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

3. The Machinations of Life

96 • C h a p t e r 3 The Machinations of Life Death in contemporary Western society is no longer an affair embedded in shared social contexts, from which it derives its significance. There are few cultural practices that prepare contemporary Westerners for death in the way they were prepared in earlier Western society, as Philippe Ariès has demonstrated.1 According to Daniel Callahan, our society does not know how to respond to a person who approaches death or a family experiencing the loss of a loved one.2 The problematic place of death in contemporary culture is due in no small part to the fact that we have become increasingly medicalized.3 And in typical modern Western fashion, death—like religion—is normally not a social matter but a private one. I have begun to trace how medicine contributes to the shifting place of death in society. Foucault points out in Birth of the Clinic that medical men robbed graves in order to save cadavers from putrefaction and to scientifically study the body frozen in death.4 Yet death as stasis is a very thin moment—a fleeting moment—in the history of a living body. Death is represented as an ideal-type, even for the physiologists who resisted the ideal-type of “the average man.” Vivisection, as noted by Bernard , is no different from opening cadavers.5 For Bichat, by stopping the movement of matter in the living animal, one brings “life” more clearly into focus. It did not matter that this ideal-type of the dead body was a figment of medicine’s imagination or that death, as thus conceived, was not a static reality on which to build scientific knowledge. As with all forms of nominalism, one establishes one’s ground in defining it. The dead body provided the ideal definition because in the dead body, matter has stopped its motion. One can map the features of the dead body over the living body for the purposes of knowing and controlling the living body, independently of cultural understandings of death. Moreover, since formal and final causation are nothing more than post hoc additions to the animal machine, life, as such, cannot have an intrinsic telos but only a terminus. Life begins and ends in nonliving matter. There is a paradox in all of this: the idea of life as locomotion of nonliving matter makes death nearly impossible because the failing motion of the material of the body can be replaced by more effective machines. On the metaphysics of contemporary medicine, the body is a perpetual motion machine, potentially living forever, as long as its parts are replaced. I have claimed that medicine’s epistemology of death and its metaphysics of efficient causation result in an ideology of life as a series of causes and effects, without purpose or final cause, that plays itself out in death. In this chapter, I show how this ideology of life creates the technologies of physiological functioning that culminate in the intensive care unit (ICU). These developments also have unintended consequences. People become caught in the dream that medicine can sustain mechanical life indefinitely. A metaphysics of efficient causation and an epistemology of stasis always result in a kind of violence, for one merely has to exert a greater force over the dying body in order to keep its matter in motion. The cold ground of medical knowledge—the dead body— and the cold efficiency of the body as machine return with a vengeance in the lives of patients sustained on the machines of the ICU. The automatic function of the machine resists death.6 Techniques and TechnoLogies of susTaining Life Abraham Flexner’s influential 1910 report on medical education both prescribed and articulated the argument for intimately linking medicine with the laboratory. It is no accident that Flexner’s report emphasized Th e Mac h in a tion s of Li fe • 97 laboratory medicine. This emphasis was in the air; Simon Flexner, Abraham ’s brother, was the chief scientific officer of the recently established Rockefeller Institute for Medical Research.7 The triumph of mechanical medicine was nearly complete by the 1960s. The scientist in his lab coat had moved out of the laboratory and directly into the hospital. He carried with him the perspectives of the laboratory and a slightly different gaze. As...