/time; implantation as body-spatiality/movement; implantation as body-emotionality; implantation as body-sexuality/gender; and implantation as body-relationality. After intensive reflection on the existential themes in this study it was necessary to move into a higher level of analysis that would complete the phenomenological journey. The phenomenological journey extended from exploring the phenomenon of heart implantation with an ICD to an understanding of the phenomenon as liminal-Being. The findings from this research are expressed in terms of how participants experienced liminality in many existential ways. The phenomenon of implantation in relation to implanting the heart with an ICD, is an experience of liminality for recipients of the biotechnology in the context of 'Being on the threshold of life and death.' This project provides knowledge that existential-needs such as, indepth education, informed consent, negotiation, and support, experienced by the key players within the four groups, are not always met. The journey of this thesis identified a continuous thread of body-liminality experienced by all participants, albeit in differing ways. Collaboration between all players in heart implantation within the context of support groups is a strategy worthy of consideration withing a healthcare system that appears more involved with bioelectronics than humanity.