Can medicine be cured?

In this brilliant book, Jeffrey Bishop, who is both a physician and a philosopher, turns his clinical and analytical gaze on medicine. His diagnosis is bleak: “There is something rotten in the heart of medicine.” Nine of the ten chapters are devoted to the diagnosis, showing the source and history of the disease and some of its symptoms, always focusing on how medicine approaches death and care for the dying. These chapters demand patience from the reader, but they are important not only for physicians but also for those of us who are or will be their patients. In the last chapter, he turns his attention to therapeutic possibilities for medicine and raises a series of provocative questions, the most provocative of which is the last line of his book: Might it not be that only theology can save medicine?

Bishop begins with etiology, with a history of the causes and origins of the disease that has infected medicine. He briefly acknowledges the influence of Francis Bacon’s account of knowledge as power over nature and over its threats of death and suffering. Then, following Michel Foucault’s account of the genealogy of modern medicine in The Birth of the Clinic, he focuses on the work of Claude Bernard, whose “clinical gaze” upon the dead body in autopsy (and vivisection) became foundational for medicine. In the 19th century, the dead body, the corpse, became “the epistemologically normative body,” the body by which other bodies are known. The clinical gaze upon the body as an object to be measured and manipulated came to characterize medical care of living and diseased bodies.

Because purpose and telos can hardly be ascribed to a corpse, this new epistemology for medicine provided as a corollary “the metaphysics of efficient causation.” Together they turned the patient from “subject” to “object,” dismissed the particularity of patients and rejected any attention to purpose and a final telos in life. They allowed for, and called for, medicine’s sovereign dominion over death and dying.