Extraterritoriality at the end of life: disregard and the exceptional in St. Croix, U.S. Virgin Islands

This article approaches the theorisation of extraterritoriality through an ethnographic examination of the shaping of end-of-life experiences and trajectories through federal healthcare governance in St. Croix, an island in the unincorporated territory of the U.S. Virgin Islands. Drawing on critical phenomenological approaches to the organisation of attention, I advance disregard as a central dynamic shaping how the end of life unfolds on St. Croix through the constitution of the U.S. Virgin Islands as exceptional. I demonstrate the workings of disregard and the reproduction of exceptionality through analyses of the everyday workings of Medicare, the universal health coverage programme for American citizens 65 years old and over. Specifically, the case study examines how the bureaucratic disregard within Medicare worked to create and then maintain a situation in which the medical equipment that can support and extend the capacities of older adults' bodies in the territory was unavailable. I suggest that this points to the broader import of disregard and the reproduction of exceptionality in constituting the extraterritoriality of the U.S.'s insular areas, and to the importance of the body as a locus of extraterritoriality.