Book Review: The Anticipatory Corpse: Medicine, Power, and the Care of the Dying

Abstract

The Anticipatory Corpse: Medicine, Power, and the Care of the Dying. By Jeffrey P. Bishop. Notre Dame Studies in Medical Ethics. Notre Dame, Ind.: University of Notre Dame Press, 2011. xv + 411 pp. $35.00 (paper).Although much of this extraordinary book narrates a careful genealogy of modem medicine and so attends to how things begin and develop, at its heart it is really a book about ends: the end of life, certainly, but also the ends of life, and the ways in which life's ends are elided by modem medicine. Most of the book is a searing critique and a compelling intervention into contemporary discussions of bioethics. The argument is compelling, original, and deeply important, and The Anticipatory Corpse should be high on the reading lists not only of ethicists, philosophers, and theologians, but also of clergy, hospice workers, and those in the healing professions.Jeffrey Bishop is himself both a philosopher and a physician and now leads the Albert Gnaegi Center for Health Care Ethics at Saint Louis University. At the heart of his argument is a critique of a medical nominalism that evacuates bodies of both formal and final causality and thus permits medicine the fantasy of exhaustive knowledge and potentially unimpeded power. In part 1 of the book, Bishop develops his critique through a dialogue with Michel Foucault. Bishop reconstructs and, more importantly, extends Foucault's pioneering work on the birth of the clinic. Foucault's narrative draws to a close at about 1830, but Bishop tells the story not only of the birth of the clinic but also of the transformations in medical practice and theory that have taken place in the nearly two centuries since. Like Foucault, Bishop pays attention to the way that medicine changes by shifting its primary operative space (from the formal space of diagnostic tables to the political space of public health to the putatively anaesthetized space of the clinic to the complexly negotiated space of the today's medical schools). More controversially, however, Bishop adopts a second Foucauldian thesis, namely, that modern medicine founds itself epistemologically upon the dead body as an ideal type. According to Bishop and Foucault, the corpse has become the normative body for medical knowledge. Tied to this ideal epistemology of the cadaver is a metaphysics that pays attention only to efficient causality, which is to say to the realm of bodily function rather than purposes, intelligibilities, intentions, and so forth. To treat the body in terms of function alone without regard to why the body functions is to treat the body as a kind of machine, in effect, a dead thing subject to a mediealized metaphysics of control.In the second section of the book, Bishop turns his focus from genealogy to a closer, more contemporary look at how modern medicine comports itself in its care for the dying. A chilling picture emerges of mechanized life-support, ICUs, brain death, and the problems raised by organ transplantation. Many of these topics are regularly treated in contemporary bioethics, but Bishop's genealogical work allows him to intervene in these debates in surprising and significant ways. For example, Bishop's discussion of the moral, spiritual, and biopolitical quandaries raised by patients in persistent vegetative states both illumines and substantially reorients what often seems to be an intractable cultural impasse. …