Jeffrey Bishop’s splendid book The Anticipatory Corpse is published as part of the Notre Dame Studies in Medical Ethics series, edited by David Solomon. Bishop’s monograph has both everything and nothing to do with medical ethics. Although it is a work in the philosophy of medicine, I think Bishop also demonstrates that bioethics truly needs the philosophy of medicine. Bishop uses the tools of the philosophy of medicine to dissect some very traditional and important issues normally seen within the purview of bioethics, and by attending to them in this way, he illustrates how they should really be thought of as philosophical problems. It is a brilliant move and remarkably persuasive.

For his analysis, Bishop principally draws on the work of the French philosopher/historian Michel Foucault. Prior to his discussion of Foucault’s work, however, Bishop presents a case from his own clinical experience. I think this juxtaposition between an actual clinical encounter and Foucault powerfully illustrates that Bishop sees Foucault’s work as vital to understanding the everyday world of clinical medicine; it suggests—to slightly alter Stephen Toulmin’s often-cited observation concerning medicine and ethics—that perhaps philosophy can save the life of medicine. The case concerns a mother with cancer who eventually exhausts every possible medical treatment, including those that could only marginally be considered treatment. Bishop concludes,

Nancy’s “bad” death is a natural result of the philosophical metaphysics of contemporary medicine.

Death is the primary focus of this book, but this is not simply because it is a useful way to explore contemporary medicine; Bishop argues that “medicine needs death” (p. 17). In language that echoes biblical genealogies, he advances that “dead anatomy begets physiology; physiology begets technology; technology—the replacing of a dead organ by a dead machine—begets a life worse than death. An over-technologized medicine begets a biopsychosocial medicine; a biopsychosocial medicine begets a biopsychosociospiritual medicine; a biopsychosociospiritual medicine begets holistic, palliative care medicine; but the holistic care of the dying comes to look totalizing, indeed totalitarian” (p. 18). This perverted genealogy also informs the structure of Bishop’s book, as we follow this macabre metaphysical birthing from the introduction and dominance of the scientific paradigm (fundamentally predicated on an understanding of the dead body), to the creation of technology that placed people in a liminal state of the living dead, to the construction of a category of death that allows the newly constructed dead to become objects for the harvesting of organs for the living, and to the construction of a discourse that attempts to control death by providing “total care.”

Many of these chapters can stand by themselves as fascinating histories of particular moments in contemporary medicine. His explication of Foucault’s work provides both an accessible and clear introduction to the history (and various modifications) of Foucault’s method of cultural analysis and a thorough explication of The Birth of the Clinic. Bishop’s chapter “Maturing the Clinic” provides an intriguing overview of the shifting epistemology of Western medicine and, in particular, the incorporation of the episteme of the physiologists of the nineteenth century. In “Commissioning Death” Bishop looks at the construction of a definition of death that would allow transplant medicine to flourish. In “The Discursive Turn” he examines how the failure of technology to master and control death resulted in a new attempt to control not the body but the discourse. This new discourse introduced psychological and sociological methods to counter the biological reductionism of contemporary medicine, but Bishop submits that the new models of the biopsychosocial—and then the biopsychosociospiritual—in the end simply introduce new ways of disciplining patients, that is, of providing total care. “The Palliating Gaze” chapter examines the shifting discourse within the palliative movement; he traces its roots in the work of Cicely Saunders to its routinization under medicine’s epistemology and metaphysics: “Under a metaphysics of efficient causation, it is inevitable that palliative care will become under the governance of the state, the place where death is caused, as the final effect in an immanent series of cause and effect” (p. 278).

Bishop’s discussion of efficient causation is an important theme that runs throughout his book, and it is one of the reasons that medicine has become so infused in all aspects of our lives. Medicine is a form of applied science—or, rather, it is perhaps more accurate to say that it is an explicit application of scientism. When medicine made its deal with science in the nineteenth century, it also implicitly agreed to take on science’s metaphysics—or, rather, its rejection thereof. Why is this important? Science developed by rejecting as much as possible any concerns with final causation and instead heralded efficient causation. As Bishops points out, in the end medicine’s rejection of a concern for metaphysics results in the rejection of “a metaphysics of meaningful formal and final causes, according to which bodies have meanings and purposes from start” (p. 310). Bishop, in the end, finds himself in a bind. His own analysis shows that every new reform has in turn become another way of controlling patients:

Even as he examines the earnest attempts of others, such as Eric Cassell and Rita Charon, to try to repair contemporary medicine’s damages, he sees that they make assumptions that cause them to unintentionally impose a dualism on patients. Bishop does hesitantly proffer that a phenomenology of care, one that does not reduce patients or inadvertently control them with a particular discourse, may be one way to counter the various master narratives of medical culture without itself begetting a new master narrative. Drawing on Heidegger (and Levinas’s revisioning of Heidegger), he argues that, in the end, “prior to Dasein is Mitda-sein; being-in-the-world is always already a being-there-with-others-in-the-world” (p. 306). It is Bishop’s hope that if we are able to recognize that we do not exist outside a relation to an Other, then we will see ourselves as “being-with-others in community” and thus “the virtue of the community” will ensure that “one can learn how properly to offer care because care has already been received” (p. 306). But as Bishop himself admits, he cannot fully predict what this new medicine would look like or how the reintroduction of metaphysics would be practiced.

On a side note, I wish to express appreciation for Bishop’s refusal to demonize either the various reform movements or the reformers themselves. As a clinician, it is not surprising, but still valuable, that Bishop does not see the alienation produced by contemporary medical care as the intention of the vast majority of healthcare professionals. Bishop often includes observations that I have never seen in the work of scholars of critical medical studies, science technology or society (STS), or any Foucault-grounded history: “No practitioner of medicine wants to turn a person into an object, an object that he subjects to technological manipulation in the ICU” (p. 119). In many ways, the true subject of Bishop’s book could be why good people trying to help those suffering inevitably create systems that cause more suffering.