Lysaught, M. Therese

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteTheology Faculty Research and Publications Theology, Department of7-1-2012Review of The Anticipatory Corpse: Medicine, Power,and Care for the Dying by Jeffrey P. BishopM. Therese LysaughtMarquette UniversityAccepted version. Modern Theology, Vol. 28, No. 3 ( July 2012): 563-566. DOI. © 2012 John Wiley &Sons, Inc. Used with permission.                                                                             Marquette Universitye-Publications@MarquetteTheology Faculty Research and Publications/College of Arts andScienceThis paper is NOT THE PUBLISHED VERSION; but the author’s final, peer-reviewed manuscript.The published version may be accessed by following the link in the citation below.Modern Theology, Vol. 28, No. 3 (July, 2012): 563-566. DOI. This article is © Wiley andpermission has been granted for this version to appear in e-Publications@Marquette. Wileydoes not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Wiley.Book Review of The Anticipatory Corpse:Medicine, Power, and the Care of theDying, by Jeffrey P. BishopM. Therese LysaughtDepartment of Theology, Marquette University, Milwaukee, WIThe Anticipatory Corpse: Medicine, Power, and the Care of the Dying by Jeffrey P. Bishop (Notre Dame,IN : University of Notre Dame Press , 2011 ), xv + 411 pp.Contemporary western culture—and specifically contemporary medicine—lives in denial of death. Theeconomic, political, and social behemoth that is contemporary healthcare deploys all the weapons in themedical armamentarium to reject death, to forestall it, to refute its very existence and its power over us.The biotech industry, particularly in its pharmaceutical incarnation, joins this battle, promising thatsoon, very soon, youth will be extended, aging and senescence will be an historical artifact, the span oflife will exceed what we can imagine. The medical-industrial complex must be unfettered in this work,free especially from government intervention, for to allow the State into the sacred space of the clinic,that privileged relationship of physician and patient, will only be to court death, inevitably bringing“rationing” and “death panels.”                                                                                                                                        Or so goes the regnant myth.Jeffrey P. Bishop, a physician and a philosopher, tells a different story. In The Anticipatory Corpse:Medicine, Power, and the Care of the Dying, Bishop—who is the Tenet Endowed Chair in Health CareEthics and the Director, Albert Gnaegi Center for Health Care Ethics at Saint Louis University—arguesthat rather than living in denial of death, “death is at the center of medicine, at its core, and even atits cor” (p. 8). Tracing the development of an epistemology of death and a shift to a metaphysics ofefficient causation in late eighteenth-century medicine, Bishop further argues that death and itsviolences are present in and cloaked by the practices of contemporary medicine; that a medicine shornof formal and final causality, reduced only to efficient causality, is deeply problematic; and that we cansee these dynamics played out not only in the configurations of contemporary medical practice, butequally in the allied discourses of bioethics and biopsychosocial medicine, particularly insofar as thesediscourses treat death and dying.These are original and insightful claims backed by superb scholarship and careful, effective, andcompelling argument. Bishop weaves together evidence from primary and secondary texts in the historyof medicine, seminal philosophical and critical theorists, contemporary bioethics and clinical medicine,and more. His reading of the history of medicine and bioethics provides a far more plausible accountthan most of the unnuanced, linear, continuous, triumphalist readings of this history typicallyencountered in bioethics. Bioethics, especially in the ways it simply serves as a handmaiden for thisepistemology and metaphysic in service of the state, withers under this physician's gaze as he unmasksits nihilism.Bishop's argument is strengthened by two additional features of the book. The first is his social locationas a practicing internist—he launches this tour de force from inside the world of contemporary, clinical medicine whose realities he knows well. He has walked with patients through their journeys of healing and dying; these patients seem almost tangibly present throughout the book, a silent cloud of witnessesauditing his argument. Second, Bishop's writing is refreshingly clear. It is a rare hand that can render Foucault and Heidegger accessible while telling an engaging narrative of death—a page-turner whoseart, complexity, and power are impossible to capture in a brief review.Bishop's argument develops in three parts. Chapters one and two provide the historical andphilosophical grounding for his analysis of contemporary practices. Here he traces how four disparatedevelopments in late eighteenth-century medicine—the post-Renaissance medicine of the forms, the clinic, pathological anatomy, and statistical medicine—came together to transform theconceptualization of the space and location of disease. Chapter 1, “Birthing the Clinic,” provides a clear,succinct, and focused review of Foucault, whose work is essential to Bishop's argument. Of the manynuanced points of Foucault's analysis marshaled here, two are of particular importance. First isFoucault's claim that the dead body becomes epistemologically normative for contemporary medicinevia the development of anatomy and pathological medicine (p. 29), that “death becomes the fundamental ground of medical knowledge” (p. 59). Second is Foucault's observation of nominalism'seffects on the metaphysics of medicine: late eighteenth-century medicine precludes formal and final causation from its understanding of the body and elevates material and efficient causation. With thisepistemology of death, “the resulting metaphysics of efficient causation allows mastery over the livingbody as a machine, as dead matter in motion . . . In addition, this medical nominalism allows not                                                                                                                                   only for an exhaustive description of the body in motion but also for an exhaustive description of thebody politic” (p. 60).Foucault traces these developments through 1830. In Chapter 2, Bishop extends Foucault's analysis intothe late nineteenth century, examining how this epistemology and metaphysics shaped what appears tobe a medicine of “life”—that of the preeminent physiologists Xavier Bichat and Claude Bernard. Here he also narrates the development of statistical medicine. Via the rise in Germany of Statistiks—the story ofthe State—and “political arithmetic” in Britain, Bishop shows howmedical dominion comes to coincidewith the space of the state, not only via epidemics and later public health, but more importantly throughthe normalizing notion of the “ideal type,” extending itself particularly through the emerging fields ofpsychology and eugenics via the work of Francis Galton. Medicine and the state, in other words, havelong been deeply intertwined.In transitioning from part one, Bishop notes that “with the rise of physiology it requires very littleimagination to realize that a dead, nonfunctioning organ can be replaced by another dead, nonlivingmachine” (p. 91). In part two, he proceeds to show, carefully and compellingly, how this logic, with itsepistemology of death and metaphysics of efficient causation in service of the body politic, has shapedand continues to shape the contemporary approach to end of life care. The reader becomes spectator toBishop's vivisection of the intensive care unit (Chapter 3), contemporary debates about physician-assisted death (Chapter 4), the redefinition of death as brain death by the Harvard Ad Hoc Committeeand the President's Commission (Chapter 5), the development of and rhetoric around organtransplantation (Chapter 6—a particularly macabre account), and the culture wars over the care of patients in a persistent vegetative state (Chapter 7). Particularly illuminating is his account of howbioethics, as it has emerged over the past forty years, has served to advance and mask the absurditiesand violences essential to this intertwined complex of end of life practices.Readers may well be surprised by the third section, where Bishop deploys his analytical scalpel on thedevelopment of biopsychosocialspiritual medicine and palliative care. Here statistical medicine, whichgets little play in part two, returns: “If death cannot be mastered through the use of technology,perhaps it can be mastered psychologically and sociologically through expert discourses of psychologists and social scientists” (p. 228). Via the now ubiquitous assessment instruments for grief, religiosity,spirituality, meaning and more—instruments that continue to eschew questions of formal or final cause—medicine seeks to become totalizing. Importantly, Bishop shows how contemporary palliativecare has diverged in essential ways from Cicely Saunders' original vision and practice of hospice.The final chapter, entitled “Anticipating Life,” provides the constructive turn and gestures toward placesof hope. The bulk of the chapter develops a reflective and almost lyrical phenomenology of embodiment, one that seeks to demonstrate how formal and final causes—“intentions and capacitiesand potencies . . . particular histories and teloi”—are embedded in the body, deeply boundtogether with material and efficient causes (p. 289). This account of embodiment also generates a phenomenology of accompaniment, a mutually constitutive call-and-response of patient and physicianthat calls the physician (and community) equally to “do something” for the patient but to also andalways to “be-there-with and suffering-there-with” the patient.In the end, this physician-philosopher offers the following “hesitant” conclusion, offered in the final paragraph of the book:                                                                                             It might just be that the practices of religious communities marginalized in modernity andlaughed at as unscientific are the source of humane medicine. Perhaps there, in living traditionsinformed by a different understanding of space and time, where location and story providemeaningful contexts to offer once again hospitality to the dying as both cura corporis and cura animae, we will find a unity of material, function, form, and purpose. . . . We have nowmoved away from phenomenology to questions that bear on thinking and doing, which arequestions properly of holy men and women, of saints . . . who offer themselves to theliving and the dying. Avoiding a theological turn here becomes hazardous. . . . Might it bethat only theology can save medicine? (p. 313).And so we see what is at the cor of Bishop's alternative epistemology—an epistemology of life.Book reviews must offer critiques, so I will offer two. His section on the medical school at the end of chapter two is too short and not well integrated into the overall argument. More substantively, Bishopintroduces Agamben and his invocation of the Greek notions of zoēand bios—bare life and the goodlife—in Chapter 7 to dissect the cultural cacophony around patients in PVS. This section is far lesscompelling than the rest of his analysis.But these are mere quibbles. Because of its interdisciplinary breadth and depth, its nuance andprecision, and its take-no-prisoners approach, this book will prove to be a seminal, conversation-changing monograph especially in bioethics and philosophy of medicine. Most bioethicists, I hazard, willtake umbrage at the book, but the argument will be difficult for them to gainsay. It will challenge thefundamental presuppositions that structure most courses in bioethics or death and dying. It is certainly amust-read for scholars and graduate students in these fields, but with guidance, it is an accessible andimportant text to use with undergraduates interested in bioethics or theology and medicine as well.

Review of \u3cem\u3eThe Anticipatory Corpse: Medicine, Power, and Care for the Dying\u3c/em\u3e by Jeffrey P. Bishop

https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1236&amp;context=theo_fac

Review of \u3cem\u3eThe Anticipatory Corpse: Medicine, Power, and Care for the Dying\u3c/em\u3e by Jeffrey P. Bishop

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