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

by Jeffrey P. Bishop

Overview

In this original and compelling book, Jeffrey P. Bishop, a philosopher, ethicist, and physician, argues that something has gone sadly amiss in the care of the dying by contemporary medicine and in our social and political views of death, as shaped by our scientific successes and ongoing debates about euthanasia and the “right to die”—or to live. The Anticipatory Corpse: Medicine, Power, and the Care of the Dying, informed by Foucault’s genealogy of medicine and power as well as by a thorough grasp of current medical practices and medical ethics, argues that a view of people as machines in motion—people as, in effect, temporarily animated corpses with interchangeable parts—has become epistemologically normative for medicine. The dead body is subtly anticipated in our practices of exercising control over the suffering person, whether through technological mastery in the intensive care unit or through the impersonal, quasi-scientific assessments of psychological and spiritual “medicine.” The result is a kind of nihilistic attitude toward the dying, and troubling contradictions and absurdities in our practices. Wide-ranging in its examples, from organ donation rules in the United States, to ICU medicine, to “spiritual surveys,” to presidential bioethics commissions attempting to define death, and to high-profile cases such as Terri Schiavo’s, The Anticipatory Corpse explores the historical, political, and philosophical underpinnings of our care of the dying and, finally, the possibilities of change. This book is a ground-breaking work in bioethics. It will provoke thought and argument for all those engaged in medicine, philosophy, theology, and health policy.

Product Details

ISBN-13:	9780268022273
Publisher:	University of Notre Dame Press
Publication date:	09/19/2011
Series:	Notre Dame Studies in Medical Ethics and Bioethics
Edition description:	1
Pages:	430
Product dimensions:	6.10(w) x 9.00(h) x 0.90(d)

About the Author

Jeffrey P. Bishop is Tenet Endowed Chair in Health Care Ethics and director of the Albert Gnaegi Center for Health Care Ethics at Saint Louis University.

Read an Excerpt

Medicine is a good in Western society. Those of us who are engaged in the practices of the good of medicine—especially in light of the status that medicine has achieved—think of ourselves as practicing a good that is virtually unqualified. So, when critiques come, we, the practitioners of medicine, tend to have one of two responses: either outright dismissal of the criticism or a quick attempt to resolve the problem. What follows in this book is another critique of medicine, particularly in its mode of caring for the dying. By “the dying,” I mean those who are in the ICU and in palliative care. I have no doubt that there will be those who will dismiss my critique outright. As for the second group, those who hear the critique and accept it as, at least in part, accurate, they will no doubt attempt a quick remedy, one that fixes the problems that affect a broken medicine. Those remedies will range from a call for better scientific data in order to know better how to care for the dying, to a call for a good dose of humanism in order to solve the problem. The former will emphasize the science of medicine; the latter will emphasize the art of medicine. The former will say that medicine needs better science in order to become, once again, humane; the latter will call for a therapeutic course of humanistic education, a humanities pill to fix what ails us. Yet it seems to me that we have been attempting both fixes for so long that we do not even know where the problem lies.

It is virtually impossible to think about how to solve any problem in medicine without our thinking becoming almost immediately mechanical and instrumental. We already live inside a way of thinking that prevents us from thinking differently; not that thinking differently is impossible, it is just difficult. If we are to prevent all practices in medicine from becoming thoughtless doing, we must once again turn to how we think about what it is that we do. In order to achieve this, however, we must, paradoxically perhaps, realize that all thinking is also a kind of doing. The strict line between theoria and praxis, so prominent in the West, and the strict division between subject and object are, in a way, false ones, but they continue to flourish in our practices. These lines (theory vs. practice, subject vs. object) sit at the very heart of the West, if we are to believe thinkers such as Nietzsche and Heidegger; or perhaps these lines are just an aberration of late Western Scholasticism, or are lines drawn at the Enlightenment. If we accept Foucault’s position—which does not preclude accepting any one of these possible readings on the history of Western thought—we know that there are various kinds of practices implicit in all theoretical endeavors, and at the same time there are implicit theoretical stances in all that we do. Thus, we must think, once again, about what it is that we do by examining critically what we do.

Medicine as a discipline is mostly concerned with doing and with the effects it brings about in the world. Medicine concerns itself with how to pragmatically produce or cause those effects in the world. Or, as Carl Elliott points out, medicine collapses into an unthinking pragmatism, an inane “practice in order to be practical.” Medicine is a practice ordered toward and by its own practicality. Medical information is justified as medical knowledge if one can do something with it in the world. Medicine’s metaphysical stance, then, is a metaphysics of material and efficient causation, concerned with the empirical realm of matter, effects, and the rational working out of their causes for the purposes of finding ways to control the material of bodies; that is to say, medicine’s metaphysics of causation is one of material and efficient causation at the expense of final causes or purposes. Among Aristotle’s four causes, early modern science—including medical science—historically repudiated or, at the very least, minimized formal and final causation and elevated material and efficient causation. Efficient causality reigns supreme in all technological thinking, such that even matter comes to be thought of not so much as a cause, but as the stuff that stands in reserve of power, awaiting knowledge to mold it into what we desire it to be. On this view, matter—the body—has no integrity, except that it is driven by an automaticity and can be bent to our desires. At least since Bacon, it has been understood that knowledge is power gained to relieve the human condition. That is to say, true knowledge can do things with the world. The purpose of knowing—the end of knowing—is to bring about desired effects in a world of immanent cause and effect.

Medicine gives no thought to its metaphysics; it might even deny having one. And it gives no thought to its practices, because medicine is about doing and not about thinking. For Western medicine, and perhaps for all of scientific and technological thinking, the important problem in the medical world is how to manipulate the body or the psyche in order to get the effects that we desire. Bodies have no purpose or meaning in themselves, except insofar as we direct those bodies according to our desires. In this sense Eric Krakauer has said that medicine is the standard-bearer of Western metaphysics. The world—the body—stands before us as a manipulable object, and all thinking about the world or the body becomes instrumental doing; thus, to do good we must manipulate the world and show our effects toward some measureable outcome.

Editorial Reviews

The book’s interdisciplinary nature, along with its careful analyses combined with concrete stories of real human struggles with death and dying, no doubt, will be of interest to those engaged in medicine, bioethics, philosophy, theology, and debates concerning public health policies; but all those interested in the place of the body in modern technoscientific culture will find it engaging and cogent.” —Per Caritatem

". . . this book will prove to be a seminal, conversation-changing monograph especially in bioethics and philosophy of medicine. . . . It will challenge the fundamental presuppositions that structure most courses in bioethics or death and dying. It is certainly a must-read for scholars and graduate students in these fields, but with guidance, it is an accessible and important text to use with undergraduates interested in bioethics or theology and medicine as well." —Modern Theology

"This is a genuinely novel approach that invites one to completely reassess why healthcare institutions and professionals function as they do. It also invites us to question how our lives are shaped by our anticipated deaths. . . . This is not an easy book, but it is worth devoting time to reading it and thinking about the questions it poses. It is beautifully written and carefully argued, and instead of shying away from difficult and potentially disruptive issues in modern medicine it exposes them and challenges us to think again." —Times Higher Education

“In this evocatively titled book, physician Bishop joins his Catholic sensibility with a Foucaldian analysis of medicine and power to expose the ambiguities and complexities of contemporary end-of-life issues. . . . Bishop examines issues such as how the need for donated organs since the 1950s has shaped care of the dying in troubling ways, the contesting passions surrounding the Terri Schiavo case, and the trivialization of the religious lives of caregivers and dying patients as wrought by the professionalization of palliative care.” —Library Journal

"The Anticipatory Corpse: Medicine, Power, and the Care of the Dying [is] a compelling read and a groundbreaking work in philosophy and bioethics. Written by physician, bioethicist, and philosopher Jeffrey P. Bishop, the book presents an eloquent argument as to how the profession’s care of dying persons has evolved as well as a provocative and insightful critique of the present state of such care. . . . The Anticipatory Corpse . . . is engaging, provocative, and difficult to put down. . . . For physicians, lawyers, philosophers, chaplains, nurses, and other professionals whose work is centered on life’s final chapter, I wholeheartedly recommend this book." —Journal of the American Medical Association

“Jeffrey Bishop . . . takes the reader on a journey into the past to provide insight into how the dead body plays an integral and unrecognized role in the present state of medicine in his book . . . . He argues that the corpse is the end of the practice of medicine.” —Journal of Medical Humanities

“It is hard to overestimate the importance of Bishop’s book, not least because of the unchallenged, well-nigh hegemonic place occupied by medicine in western culture . . . . The theological acuteness and pastoral warmth that flow through Jeffrey Bishop’s book make it the most compelling argument for the superiority of this type of humane medicine over the ubiquitous and utterly flaccid ‘biopsychosociospiritual’ pretensions of modern medical practice. But as a challenge to the story of western liberalism, and the central place of medicine within it, The Anticipatory Corpse is also the most important book of 2011.” —ABC Religion and Ethics

“The Anticipatory Corpse is interesting, provocative and important—one of the most novel contributions to the field of bioethics of the last several decades. Bishop has many illuminating new things to say about the ethics of medical care for the dying. In the process, he helps to explain why bioethics itself is in such a sad state.” —America

"In this brilliant book, Jeffrey Bishop, who is both a physician and a philosopher, turns his clinical and analytical gaze on medicine. His diagnosis is bleak: 'There is something rotten in the heart of medicine.' Nine of the ten chapters are devoted to the diagnosis, showing the source and history of the disease and some of its symptoms, always focusing on how medicine approaches death and care for the dying. . . . In the last chapter, he turns his attention to therapeutic possibilities for medicine and raises a series of provocative questions, the most provocative of which is the last line of his book: Might it not be that only theology can save medicine?" —The Christian Century

“The Anticipatory Corpse has the potential to become a classic in the field of medicine. . . . Bishop’s critique of contemporary medical practices and the fundamental philosophical questions underlying them are a stark reminder that the practices of medicine—many of them very good indeed—should not become ends in themselves.” —Ethics and Medicine

From the Publisher

"Jeffrey Bishop has produced a masterful study of how the living body has been placed within medicine's metaphysics of efficient causality and within its commitment to a totalizing control of life and death, which control has only been strengthened by medicine's taking on the mantle of a bio-psycho-socio-spiritual model. This volume's treatment of medicine's care of the dying will surely be recognized as a cardinal text in the philosophy of medicine."

Rice University, Baylor College of Medicine - H. Tristram Engelhardt

"With extraordinary philosophical sophistication as well as knowledge of modern medicine, Bishop argues that the body that shapes the work of modern medicine is a dead body. He defends this claim decisively and with urgency. I know of no book that is at once more challenging and informative than The Anticipatory Corpse. To say this book is the most important one written in the philosophy of medicine in the last twenty-five years would not do it justice. This book is destined to change the way we think and, hopefully, practice medicine."

Stanley Hauerwas

"Jeffrey Bishop carefully builds a detailed, scholarly case that medicine is shaped by its attitudes toward death. Clinicians, ethicists, medical educators, policy makers, and administrators need to understand the fraught relationship between clinical practices and death, and The Anticipatory Corpse is an essential text. Bishop's use of the writings of Michel Foucault is especially provocative and significant. This book is the closest we have to a genealogy of death."

University of Calgary - Arthur W. Frank

In this evocatively titled book, physician Bishop (health-care ethics, Saint Louis Univ.) joins his Catholic sensibility with a Foucauldian analysis of medicine and power to expose the ambiguities and complexities of contemporary end-of-life issues. His narrative is thesis driven: the dead body, not the living patient, is the "normative body" of medicine, and "animation of dead matter" is thus implicit in medical practice. This concept is reinforced by factors such as the impact of a medical student's first encounter with a dead body on the dissecting table and the acceptance of animal experimentation, despite its historic cruelties, in medical research. Through the lens of his thesis, Bishop examines issues such as how the need for donated organs since the 1950s has shaped care of the dying in troubling ways, the contesting passions surrounding the Terri Schiavo case, and the trivialization of the religious lives of caregivers and dying patients as wrought by the professionalization of palliative care. VERDICT Raising important questions but providing few answers, this is a book for sophisticated readers with some background in philosophy.—Kathy Arsenault, St. Petersburg, FL

Library Journal