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

by Jeffrey P. Bishop

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. A ground-breaking work in bioethics, this book will provoke thought and argument for all those engaged in medicine, philosophy, theology, and health policy.

"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 with with urgency. I know of no book that is at once more challenging and informative as 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, Duke Divinity School

"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." --Arthur W. Frank, University of Calgary

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

Genres: Medicine, Philosophy, Nonfiction, Theology, Death, History, Medical

430 pages, Paperback

First published October 15, 2011

Reviews

[Niamh Colbrook · Rating 5 out of 5]

A book I could rave about for a long time...

This book is simply brilliant. Bishop's writing is clear, perceptive, and engaging. He engages with the problematic metaphysics of contemporary medicine rigorously and critically, yet compassionately. Balancing historical analysis with philosophy, cultural critique, his own medical expertise and a continual eye to the practical questions of the care of those who suffer, he weaves a complex picture with a brilliant clarity in delivery. The structure of the book is clever, and gives the reader some breathing space to absorb, reflect, and ready oneself for the next step in the argument that weaves throughout the book.

I'll leave you with what is one of my favourite ever last lines: 'Might it not be that only theology can save medicine?'

[Michael Battistone · Rating 5 out of 5]

One of the most difficult books I have read, though the final chapter was phenomenal. This book helped me understand the philosophical underpinnings of the development of the medical profession, as well as those which underlie recent attempts to reform and "re-humanize" medical practice --and why these will always fail to achieve what they aspire. Bishop's insights regarding the role of suffering in the "call and response" involved in becoming a physician is prompting me to reflect on my work with medical students and other learners in health professions education.

[Evan Beacom · Rating 4 out of 5]

Important critique of contemporary medicine, and in terms of the medical aspects, very well-researched. Convincing on the whole, if not in some of it's finer points.

[Kelly · Rating 4 out of 5]

This was a bit of a slog for me, as I’m not a philosopher and haven’t read much in the field, and Bishop’s style can be dry and hard to understand at times. The topic was very interesting, though —essentially, how the fact that so much of medical education is focused on learning from dead bodies (dissecting cadavers and similar) has shaped medicine’s philosophical approach to the divide between life and death. Bishop claims this has led to an overly technological approach to end of life care, an over-reliance on extraordinary measures, and an over-dependence on individual patients’ or families’ decisions (rather than some kind of more straightforward physiological or even philosophical criterion to determine when death has occurred) to determine when to stop treatment. He examines this phenomenon in many different areas, such as organ transplants and persistent vegetative state. He does a very thorough job of covering different philosophers’ and, to a lesser extent, worldviews’ (focusing on Christianity, and Catholicism in particular) approaches to these many issues. I did find it was somewhat hard, though, to tell where the author personally stands on some issues, which some might see as a strength but I found a bit frustrating. I was also somewhat frustrated by that the book spent much more time examining the problems Bishop sees in the philosophy of medicine than offering any solutions. He did telegraph this up front, but I was still left with an unsettling feeling of, “OK, I see all these problems you’re pointing out, but what do we do about them?” I would have liked a bit more on that score.

Overall a bit dense, but provides a great history of medicine—particularly philosophy of medicine —and raises lots of fascinating questions and implications of the way medicine currently works. Definitely recommended for the particularly philosophically-minded who are interested in medicine, especially end-of-life care.

[Jay · Rating 5 out of 5]

A masterful read. From formal to political, then to clinical, to anatomical, to epidemiological, to disciplinary, and finally centering the dead body as the normative body, Bishop weaves a complicated narrative essential for the modern healthcare practitioner to comprehend, for there are intense theologies (and thus bioethical demands) on the ventilator, brain death, and hospice care, to name of few of what Bishop discusses here.

Guiding the reader from Foucault (panoptical gaze) to Engel (biopsychosociospiritual model) to Kübler-Ross (death and dying) and others, Bishop integrates many disciplines per this progression of medicine into the modern moral & biopolitical projects and phenomena of critical care, transplant, and palliative medicine.

Two of many points I will take away:

Emanuel’s “bounded zones of death” as an example of reclaiming medicine’s biological power back to thicker communities of moral traditions, and,

Resisting medicine’s urge to alleviate suffering at all costs, even in masking (“palliative”) death via biological, psychological, sociological, and even spiritual discourses such that no meaning can be made out of the experience of death.

And simply put, to stand beside, more so than managing, the dying.

[Kathleen O'Neal · Rating 4 out of 5]

I read this book as research for a paper on the assisted suicide/euthanasia issue that I wrote for Dr. Denise Albanese's Cultural Study of Science and Technology class in the spring of 2024. While there was a lot about this book I found myself disagreeing with (the view of the family as a largely benevolent institution, concerns about doctors doing "too much" to prolong the lives of sick people when I've watched so many disabled comrades with rich, wonderful lives die from medical neglect, the weird phobia around organ donation), I found the analysis of euthanasia/assisted suicide to be very prescient and this book was a joy to read and think with, including when I often found myself arguing mentally with the author's analysis. The analysis of the stories of Terri Schiavo and Eluana Englaro were also very thought-provoking. The author's concerns about palliative care becoming "total care" and ultimately "totalizing care" struck me as being right on. This is a book I'm going to be thinking about for a long time. Recommended.

[John Seago · Rating 5 out of 5]

Bishop argues that medicine has at its core a dangerous and corrupting animating philosophy. Medicine has adopted a modern metaphysic that ignores final and formal causes and only acknowledges efficient and material causation. This means that, when observing the human body, medicine is limited to the physiology of function. In other words, patients are seen as bodies and not persons. They are not human beings with feelings, goals, beliefs, and meaning, but instead as difunctional machines that must be mended (117). His argument is bolstered by his extended analysis of specific clinical practices including organ donation, physician-assisted suicide, palliative care, and medicine's recent deployment of psychology. Although his rhetoric and tone could be off-putting, the biggest weakness of the book is that Bishop fails to prescribe possible cures for the disease he spends so much time and effort diagnosing in great detail.

[Tara Brabazon · Rating 5 out of 5]

A powerful book. A confronting book. Magnificently written. The intricate argument is well constructed. A convincing analysis. I think differently now.

The challenge is that the book is undergirded by Foucault. Thankfully, this is early Foucault. The argument tested in Anticipatory Corpse is - the heart of medicine is a dead body.

The book explores the dance between death and denial. The medical interventions through technology are a focus, showing how the technology displaces a conversation about meaning and purpose.

The last section explores how grief is medicalized, creating the - to be frank, ridiculous - binary opposition between 'normal' and 'deviant' grief reactions. Bishop argues, movingly, "there is no way to account for what is lost in death."

While there are strong critiques of Foucault, this book is profound, building strongly from this foundation.

Amazing.

[Tyler Hurst · Rating 3 out of 5]

Interesting concept. I am appreciative of the exposition of Heidegger and Foucault, but not convinced by the epistemological conclusion—as provocative as it is. Also, it’s easy to get bogged down in some dry and slow parts.

[Joseph Gascho]

Very cerebral, one of those books that one should read again and more carefully--author rasies a lot of questions about the push for tissue donors and the ethics of that push