Can Medicine Be Cured?
Verhey, Allen, The Christian Century
The Anticipatory Corpse: Medicine, Power, and the Care of the Dying
By Jeffrey P. Bishop
University of Notre Dame Press, 432 pp., $35.00 paperback
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. These chapters demand patience from the reader, but they are important not only for physicians but also for those of us who are or will be their patients. 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?
Bishop begins with etiology, with a history of the causes and origins of the disease that has infected medicine. He briefly acknowledges the influence of Francis Bacon's account of knowledge as power over nature and over its threats of death and suffering. Then, following Michel Foucault's account of the genealogy of modern medicine in The Birth of the Clinic, he focuses on the work of Claude Bernard, whose "clinical gaze" upon the dead body in autopsy (and vivisection) became foundational for medicine. In the 19th century, the dead body, the corpse, became "the epistemologically normative body," the body by which other bodies are known. The clinical gaze upon the body as an object to be measured and manipulated came to characterize medical care of living and diseased bodies.
Because purpose and telos can hardly be ascribed to a corpse, this new epistemology for medicine provided as a corollary "the metaphysics of efficient causation." Together they turned the patient from "subject" to "object," dismissed the particularity of patients and rejected any attention to purpose and a final telos in life. They allowed for, and called for, medicine's sovereign dominion over death and dying.
Important to Bishop is Foucault's notion of "biopolitics." Medicine becomes the way to govern our bodies, not only for their own good but also for the good of the body politic. Medicine wins the support of government--which has charge of public health--not so much by coercively restraining our desires as by shaping and disciplining them.
Here another strand of "scientific" medicine became important, one based not on physiology but on statistics. Statistical medicine garnered the interest of governments, insurance companies, eugenicists, and not least a set of new "experts," the psychological and social scientists. Statistical medicine allowed for, and called for, a new ethic for medicine--a utilitarian calculus of the greatest good for the greatest number.
Symptomatically, medicine's disease was expressed in the medicalization of death. Impressed by medicine's successes, physicians and others imagined death as the great enemy to be defeated by the greater powers of medicine. But death will not finally be defeated by medicine, and in resisting death medicine sometimes does violence. There can be violence in routine cardiac-pulmonary resuscitation efforts and in other measures to force dying life to stay alive. Violence is also done to patients and their families when dying is reduced to a matter of physiology and medical control, demeaning any sense of the meaning and purpose of life. If all that is seen in the clinical gaze is death as the terminus in a series of physiological causes and effects, then life and death have no meaning.
Protests were lodged against the medicalization of death, but the protests and proposed remedies were formed (or deformed) by the emphasis within liberal society upon the "autonomous self" and by medicine's claim to sovereignty over death. …