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

4. Embracing Death

c h a p t e r 4 Embracing Death No practitioner of medicine wants to turn a person into an object, an object that he subjects to technological manipulation in the ICU. Yet the pragmatism of medicine focuses on ways to manipulate the physiological body. Medical scientists of the 1950s and 1960s focused their research not on life in a meaningful sense but on life defined by the measures of physiological function. The power of technology renders the practitioner forgetful of meaning and purpose. For medicine, then, the important question becomes, Who holds the power over physiological functioning? This question is an “ethical” question. The debate in medicine has not been about philosophically exploring ways in which life as such might be meaningful; instead, its focus has been on who can invest meaning back into, and who should exert power over, the meaningless mechanism, and on how to carry it out. Several medical professionals have attempted to respond to the meaninglessness of technology deployed in the ICU specifically, and at the end of a life, generally. Take, as an example, surgeon Sherwin Nuland ’s eloquent How We Die.1 Nuland, with mild disdain, declares that “[p]oets, essayists, chroniclers, wags and wise men write often about death, but have rarely seen it.”2 After all, philosophical or poetic musings on death are fruitless, because poets and philosophers do nothing; that is to say, they do not intervene in the realm of efficient causes. • 119 Doctors—those pragmatists who have seen death and stepped in to stop it, or at least to delay it, or to make it easier—know death and can do something about it. Thus, Nuland narrates how we die. Armed with these metaphysical commitments, Nuland eloquently demystifies death, trying to bring into relief the only thing that is hidden to the medical mind, namely, the mechanism of our death, the “how” in How We Die. His objective is to make mundane that which is not part of our contemporary consciousness—the mechanism by which we will die. Against the musings of poets and philosophers, if we know how we die, then we can assert some sort of mastery over our death. The ICU has become our “high tech hope,”3 for it asserts a mastery over the failing mechanism, even if it merely hides death by replacing one mechanical function with another. Yet, as I have argued, it is precisely because medicine has thought of death and therefore life in purely mechanical terms that medical structures result in endless mechanical life in the ICU. For Nuland, the answer to death’s enigma is an intellectual apprehension of efficient causation—how, but never why, we die, which is also the mere inverse of how, but never why, we live. After all, in a world where formal and final causes are not engaged, there can be no satisfactory answer to the “why” question. In other words, Nuland’s task is to shape the ways in which I, as my own sovereign, imagine the ways that “I,” the subject of that sovereignty, will die by bringing into relief how I will die. Nuland’s expertise and authority as a doctor are grounded in the fact that he has manipulated the matter of the body, and his directive is to turn that manipulation back over to the patient—all for the good of the patient, no doubt. Nuland acknowledges that we may not be able to control the mechanism , but his response to the excesses of technological life is that we might be able to psychologically appropriate the failing mechanism by demystifying how we die. Daniel Callahan’s response, articulated in the last chapter, is skepticism about self-appropriation and the ability of the self to be in a position to reject technology, which must always be rejected at the right moment. Both Nuland and Callahan seem to cast the question in terms of control of the body, life, technology, and death, even if it is only by psychologically reducing fear (Nuland) and, if possible , by rejecting technology when the time is right (Callahan). Thus, 120 • the anti cipat ory c or pse both Nuland’s and Callahan’s responses are aimed at efficient control of how we die, even while they reject the efficient control of the ICU. I have already explored the ICU in the last chapter. ICU care...