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

Written by Jeffrey P. Bishop

(University of Notre Dame Press, 2011)

Reviewed by Amy MacInnis

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The Anticipatory Corpse is a critique of current approaches in medical care for the dying by Jeffrey P. Bishop, a physician familiar with the philosophy grounding medicine in the West. The author asserts that even biopsychosociospiritual care (his term), including palliative care, is a cloaked attempt to master death that serves only to dehumanize the patient. This is because the metaphysics and epistemology on which such care is based are fundamentally flawed, failing to grant death a purpose while paradoxically treating the dead body as normative in medicine. Bishop’s position is advanced with complex philosophical and medical analysis, all of which cannot be conveyed in a short review. Hence, I will summarize and comment on some of his key arguments.

To begin, the author relies heavily on Foucault’s historical-philosophical method as he traces the development of medicine—from a theoretical focus on the forms of disease, to a social concern for statistics, to a scientific focus on what is observed, described and penetratingly analyzed about the patient—and examines medicine’s political space—from tables (i.e. charts), to public health, to clinics—to reveal why the dead body has become “epistemologically normative in medicine” (p. 29). Bishop credits this last assertion—one of his main theses, as indicated by the book’s title—to Foucault’s insight. Nevertheless, I think Bishop could have made his point just as strongly without going into such excessive detail about Foucault and Kantian epistemology in the first chapter.

Certainly Bishop does not need Foucault to support another of his central positions, namely, that the metaphysical presupposition in medicine rejects all but efficient causation. Bishop repeatedly draws the reader’s attention to the materialistic approach in medicine that has lost a sense of telos, or final purpose. Consequently, he argues, life is now defined in reference to death, as the series of functions resisting death, and death is meaningful only insofar as it contributes to another body’s functioning through organ transplantation (more on Bishop’s fascinating take on this below) or insofar as the one dying is given sovereign control over death, that is, the ability to choose when and how to die. I think the denial of Aristotle’s first, formal and final causes contributes more to the objectification of the patient, which we will discuss shortly, than Foucault’s observation that medicine bases its understanding of life on death. In other words, concerning its inadequate treatment of the dying, I think medicine’s metaphysics is more to blame than its epistemology, although Bishop equates the two. Continue reading