Ishiguro's Inhuman Aesthetics

The question of what it means to be human pervades Kazuo Ishiguro's novel Never Let Me Go, which gradually reveals a counterfactual twentieth-century England where clone colonies provide ready supplies of organs for donation. In the tradition of Aldous Huxley's Brave New World (1932) and George Orwell's 1984 (1949), the novel envisions a dystopian civil society where clones struggle to comprehend the significance of their own circumscribed personhood. Perhaps unsurprisingly, this interrogation of what it means to be human emerges through a critique of Romantic-inspired assumptions about aesthetics and empathy. While the novel attracts attention for its theme of genetic engineering, its deepest anxieties arguably concern the ethics of artistic production and consumption in an age of multiculturalism and globalization. Through its veneer of science fiction, Never Let Me Go offers an allegory both for national concerns about the state of England and for transnational fears about rising global inequality. In its portrait of the systematic exploitation of the clones and its implicit exploration of vulnerable actors in our modern economic order, the novel indicts humanist conceptions of art as a form of extraction that resembles forced organ donation. If Romantic-inspired views of empathy rely on the claim that art reveals the human soul, Ishiguro's novel implies that the concept of the soul invokes a fundamentally exploitative discourse of use value. In this respect, Never Let Me Go shares in a pervasive late-twentieth-century cultural skepticism about the viability of empathetic art. [End Page 785] Yet Ishiguro's critique does not—as might be expected—abandon the ethical potential of works of art. Instead, it makes a case for an ethics offering a very different approach to art and empathy that relies on the recognition of the inhuman. As an alternative to humanist modes of representation, Ishiguro's inhuman style suggests that only by recognizing what in ourselves is mechanical, manufactured, and replicated—in a traditional sense, not fully human—will we escape the barbarities committed in the name of preserving purely human life. Never Let Me Go implies that if there is to be any empathetic connection with Ishiguro's protagonists, it will not occur through the consoling liberal realization that clones are humans, just like us. It will evolve through the darker realization that art, along with the empathy it provokes, needs to escape the traditional concept of the human. The novel thus calls for what seems like a contradiction in terms: an empathetic inhuman aesthetics that embraces the mechanical, commodified, and replicated elements of personhood. While inhuman is often used as a synonym for cruel or unethical, Ishiguro's novel suggests exactly the reverse. As its aesthetics of replication allows us to sympathize with others without recourse to such constraining ideals, Never Let Me Go reinvents empathy for a posthumanist age

Commemoration from a Distance: On Metamemorial Fiction

Exploring two works of contemporary American and South African fiction, this essay meditates on memorials created at a distance from original sites of violence. These two metamemorial fictions both make concerns with comparative suffering and outsider participation an integral part of the commemorative process they address. They create an ambivalent space for the outsider to participate in the commemoration of atrocity: both by honoring the dead and, provocatively, by investing such empathetic acts with signs of fraudulence. These fictions envision new kinds of public memorials that foreground the significance of sacrilegious as well as sacral impulses to commemorate the dead

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Pirates, spies, soul-stealers: spirituality transformed

In the past decade the worldwide yoga industry has become a multi-billion-dollar business. Yet, ironically, the one country where yoga does not yet thrive commercially is the very place from which yoga is thought to originate: India. Why should this be

Asian Review: Is Yoga India's Business?

In the past decade the worldwide yoga industry has become a multibillion-dollar business. Yet, ironically, the one country where yoga does not yet thrive commercially is the very place from which yoga is thought to originate: India. Why should this be

Microloans and Micronarratives: Sentiment for a Small World

This essay evaluates the contribution that sentimentality might make to cosmopolitan practices in contemporary life. In particular, it considers how the legacy of feminized sentimental fiction informs twenty-first-century rhetoric on the Internet. The essay examines how the person-to-person microlending Web site Kiva fosters attachments with distant others through the illusion of intimacy that reshapes the global into an emotionally manageable size. This sentimental promise of a small world is both what enables and what haunts a cosmopolitan sense of responsibility to others