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

Transition Two

Transition Two In this book I have taken as my starting point Michel Foucault’s thesis that at the heart of medicine is a dead body. This dead body begins as an epistemological ground for medicine, but it also has metaphysical import. Time is frozen in the space of this body. Never mind that, in reality , the body begins to decay after death, or rather, it begins to decay to some degree even while the dying person is alive. The static dead body became for medicine an ideal-type, a representation that could be mapped onto living bodies; all movement in the living body is seen through this lens. Whereas Foucault only hints at further developments of this idea, I have argued, further, that Aristotle’s metaphysics of causation was abandoned in medicine, or rather was modified, in that formal and final causes were deemphasized and efficient and material causes were elevated. The body, like the rest of the world, became mere matter operating according to efficient causation: function, not purpose, became the unifying moment of analysis. The nineteenth-century physiologists believed that they were studying life because they were studying animation, whereas the anatomists were merely studying the dead body. However, the physiologists themselves caused death in order to understand life. Thus, we find Bichat asserting that “[l]ife consists in the sum of the functions by which death is resisted,” death being the more mechanically likely condition and • 223 life being an accident of motion. Bernard could claim, as he opened up the living animal—whose blood and cries must be ignored for the sake of understanding life—that he had peered deeply and penetrated profoundly into animal life. At the core of that life, Bernard—that Newton of physiology—found that there was no real difference between life or death in physiology. Physiology, then is about dead matter, or, equivalently , about purposeless matter in motion. Life is nonliving matter forced to move until it becomes, again, inert, nonliving matter. The impetus for movement is the brute force of the prior cause. For the scienti fic mindset of the physiologists, life must lose its purpose and its meaning so that its truth can be known. The result is the violence perpetrated on the living bodies of animals that must be caused to die and the violence of the prior cause forcing an effect into being; these are central features in the constitution of medical knowledge. Bichat finds that in destroying function— in the death of the heart, or brain, or lungs—we can reconstruct what we mean by life, given that life is the sum of all functions resisting death. Intervene with death and destruction, and we can see how life behaves materially and efficiently. Bernard can claim that, in physiology, life and death have no meaning. The values of the laboratory translate directly into the clinic, where life is still understood as the motion of dead matter , which is playing itself out toward a terminus, a final resting position. And the norm of matter in motion produces life in the ICU. Living cadavers and heart-lung preparations thrive in the ICU. The mechanical function of a failing body is replaceable by the mechanical function of machine or by the mechanical function of living organs taken from the dead. Beginning in the 1950s, physiologists and doctors began to be able to keep patients alive on machines. The animal machine could be forced to stay alive through the machines of technology. Physiological life, because it had no purpose, became its own good, ordered to nothing else. A life with function in the ICU but without purpose, however, can only be sustained for so long before that life becomes intolerable, indeed, worse than death. Rather than urging patients to revolt and to demand that medicine think about final causes and purposes of human living, liberalism proclaimed—in response to the coldness of life and death in the ICU— that the patient was her own sovereign over a mechanical medicine. 224 • the anti cipat ory c or pse Sovereign decision became the efficient cause of stopping or starting the technologies of medicine. For the dying, since death is the final effect of refusing technology, it makes sense that a sovereign decision for death would require a doctor’s assistance in causing that death. After all, decision is the prior cause in both refusing technology...