- Anatomy and Governmentality: A Foucauldian Perspective on Death and Medicine in Modernity
Several “bio-ethical” issues have appeared on the moral horizon recently, stimulating some reconsideration of the direction in which medicine has developed in modernity. Many of these issues are closely related to questions of funding, such as the comparative costs of promoting the health of different populations, or the allocation of research funding for specific diseases. As one would expect, such issues have led to the formation of groups of “at risk” individuals that can effectively assert their medical interests, as well as exact retribution for policies that adversely effect those interests. This politicization of medicine is long overdue, but pluralistic responses, alone, do not pose a significant challenge to medical authority. While such strategies can certainly provide benefits for particular groups, especially those that have been traditionally ignored by medicine, 1 they also tend to extend and reinforce medical authority by promoting the further categorization, testing, monitoring, and disciplining of populations according to lines that are often laid down, ultimately, by medicine.
However, some bio-ethical issues at least have the potential for carrying the reconsideration of medicine beyond the pluralistic fray, and provoking reflection upon the fundamental role that medicine has played, and continues to play, in establishing and maintaining modern identities and the order they inhabit. Examples of such issues are: the “mapping” of the human genome; the development of cloning and gene-therapy techniques; the shortage in transplantable human organs and the development of alternative sources of supply, such as xenotransplantation (i.e. interspecies transplantation) and the production of organ tissues in laboratories; the development of ever-more extensive life-saving/death-prolonging techniques that can be employed in cases of both premature births and deaths; and, of course, physician assisted suicide. While issues such as these will undoubtedly generate a certain amount of pluralistic wrangling, they also create the opportunity for an extensive and potentially disruptive politicization of medicine; this paper is part of a larger attempt to take advantage of this opportunity.
Although several contemporary theorists have made valuable contributions to uncovering the powerful role that medicine has played in modernity, 2 this paper focuses only on the work of Foucault; for no theorist has contributed more to a critical understanding of modern medicine. For the purposes of this essay, Foucault’s conception of “governmentality,” which he developed in his courses at the College de France in the late 1970’s, is of particular importance. I will say more about governmentality later, but here only want to point out that this concept identifies precisely the level at which I would like to politicize medicine. As Foucault described governmentality:
The population now represents more the end of the government than the power of the sovereign; the population is the subject of needs, of aspirations, but it is also the object in the hands of government, aware, vis-a-vis the government, of what it wants, but ignorant of what is being done to it. Interest at the level of the consciousness of each individual who goes to make up the population, and interest considered as the interest of the population regardless of what the particular interests and aspirations may be of the individuals who compose it, this is the new target and the fundamental instrument of the government of population: the birth of a new art, or at any rate of a range of absolutely new tactics and techniques. 3
Although Foucault did not publish a detailed examination of medicine during those years that he developed his ideas on governmentality, he was nevertheless keenly aware of medicine’s centrality to this uniquely modern assemblage of power. In a 1976 interview that has been published as “The Social Extension of the Norm,” Foucault emphasized that:
Medical power is at the heart of the society of normalization. Its effects can be seen everywhere: in the family, in schools, in factories, in courts of law, on the subject of sexuality, education, work, crime. Medicine has taken on a general social function: it infiltrates law, it plugs into it, it makes it work. A sort of juridico-medical complex is presently...