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

February 23, 2012

I approached this book with caution. It begins with the story of Nancy, a woman diagnosed with pancreatic cancer, a disease I have witnessed at close quarters and had no wish to reacquaint myself with. Then, in setting out his approach to the philosophy of death and dying, the author makes clear his debt to Michel Foucault, a figure whose work I have always found at one and the same time compelling and intimidating. It is testament to the calibre of Jeffrey Bishop's writing and scholarship that I stayed the course and was glad to have done so.

Everyone should be interested in death, and as such the readership for this work should be wide. However, the book is first and foremost a much-needed contribution to the intellectual canon of modern bioethics, and as such it will be of most interest and value to those whose work entails the practice or critique of modern medicine.

Having said this, Bishop's experience as a physician and his personal qualities shine through, and even when he is dealing with the more theoretical aspects of his enquiry, one feels that he remains connected to Nancy and many others who have turned to him for help and guidance. Bishop is true to Foucault's historical mode of analysis and more committed to deconstruction than constructive argument. Indeed, in the final pages of the book there are no less than a dozen question marks, the most significant coming right at the end when he asks: "Might it not be that only theology can save medicine?"

This is a very big question to leave us with, and one that took me somewhat by surprise. But I really should have been expecting surprises by this stage.

Many people have argued that an understanding of modern medicine depends upon our appreciating its focus upon and conceptualising of the human body, but Bishop shifts our attention to the role of the dead body and offers a compelling account of how "medicine's metaphysics is one dominated by efficient causation - the animation of dead matter".

This is a genuinely novel approach that invites one to completely reassess why health-care institutions and professionals function as they do. It also invites us to question how our lives are shaped by our anticipated deaths

In the course of his enquiry Bishop's gaze falls upon a wide range of contemporary issues. His analysis of organ donation is hard-hitting and ultimately critical. His questioning approach to concepts such as brainstem death and the status of the dead donor has a true urgency to it. His account of the modern intensive care unit is chilling yet entirely plausible. But perhaps the biggest surprise is his perceptive and challenging examination of modern palliative medicine, a specialty that has often prided itself in being apart from, and in some sense better than, others when it comes to the humanising of medicine.

Having worked alongside palliative care professionals for many years, I recognise the shifts in practice that Bishop describes, and I look forward to seeing what my colleagues make of his claim that their adoption of a bio-psychosocial approach has moved medicine towards a totalitarianism that "demeans the very thing that palliative care and hospice care are designed to address".

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.

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

By Jeffrey P. Bishop. University of Notre Dame Press 432pp, £31.50. ISBN 97802680223. Published 15 October 2011

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