Life Sentences: The Modern Ordering of Mortality 9781442688490

Table of contents :
Contents
Tables and Figures
Acknowledgments
Introduction: The Modern Ordering of Mortality
1. Thou Shalt Not Die Violently: Death and the Modern Problematic of Order
2. Thou Shalt Not Die Prematurely: The Political Economy of Death
3. Thou Shalt Not Kill Thyself: The De-moralization of Suicide
4. Thou Shalt Not Die an Undignified Death: The Discursive Constitution of Death with Dignity
Conclusion: Thou Shalt Die an Orderly Death
References
Name Index
Subject Index

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LIFE SENTENCES

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ZOHREH BAYATRIZI

Life Sentences The Modern Ordering of Mortality

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

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© University of Toronto Press Incorporated 2008 Toronto Buffalo London www.utppublishing.com Printed in Canada ISBN 978-0-8020-9755-2

Printed on acid-free paper

Library and Archives Canada Cataloguing in Publication Bayatrizi, Zohreh, 1973– Life sentences : the modern ordering of mortality /Zohreh Bayatrizi. Includes bibliographical references and index. ISBN 978-0-8020-9755-2 1. Death – Social aspects – Western countries – History. 2. Death – Social aspects – History. 3. Life and death, Power over – Social aspects – History. I. Title. HQ1073.B394 2008

306.9

C2008-903055-9

This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Aid to Scholarly Publications Programme, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council. University of Toronto Press acknowledges the financial support for its publishing activities of the Government of Canada through the Book Publishing Industry Development Program (BPIDP).

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For my parents

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Contents

List of Tables and Figures ix Acknowledgments xi Introduction: The Modern Ordering of Mortality 1 Thou Shalt Not Die Violently: Death and the Modern Problematic of Order

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2 Thou Shalt Not Die Prematurely: The Political Economy of Death 50 3 Thou Shalt Not Kill Thyself: The De-moralization of Suicide

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4 Thou Shalt Not Die an Undignified Death: The Discursive Constitution of Death with Dignity Conclusion: Thou Shalt Die an Orderly Death References 171 Index of Names 189 Index of Subjects 195

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Tables and Figures

Tables 1 3.1 3.2 4.1

Death and Economic, Political, and Cultural Ordering Ratio of the Number of Suicides to Population 109 Suicide–Fertility Table for Europe 116 Estimates of Frequencies of Medical Behaviour that Shortens Life 149

Figures 1.1 1.2 1.3 2.1 2.2 2.3 2.4 2.5 2.6 3.1 3.2 3.3

Frontispiece of A Dialogue 24 The Destruction of the Leviathan 34 Original Frontispiece of Leviathan (1651) 36 London Bill of Mortality 1603 57 Table of Christenings and Burials for London Chances of Survival for Each Age Group 61 Table of Notorious Diseases 65 Table of Casualties 65 Mortality Table for London 80–1 Death of Thomas Chatterton 90 Suicide Map of France 110 Increase in Number of Suicides per Million Inhabitants 113

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Acknowledgments

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Acknowledgments

In the ‘Vocation of Science,’ arguably sociology’s richest lecture in biblical allusions and metaphors, Max Weber explored the fate of science, of scholarly activity, and of teaching in a disenchanted and highly intellectualized world devoid of any belief in gods or in ultimate truths. Weber advised the large crowd of students against seeking the value or meaning of life from their teachers. Yet, as Weber himself might have been aware, the challenge remains to teach with both passion and integrity in the absence of ultimate truths and to enrich not only the intellect but also the heart. I have been fortunate to be blessed by the guidance and friendship of Thomas Kemple, a teacher who has truly mastered this art. It was in his graduate seminar that I first grasped the significance of marginalized and forgotten texts and of liminal elements within mainstream texts. In particular, Professor Kemple’s interest in the literary and aesthetic aspects of sociological texts as a repository of suppressed or alternative sociological expressions inspired my own discussion of the literary and artistic elements in the history of development of modern conceptions of death. This book owes its title to the late Richard Ericson, who one day with his usual concision summarized the manuscript as a demonstration of the fact that our obsession with fighting death has turned living into an obligation. Professor Ericson’s highly influential work on risk and on the subjection of various aspects of life to risk calculation and management inspired my own interest in examining the history of the conceptualization of death as a risk. I initially explored this topic in a graduate seminar I took with him, and it was as a result of his encouragement that I developed my seminar paper into a doctoral project and eventually this book. Much of this manuscript was written during

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my stay at the University of British Columbia’s Green College, which was, during Professor Ericson’s tenure as principal, maintained as an ideal research retreat for young scholars. This book primarily addresses intellectual and cultural developments within the context of nation-state building in modern Western Europe. Professor John Torpey’s expert knowledge of the social and political history of Europe helped me explore this largely unfamiliar territory with greater confidence. Practical advice, hard questions, a spirit of intellectual generosity, and good humour characterized much of our professional and personal encounters and, for that, I am grateful to him. I would also like to thank Professors Ian Hacking, Margaret Schabas, and Thomas Salumets, as well as the anonymous readers for the University of Toronto Press for their endorsement and critical feedback on various drafts of this book. Kate Baltais edited the manuscript superbly, and I thank her for that. The original manuscript was produced with financial support from the University of British Columbia, the Killam Foundation, Green College, UBC, and Saint Mary’s University. Part of my research was conducted during my stay at the Department of Legal Theory, Faculty of Law, University of Groningen, the Netherlands. I would like to thank Dr John Griffiths, chair of the project entitled Medical Behaviour That Potentially Shortens Life (now replaced by a program called Regulating Socially Problematic Medical Behaviour), as well as other current and former members of the project, especially Dr Rob Schwitters, Dr Heleen Weyers, Kim Goossens, Winnie Schrijvers, and Sofia Moratti, for their assistance. I would also like to thank Alexander Harmsen and Kim Goossens for their help in finding and translating material from Dutch and Leah Ellingwood for her assistance in indexing and preparing the manuscript. Mr Alireza Farahmand first introduced me to the significance of historical investigation and blessed me with his unwavering support and friendship through the difficult years of my immigration to Canada and life as a graduate student. He read and commented on various drafts of this work. As a result, the book is much more conscious of its own historical and cultural specificity. Few people can remain loving and likeable while writing a book. My work habits imposed prolonged periods of silence and isolation in my personal life. Heartfelt thanks to Derek Kaplan for both respecting and interrupting that silence at the right times. Derek contributed to

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this work in more ways than I would ever be able to properly acknowledge but the cover design is his best gift to the book. It brilliantly captures the central idea of this book through the metaphor of a musical conductor ordering the endless repetition of the heartbeat against a cacophonic backdrop of mortality tables: to make death orderly is to order life. We are ordered to live and to live long. Parents must be thanked for simply being parents. But as I tried to dream big in a small, conservative, and war-stricken town in Iran, my parents made unusual sacrifices and bravely stood several steps ahead of their time. This book is dedicated to my mother Massumeh Nezafat and my father Mostafa Bayatrizi.

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LIFE SENTENCES

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Introduction: The Modern Ordering of Mortality

Life Sentences: Commandments on How to Live and Die This book was inspired by the legalization of euthanasia in the Netherlands in the spring of 2002, an intriguing development, especially considering that, while some states are gradually recognizing the right to euthanasia, no state has completely recognized the right to suicide. State agents in many countries, including the Netherlands, reserve the right to intervene and save the life of a person who has attempted or is about to attempt suicide and to commit him or her to psychological counselling or psychiatric care. Thus, the legalization of euthanasia brings up an age-old question: under what conditions is it permissible to die or, for that matter, to kill? Over the five years that it took to complete this project, other events further highlighted the salience of this question for the contemporary world. On 11 September 2001 terrorists attacked the United States, killing several thousand civilians. That led to wars in Afghanistan and Iraq that have claimed much higher numbers of civilian deaths. In the early months of 2005, an ethical and political crisis unfolded in the United States over whether it was right or wrong to let Terri Schiavo, a severely braindamaged woman in Florida, die. Families, activist groups, protestors, lawyers, and all levels of the judiciary, as well as state and federal politicians at the highest levels were mobilized to influence the outcome. Meanwhile, famine and easily preventable diseases continued to take thousands of lives around the world quietly and without the same level of media attention. U.S. President George W. Bush, who avowedly made it his mission to promote the ‘culture of life’ in the United States, also reaffirmed his endorsement of capital punish-

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ment, waged two wars, was instrumental in preventing a UN ceasefire during the Israeli bombing of Lebanon in 2006, and promoted a culture of vengeance and intolerance as official state policy for dealing with terrorism. His Democratic opponent in the 2004 presidential election, John Kerry, went out of his way to stress that under his command the United States would capture and kill terrorists, with added emphasis on the word kill and with no reference to due process of domestic and international law, all in an attempt to strengthen his image in national security and foreign policy matters. How do we make moral sense of these manifestations of killing and dying and of the conflicting values and practices that govern killing and dying? What is it that makes the death of a brain-dead Florida woman less tolerable than that of an anonymous child in Africa killed by an easily preventable disease? How does the increasing popularity of euthanasia and physician-assisted suicide in the affluent societies of the West fit this already complicated picture? To answer these questions one has to first examine the processes that have changed dramatically the meaning and value of life, as well as the experience of living and dying, in the West in the past three and a half centuries. The main argument of this book is that the genealogy of modern Western death can be characterized as the gradual formation of a discursive framework that regulates the occurrence of death at the political, economic, and cultural levels. Sociologists, anthropologists, and historians would agree that the experience of death and dying is often mediated, handled, and regulated through culturally and historically specific social frameworks (Durkheim, 1965 [1912]: 436; Hertz, 1960; Caccamo, 1988; Bauman, 1992; Aries, 1974). What is contentious is the exact nature and the evolutionary pattern of these social frameworks. It is often argued that societies in general, and modern Western societies in particular, tend to deny the reality of human mortality (Freud, 1922, 1985 [1915]; Becker, 1973; Aries, 1974; Elias, 1985; Bauman, 1992; cf. Parsons and Lidz, 1967). Medicine’s aspiration to postpone death at any cost, as well as the suppression of open public discourse on death and dying, have been cited as evidence for the existence of this attitude of denial. Freud (1985: 79) contends that the denial of death is a universal function of the unconscious mind but that, with the progress of science and medicine, this denial has reached unprecedented levels. Similarly, Bauman (1992) argues that culture is an attempt to transcend the spatial and temporal boundaries of being and, in particu-

Introduction

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lar, to overcome our knowledge of our mortality and of the futility of life; for him, the modern Western form of the denial of death is unique in that it has been derived from and reinforced mainly by medicine. The denial of death thesis, however, cannot adequately account for some emerging aspects of death and dying in modern societies. If modern Western culture is single-mindedly dedicated to denying death, why does it allow the voluntary termination of life within the institutional setting of medicine, which is supposed to be at the forefront in the fight against death? More importantly, and as we shall see in the following chapters, the denial of death thesis fails to explain the proliferation of medical, sociological, and statistical writings on death dating back to the mid-seventeenth century. This book argues that cultural attitudes towards death can be best understood in terms not of denial but rather of strategies of ordering death, that is, culturally and historically specific social frameworks for handling, regulating, giving meaning to, and experiencing death, while at the same time managing and containing the threat imposed by the unpredictable nature of human mortality. Such strategies might involve a variety of contradictory, yet often complementary tactics, including efforts to postpone, fight, deny, scientifically objectify, or even at times hasten death, as is the case with euthanasia. In modern Western societies the ordering of mortality is predominantly discursive: it is devised, articulated, and expressed in a wide variety of social and scientific disciplines. Rather than supporting a flat-out denial of death, modern Western societies have consistently made an effort to find the proper institutional place for dealing with death by means, primarily, of placing death within a hybrid network of power (especially political and economic) and knowledge that seeks to overcome, regulate, and manage death through scientific objectification. A prime example of scientific objectification is the construction of the category of premature death as a preventable risk in the midseventeenth century. This concept of death as a ‘preventable risk’ depended on the development of new scientific techniques for measuring longevity and mortality rates, and for identifying the most common causes of death (such as accidents and contaminated water). These scientific developments worked in tandem with the rising political and economic interest in the management of life and death. Public authorities began to take account of the new information and to devise plans to prevent unnecessary or preventable deaths, while life

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insurance underwriters became interested in mortality rates as a useful instrument for predicting which segments of the population were at higher risk of death and, therefore, unsuitable for purchasing insurance policies at the standard premium, if at all. Thus, death – like sexuality (Foucault, 1990 [1978]) – has undergone a double process of gradual disappearance from everyday lived experiences in the public sphere and reappearance as a proliferating subject of scientific, statistical, medical, sociological, and actuarial discourses. Accordingly, public rituals, such as the dance of the dead, have been replaced by media advertising, sponsored by the government or by insurance companies, that contains information on how to reduce or avoid the risk of death from, for example, stroke or high blood pressure. Historically, the proliferation of scientific discourse on mortality is underscored by the discovery, in the mid-seventeenth century, of life as the new foundational element of social order, political stability, and economic prosperity, which has to be protected against the chaotic and arbitrary threat of death (Chapter 1). Hitherto, death had been an inevitability resulting from either divine ordinance or fate, to which the only response could be acquiescence and acceptance. Yet, from about 1650, death gradually came to be reframed as a malleable threat against the collective good and reconceptualized as a form of political, economic, and personal risk – to be tamed and managed using a variety of strategies to either prevent or regulate it. The following chapters will demonstrate that this centuries-long process of discursive reconceptualization is anchored in four watershed moments, in which four key forms of human mortality are problematized as being both risky, for the stability of society, but also, and most importantly, avoidable: violent death, premature death, self-inflicted death, and undignified death represent interrelated and progressive stages in the formation of the modern ordering of mortality that started in the mid-seventeenth century and continues into our own time. From Violent Death to Euthanasia: Outline of a Genealogy Thomas Hobbes’ problematization of violent death (1978 [1651]) is arguably the first building block in the process of the formation of the modern discursive ordering of mortality, for it represents the first systematic attempt at finding a proper place for death within the early modern political order (Chapter 1). It is often argued that Hobbes

Introduction

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bases his notion of political order on the fear of death: the sovereign has to be obeyed out of fear of his absolute and unconditional power over death. What is overlooked is that Hobbes introduces a new economy of blood in which the prevention and avoidance of violent death is the ultimate goal. Central to Hobbes’ conception of politics is the ideal of a peace-oriented order in which the risk of death and violence are minimized. Hobbes postulates that a peaceful or civil society would be achieved if ordinary people would forfeit their power over the life and death of themselves and others to a central authority that would, in turn, resort to violence or threat thereof only in the interest of peace. This new conception of social order calls for and warrants an unprecedented suppression of the symbolic meanings of death: having lived with the experience of sectarian violence, political mutiny, and civil wars, Hobbes is fully aware that human aspirations to salvation, honour, and glory run the risk of fostering the life that he famously describes as ‘solitary, poor, nasty, brutish, and short’ (1978 [1651], xiii: 186). The symbolic gift economy of death, in which life (one’s own or another’s) is exchanged for other-worldly or posthumous rewards, no longer has a place in civilization. Instead, Hobbes posits the priority of peace, order, and prosperity over truth and salvation. For this to happen, one must exclude the notion of life after death or, to paraphrase Jean Baudrillard (1993), the possibility of a symbolic exchange between life and death, from the context of politics. All that matters is peace and the opportunity to enjoy life here and now. Hobbes provides the first signs of an attempt to institutionalize the separation of life from death, the life beyond from the life here and now, and to exclude death in the interests of political order and the pursuit of mundane pleasures. Hobbes’ articulation of the problem of violent death in the context of a theoretical exploration of the preconditions of a peaceful political order paved the way for a similar problematization of premature death (Chapter 2). In the relative peace and calm that followed the end of the Civil War in England, early political economists and statisticians went beyond violent death and conceived of premature death as a sociopolitical problem and as a persistent but preventable threat against the value of life. This reconceptualization began with Captain John Graunt, the author of Natural and Political Observations ... upon [London’s] Bills of Mortality (1662). Graunt invented a series of techniques for quantifying mortality systematically, making it possible to bring a degree of analytical certainty to the seemingly unpre-

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dictable and arbitrarily predestined reality of death. The story of Graunt and his preoccupation with mortality records constitutes a fascinating episode in the genealogy of modern Western approaches to death. To begin with, he was a merchant and not a scientist by profession, and it was his skills and interests as a business person that defined his enormously innovative method and approach. In his spare time, Graunt obtained official records of burials, kept by the Church, and compiled them into statistical tables – using the same bookkeeping methods that he would use to keep track of his commercial transactions. Along the way, he not only founded the discipline of statistics but also objectified mortality, for the first time, as a measurable and preventable risk: mortality was the first subject and object of statistical problematization. Graunt’s work was followed up and promoted by his friend and relative Sir William Petty, a disciple of Hobbes and among the founding fathers of political economy, known at the time as political arithmetic. Graunt and Petty established statistical correlations to demonstrate the impact of various social, epidemiological, and environmental factors on mortality rates and highlighted as problematic an entire array of preventable deaths resulting from accidents, lack of hygiene, malnutrition, and ‘immoral’ lifestyle choices. Graunt, Petty, and those who followed in their footsteps dissociated death from its religious and cultural symbolics: rather than a fate or a predestined moment around which one could prospectively build one’s whole life, death became, in theory at least, an avoidable risk, and thereby measurable in quantitative terms. The quantification of death as a risk had major political and economic implications in the century that followed. Chapter 2 examines the reception and application of mortality statistics in life insurance calculations, as well as in public health advocacy, both of which were premised on the construction of life as a form of economic capital and of death as a waste of this capital (Clark, 1999; Zelizer, 1985; 1979; Doran, 1994). The statistical objectification of self-inflicted death in the nineteenth century constitutes another significant chapter in the genealogy of the modern Western ordering of mortality (Chapter 3). For centuries, throughout Europe, the ritual desecration of the selfkiller’s corpse was the primary method of suicide prevention. From dragging the body face down through the city, to hanging it upside down between two dogs, to burying it without religious rites on the crossroads pinned to the ground by a stake driven through it, Euro-

Introduction

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pean societies found creative ways to maximize the degradation inflicted on the suicide’s body. The nineteenth century abandoned degradation in favour of prevention: the punishment of the body gave way to the objectification of the soul, as statistical problematization (both medical and social) replaced penal codification. The statistical fascination with suicide is a well-documented aspect of the history of ideas and, in particular, the history of sociology and statistics (e.g., Hacking, 1990; Giddens, 1971). What is often ignored is the significance of suicide in the history of modern Western attempts to manage, prevent, and regulate mortality. Suicide was considered to be a case within the categories of premature and violent death, both of which were known to be costly yet preventable. More importantly, suicide was seen to be a manifestation of the morally condemnable will to die: thus, a public and scandalous renunciation of the value of life. Suicide challenged the moral integrity of a society that held life as the ultimate personal, political, economic, and collective good. Statistical objectification was a means to understand suicide and also a mechanism for taming this symbolic threat: the will to die was met with an equally strong will to deny the self-killer’s subjectivity in the name of statistical aggregations that silenced individual motives and meanings in favour of highlighting impersonal social and medical factors such as madness and malaise. Since the mid-seventeenth century, the moral integration of society around the value of life, along with the transformation of death into a preventable threat against it, provided impetus for a medico-legal culture that regards the preservation of life (i.e., the life of citizens in affluent societies) – at any cost – as an end in itself (Bauman, 1992, 1998; van der Berg, 1978 [1969]; Illich, 1975). In the twentieth century, this medico-legal culture came under increasing criticism for depriving the dying of a dignified death (Gilman, 1935; Shils, 1975 [1967]; Parsons, Fox, and Lidz, 1999 [1972]; Dworkin, 1993). The conception of death as the ‘ultimate evil’ is now being challenged by the emerging notion that pain and dependence are even greater evils because they threaten the dignity of the person who is dying (Chapter 4). This new notion has created an increasing demand for the legalization of euthanasia and assisted suicide throughout much of the affluent and technologically advanced world. The new preoccupation with undignified death, as well as the rising demand for euthanasia and assisted suicide, seem to imply an acknowledgment of the limits of life. However, the case of

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the Netherlands illustrates that anxiety around undignified death is only the latest stage in the battle over the institutional control of death, its place in society, and its meaning for the individual. The events leading up to the legalization of voluntary euthanasia in the Netherlands reveal a trend in which the language of the debate has been increasingly medicalized, legalized, and quantified. Policy studies in the Netherlands (and elsewhere) consistently highlight the benefits of legalizing euthanasia as a relatively risk free, efficient, and medicolegally controlled method of regulating the dying process. Emphasis on the medico-legal regulation of end-of-life decision-making renders silent and marginal the sociosymbolic meanings underlying a person’s wish to die. What emerges from this process, which began with Thomas Hobbes, is the formation of a discursive ordering of death that may be consolidated around four death sentences, that is, around four quasi-biblical negative commandments on how to die: thou shalt not die violently, thou shalt not die prematurely, thou shalt not kill thyself, and thou shalt not die an undignified death, all of which find their common ground in the positive commandment, thou shalt die an orderly death. These are, in other words, expressions of the norms that constitute what it means to die in an orderly fashion (Conclusion). These commandments are sentences, not in the sense of a juridical death sentence but rather because they are the norms, carried through statements, words, figures, and statistical tabulations regarding death. From a variety of institutional sites including medicine, demography, public health, and suicide prevention programs, they govern and regulate how, why, and when people die. These death sentences also function as life sentences: the modern Western obsession with ordering death is also an expression and extension of the obsession with life itself. The political, economic, and cultural imperative to avoid death is a life sentence. It is a decree not only about how to die but also about how to live – long, healthy, and with dignity – and to avoid a ‘solitary, poore, nasty, brutish, and short’ existence. As such, the idea of life sentences alludes to Foucault’s (2003 [1975–76]: 241) description of modern biopolitical power as the power to make live: the power to issue a life sentence, a commandment to live (see below). The discursive problematization of various forms of death, from violent to undignified, is not concerned with death, as such, but with death in its unruly and disorderly manifestations: it seeks to analyse, understand, tame, and control those forms of death and dying that

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have the capacity to disrupt social order or to weaken society’s sense of moral integration around the value of life. Thus, premature death, especially as caused by preventable illnesses and accidents, teenage suicide, murder, martyrdom, and underground euthanasia all represent anarchic or rogue manifestations of mortality, manifestations that need to be brought under a regime of ordering or given an appearance of orderliness within the institutionally authorized frameworks of public health, penal law, epidemiology, and medicine. The attempt to tame the disorderly nature of death is not specific to modern Western societies. Rather, it is a common cultural function found in various societies around the world, a point to which I will return in the Conclusion of this book. What is specific to the modern West is the primarily discursive nature of the regime of ordering that is imposed on death. To state that the modern ordering of death is predominantly discursive implies that there was an ordering of a different kind that prevailed in earlier times. It is easy, and tempting, to construct an evolutionary scheme within which one mode of ordering death is replaced by another in the passage from ‘premodern’ to ‘modern’ times. Instead, however, of investigating the diachronic or evolutionary progression of the social modes of ordering death from one mode to another, this book considers the internal synchronic dynamics of the discursive methods of ordering death. In examining the emergence of the discursive ordering of death, I have searched not only for signs of its spread across Western intellectual and cultural fields but also for signs of the persistence of its dialectical opposite: that which the discursive ordering of death tries to exclude, silence, or subvert. This dialectical opposite is nothing other than the potential that death might have a symbolic meaning or that death might be absorbed by and governed through a symbolic system of ordering. Religion, cults, and political ideologies are among the subjective and symbolic belief systems that advocate for the existence of meanings and a purpose in death. Such symbolic value systems challenge the notion that earthly, material life is the sole or the highest form of existence and posit, instead, a view of death as a window to something potentially better (salvation, immortal life) or as a price to be paid in a battle for higher objectives (national liberation, vindication, justice, equality). ‘Give me liberty or give me death’ best exemplifies the symbolic potency of this approach. Similarly, martyrdom is inspired by symbolic value systems and represents a subjective and irreversible act of defiance

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against the predominant life-affirming culture of modern societies. In contrast to these symbolic value systems, the modern discursive ordering of death perpetuates a view of death as a moment beyond which nothing exists and which should, therefore, be avoided at all costs. It seeks to extend life as the ultimate good and to protect it against the threat of such untamed and anarchic manifestations of death as suicide, epidemics, and murder. The symbolic ordering of death becomes yet another untamed threat against this discursive ordering because it presents death, whether of oneself or another person, as potentially acceptable, even desirable, and symbolically meaningful. This analytical distinction should not be taken to imply a binary division of geography into two regions or of historical time into two periods, one in which death has symbolic meaning and social significance and one in which death is exclusively governed by means of scientific objectification. Rather, it implies the existence of a historical and conceptual tension between two regimes of ordering death, one striving to give meaning to death as a symbolically powerful and ritually ordered event and the other attempting to subject death to various modes of discursive ordering. Thus, instead of pointing towards a rigid linear historical evolution, this analytical division regards the symbolic ordering of death as an ever-present potentiality – a threat or, better yet, a risk – within the modern discursive ordering of death. Nonetheless, compared with the symbolic ordering of death, the modern discursive ordering of death is in much greater harmony with the general trend of political-economic developments in modern Western societies, in particular as concerns the establishment of modern centralized states and the dominance of capitalism (more on this below). Death and Social Order: The Conceptual Background A theory regarding the relative shift in the objectives and methods of death management in the West is already anticipated, although not explicitly articulated, in the crucial last chapter of the first volume of The History of Sexuality (1990 [1978]), where Michel Foucault argues that modern Western societies exhibit a shift from the right of sovereign power over death to biopolitics or the disciplinary and discursive exercise of power over life. According to Foucault (ibid.: 142–3), in the eighteenth and nineteenth centuries and after overcoming epidemics

Introduction

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and famine, Western civilization discovered life as a subject of control and intervention. This ‘discovery’ was accompanied by a shift in the objectives and methods of power: power became more interested in managing and protecting life than in ruling through the menace of death (ibid.: 147). Accordingly, the ‘symbolics of blood,’ such as the sword, punishment, and war, were gradually abandoned or marginalized in favour of the ‘analytics of sexuality’ or a detailed knowledge of demographic changes and life processes. Biopolitics relies primarily on the proliferation of scientific discourses of life, as most notably exemplified by demography, eugenics, public health, and a whole array of sciences aimed at knowing, managing, and regulating the sexual and reproductive life of the individual within the family (ibid.: chapter 5; 1984). Elsewhere, Foucault (2003: 241) has argued that, while sovereignty was the right to take life or to let live, biopolitics consists in the power to make live and to let die. To make live involves a systematic and persistent interest in regulating and managing birth rates, old age, accidents, and morbidity. According to Foucault, towards the end of the eighteenth century, biopolitics became interested in morbidity: illnesses and conditions that, unlike epidemics, did not kill a large number of people in a short period but caused a more gradual loss of vital forces as a result of various illnesses. ‘Death was now something permanent, something that slips into life, perpetually gnaws at it, diminishes it and weakens it’ (ibid.: 244). This history can be disputed on several fronts, including whether the emergence of biopolitics can more accurately be dated back to the late seventeenth rather than the late eighteenth century, a question to which I will return in Chapter 2. Nonetheless, as Foucault has argued, the task was to ‘regularize’ death by means of forecasts, statistical estimates, and overall measures taken within the institutional frameworks of medicine, epidemiology, and insurance (ibid.: 246–7). Foucault’s work sparked a debate on the nature of the web of relations of power and knowledge that make life itself a political, economic, and moral problem. This debate rests on the assumption that ‘politics now addresses the vital processes of human existence: the size and quality of the population; reproduction and human sexuality; conjugal, parental and familial relations; health and disease; birth and death’ (Rose, 2001: 1). ‘Biopolitics was inextricably bound up with the rise of the life sciences, the human sciences, [and] clinical medicine,’ all of which engage in the systematic accumulation of detailed information regarding various aspects of society, especially life itself (ibid.: 1;

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cf. Rose, 2006). Other major scholars have addressed the origins of mathematical and statistical approaches to understanding social life and argued that the statistical problematization of poverty, illness, mortality, suicide, and hygiene have played a major role in the formation of modern and late-modern biopolitical strategies of regulating and managing life (Johansson, 2003; O’Malley, 2000; Baker and Simon, 2002). Bioscience, medicine, and epidemiology have also been criticized for their contribution to a culture of instrumental objectification of life (Bauman, 1992, 1998; Fox, 1993, 1998; Rabinow, 1996; cf. Elias, 1985). Much of this literature tends to overemphasize the transition in the West from the politics of blood to biopolitics (see, e.g., Rose, 1999, 2001), sometimes giving the impression that human societies are, historically and culturally, divided into those governed by sophisticated micromechanisms of the power over life (normally Western affluent countries) and those still appealing to a medieval symbolics of blood (often ‘third world’ dictatorships). Such interpretations are met with criticism from scholars such as Giorgio Agamben (1998, 2005), whose work exposes the persistent centrality of the power over death in the operations of politics in modern Western societies. Similarly, as some postcolonial writers have recently suggested, within the unequal global relations of power and violence, the mechanisms of a necropolitical power over death and those of the biopolitical power over life have at times overlapped, existed side by side, or even reinforced one another, often at the expense of the world’s weakest (see Mbembe, 2003; Balibar, 2001). Foucault himself has used the examples of the Holocaust and the Cold War era nuclear arms race to draw a linkage between biopolitics and necropolitics, arguing that modern wars and genocidal campaigns are waged in the name of the protection of the life of citizens and ‘on behalf of the existence of everyone’ (1990: 137). Not surprisingly, such wars and the war crimes that often accompany them are more acceptable when they happen only at the margins or the hidden interiors of the affluent world. Hence, in our time, and within the context of the ‘war on terror,’ a double standard of citizenship, or more precisely a category of non-citizenship, has emerged in a world divided between those whose life has to be protected from the mere potential of a ‘mushroom cloud’ and those, in places like Iraq, whose life can be imperilled with impunity to prevent the ‘mushroom cloud’ from ever forming. The existence of such overlaps between biopolitics and necropolitics in the West must at least be acknowledged so as to

Introduction

15

avoid a crudely ahistorical and ethnocentric categorization of societies and countries in terms of how they manage life and death (see concluding chapter). My aim in reviewing these often-cited Foucaultian arguments is not to do a study of the relations between sovereignty and death on the model that Foucault has proposed, nor to apply his theory to a series of empirical cases to prove it right or wrong or to examine its limits. Rather, I wish to reflect on what Foucault, as the most influential and most provocative theorist of the interrelations of life, death, and sovereignty, has not done or said as opposed to what he actually has done and said. My central question is: in a society so preoccupied with life how is death understood and made an object of knowledge? How is death confronted intellectually where the rational ordering of life has become so dominant? Focusing on an examination of the biopolitical discourses on life, Foucault left the issue of death largely untouched – in a passing remark, he suggests that the rise of biopolitics coincides with the decrease in the instances of applying the death penalty, the waning of death rituals, and the growing secrecy around death (1990: 138). Accordingly, for Foucault, power increasingly dissociates itself from the question of death. This book, however, demonstrates that the rise of biopolitics resulted not in an increasing secrecy over death and dying but rather in an intensifying interest in how, why, and when people die. The biopolitical discourses of life and sexuality, which are the main focus of Foucault’s genealogical analysis, meet their match in an expanding scientific literature on death and dying. Another issue largely left out by Foucault but central to my work is the exact nature of the contrast between the ‘symbolics of blood’ and the ‘analytics of sexuality.’ Foucault does touch on this issue in passing, in the context of his political and journalistic reflections on the return of a symbolic form of death, namely, martyrdom (in the Iranian Revolution of 1979), which he describes, using Marx’s words, as ‘the spirit of a world without spirit’ (1988b). Here, there is a hint that death is not merely an instrument of power or an object of knowledge but also a repressed symbol or a source of lost spiritual meaning (cf. Affray and Anderson, 2005: 32–7). In this book I am attempting to present a genealogy of this repression while at the same time providing an account of the various ways in which the symbolics of death resists and survives such repression. Baudrillard offers a starting point here. While Foucault’s primary interest is the shift in the mechanisms of

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power and the gradual replacement of sovereignty with biopolitics, Baudrillard invites us to ‘forget Foucault’ (1988) in favour of contextualizing death within the trajectory of a more fundamental distinction between ‘symbolic exchange’ and ‘political economy.’ For Baudrillard, in symbolic exchange an object has an ambivalent value that is determined by shared cultural meanings; for instance, a wedding ring is not merely an ‘empirical object,’ but has value within a system of signifying relationships that give it meaning and significance (1981: 63). By contrast, the age of political economy ‘under the cover of utility ... institutes a coherent logical system, a calculus of productivity in which all production is resolved into simple elements, in which all products are equivalent in their abstraction. This is the logic of the commodity and the system of exchange value’ (ibid.: 191). The gift and its ambivalent symbolic meaning (a wedding ring = commitment) belong to the world of symbolic exchange, the commodity and its equivalent worth in the market (20 yards of linen = 2 ounces of gold)1 stand for the world of political economy. Baudrillard provides us with a vocabulary for and insight into the suppression of the symbolic meaning of death in modern Western societies. In Symbolic Exchange and Death, he argues that the precondition for the possibility of modern political economy ‘is the separation between a group and its dead, or between each of us today and our own deaths’ (1993: 130). This division emerges because the symbolic exchange between life and after life, between the living and the dead, is governed by the logic of ambivalence, which resists and subverts political economy’s law of equivalence in the market. In some symbolic value systems, including some religions, worldly deeds, sacrifices, and rituals are believed to be reciprocated after death according to a unique, indiscernible, and ambivalent logic that is not reducible to capitalism’s logic of exact exchange between equivalent values. Consider the symbolic, ambiguous, and unquantifiable logic of exchange in ritual offerings to ancestors = a blessed harvest compared with the exact and fixed logic of exchange of equivalent values as expressed in 1 pound of sugar = 3 dollars. 1 One of Marx’s favourite examples (1977a: 162).

Introduction

17

According to Baudrillard, the primary source of social control and the foundation of security as manifest in political and economic risk management each involve shattering the reciprocity between life and death, the living and the dead. For the market’s logic of value to prevail it is necessary to exclude the dead from the group’s ‘symbolic circulation’ and to terminate the reciprocity between death and life. This is evidenced by the abandonment of rituals, such as the dance of the dead, which previously functioned to bridge the world of the living and that of the dead. Thus, in the evolution from a world ruled by symbolic exchange to one ruled by political economy, ‘little by little, the dead cease to exist’ (1993: 126). Central to this exclusion of death is the rational idea of a ‘punctual death’ as the terminal stage in life: a linear conception of life and death in which death is defined as an end, a point of no return, beyond which any exchange or contact between the living and the dead is no longer possible. The works of Foucault and Baudrillard help reveal a hidden anxiety in modern societies around the symbolics of death as a potential threat to the risk-free ordering of death fantasized by the apparatuses of modern Western biopolitics (Foucault) and political economy (Baudrillard). The gradual dominance of the discursive methods of death management at the expense of marginalizing the symbolic ordering of death seems to correspond and overlap with the passage from sovereignty to biopolitics and from symbolic exchange to political economy. Table 1.1 provides a synthesis of Baudrillard’s theory of symbolic exchange and Foucault’s theory of biopolitics as a framework for explaining the passage from the symbolic to the discursive ordering of mortality. In particular, it illustrates the political, economic, and cultural ramifications of this passage and of the corresponding shift in methods of death management. The left-hand column demonstrates the intersections of the symbolically ordered death with a political system that is primarily oriented towards sovereignty, an economic system that recognizes symbolic exchange, and a culture that has a set of provisions for accommodating and giving meaning to death. On the political level, symbolically ordered death can play a role as an instrument both for the exercise of political power and for opposing such power (Chapter 1). Max Weber’s (1964: 154) analysis of the state as an institution defined by its monopoly over the use of violence gives credence to the view that the ability to exercise power over death, albeit as a last resort, is integral to state power. Conversely, violent rebellion, which entails self-sacrifice, is also used for resisting state power, as

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Table 1

Death and Economic, Political, and Cultural Ordering

Social ordering

Symbolically Ordered Death

Discursively Ordered Death

Political

Sovereignty • Power over death • Self-sacrifice as a form of resistance

Biopolitics • Renunciation of violence as a political means in favour of the management of life • Fight against illness and death

Economic

Symbolic exchange of objects with ambivalent values • Exchange between the living and the dead • Other-worldly rewards and punishments for this-worldly conduct

Political economy’s logic of exact, equivalent exchange • Shattering of the reciprocity between the living and the dead • Death represents an irreversible and irredeemable loss

Cultural

Acceptance of super/natural death • Values give meaning to life and death

Stress on life, longevity • Scientific facts uncover the statistical and medical dynamics of mortality

endorsed not only by militant ideologies but by such legal documents as the U.S. Constitution. In the economic realm, symbolically ordered death can become a vehicle of exchange between the world of the dead and that of the living. Accordingly, it is conceivable to receive worldly, material favours by making offerings to the dead or be bestowed with other-worldly rewards in exchange for good deeds, asceticism, or selfsacrifice in this world (Chapters 1 and 2). Finally, in the cultural realm, religion and other value systems give symbolic meaning and purpose to death by, for instance, portraying it as the beginning of a new life that redeems the sufferings and sacrifices or punishes the sins of thisworldly life (Chapters 3 and 4). In contrast, and as illustrated in the right-hand column of Table 1, discursively ordered death has a largely negative relationship to politics, the economy, and culture. In the political realm, death represents a limit to the biopolitical project of protecting life against the menace of death (Chapter 1). Economically, death represents a material loss (as in loss of premiums for insurance companies, loss of healthy

Introduction

19

workers) that cannot be redeemed through any exchange scheme with the other world (Chapter 2). Culturally, death, especially the chaotic and uncontrolled presence of death, threatens the sacrosanct values of life and longevity around which the modern secular societies of the West are morally integrated. Thus, there is a greater cultural emphasis on finding objective scientific facts that can prevent death than on trying to find meaning and purpose in death (Chapters 3 and 4). Death as a Sociological Problem My investigation into the genealogy of the modern conditions of death and dying indicates that the history of the modern concept of death and the history of modern sociology have developed in surprisingly close connection. The relationship between sociology and death is far from a simple or direct one. Indeed, it can be shown that sociology cannot take death as its topic. We can study mortality rates, causes of death, the ritual handling of death, or the funeral industry – but death itself eludes sociological analysis. We cannot make sociology speak about death, but one of the first discoveries of sociology was that it could make death speak about the experience of living in society. This potential of death speech is explored in the works of Durkheim, Marx, Simmel, and Weber among others, each of whom treats the modern modes of dying – death under unsafe factory conditions (Marx, 1977a, 1977b), egoistic suicide (Durkheim, 1951 [1897]), suicide under irrational social pressures (Marx, 1999 [1846]), the detachment of life and death (Simmel, 2007 [1910]), and meaningless death (Weber, 2004 [1919]) – as symptomatic of the modern modes of social life. My study follows this sociological tradition: it accepts our limitations as sociologists to speak about death while acknowledging the ability of death to speak to us and about us through numbers, tales, tables, drawings, and texts. The analysis of the conditions of death, of how, why, and when we die – and of what we are told about how, why, and when we die – inductively and retrospectively illuminates the present-day conditions of living. The history of the many forms of modern death is inevitably the history of modern life itself. This book asks of death not only to speak about the conditions of our social life but, more importantly, to speak about sociology itself. My research suggests that a line of inquiry about mortality from an

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‘objective’ and ‘quantitative’ point of view, dating back to the late seventeenth century, has provided us with a legacy in which the question of how, why, and when we die is closely interconnected with the question of how a society may best be managed to preserve peace and prosperity. The question of death turns out to be closely connected with the question of order, which is arguably sociology’s most fundamental and most persistent question (O’Neill, 1972; van Krieken, 2002). Thomas Hobbes, the first modern Western philosopher to pose the question of how social order is possible, is also the first to point out that a society’s cultural approach to death has a central role in determining whether such order is possible. A callous approach to violent death and a general disregard for the value of life, in his view, are impediments to social order and political stability (Chapter 1). In John Graunt’s mortality statistics, we can see the first signs of the emergence of the category of ‘population’ as a new object of analysis, regulation, and management. This formulation is central to the development of sociology as a discipline concerned with statistically discernible facts in the collective domain (Chapter 2). In the late nineteenth century, Emile Durkheim studied suicide rates both to demonstrate the scientific potential of the ‘sociological method’ and to point out the hazards of living in a society plagued with anomie and/or egoism, a subject that also interested Karl Marx (1999 [1846]), albeit in a marginal work (Chapter 3). And finally, Max Weber takes the inability of science to give meaning to death as one of the main indicators of the disenchantment of the world and of the loss of meaning in life more generally, a point that was further explored by Talcott Parsons (1999 [1972], 1967) and Zygmunt Bauman (1992) (Chapter 4). Social theorists have often criticized the modern conditions of dying and lamented the loss of a world in which death has meaning and symbolic significances; however, they have yet to reflect critically and systematically on the contributions of their own discipline to the dominance of a quantitative discourse of death that ignores the questions of meaning as well as the continuity of life and death as a totality. In an increasingly expanding and influential body of literature, in which sociologists critically examine the role of medicine, epidemiology, and life insurance in reshaping the meaning of life and death, the discipline of sociology itself largely escapes scrutiny. This lacuna in our understanding of the history of death and dying is

Introduction

21

addressed here primar-ily by focusing on sociostatistical and sociological discourses while only briefly touching on medicine and other scientific disciplines. The analysis of the history of death from this perspective requires reconfiguring the history of sociology itself so as to broaden the scope of what we, as students of sociology, consider to be our tradition. Rather than starting with Marx, we need to start with Hobbes. Rather than tracing the beginnings of statistical and positivist sociological analysis to Comte and Durkheim, we need to go further back and rediscover the roots of social statistics in the late seventeenth-century works of John Graunt and William Petty. Instead of dealing with the core and canon of sociological investigation, we need to bring to light liminal texts of our sociological tradition, texts that have been pushed to the margins not because we have negated their findings and insights but, indeed, because we have perfected their objectives and methods. The return to figures such as Graunt, Petty, Chadwick, Morselli, and Guerry should not be taken as an appeal to the lost ghosts of the prehistory of social thought. Rather, this book seeks to illuminate a history of the present, a genealogy of the modes of the problematization of dying in the Western tradition of sociological investigation. In this light, sociology itself emerges as one the many biopolitical disciplines that have recently become fashionable subjects of sociological scrutiny and critique. The silver lining in this account of the history of involvement in quantifying mortality is the consolation that sociologists and social statisticians can claim a share of the credit for the increased lifespan of the population in the West in the past three and a half centuries. From early on, social statistics was invoked to expose the unequal distribution of longevity resulting from poverty, hunger, and the lack of access to medical care common among the army of the working class living in urban slums (Chapter 2). The Western sociological and sociostatistical traditions have helped to increase the longevity and the living standards of the poor, albeit at the cost of throwing their lives in the spotlight and problematizing their ‘lifestyle choices,’ such as drinking and smoking, as irresponsible. That sociology has assisted in making the dying process less meaningful is another hard fact that we have to acknowledge and deal with. Thus, what Weber said about medical attitudes to death, early in the twentieth century, seems to apply to much of our own sociological tradition: ‘All natural sciences give us

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the answer to the question: what should we do, if we wish to control life technically? Whether we should control it technically or indeed wish to, and whether that in the end has any meaning, are questions which science does not go into or which it prejudges for its own ends’ (Weber, 2004 [1919]: 278).

Recto Running Head

23

1 Thou Shalt Not Die Violently: Death and the Modern Problematic of Order

Prologue: Death and Politics Cav. hors. Well met old mill horse or indeed an asse, I must instruct thee before we doe passe How to live bravely, look on me and view My Bridle and my Saddle faire and new; Warre doth exalt me, and by it I get Honour, while that my picture is forth set Cut out in Brasse, while on my back I beare Some Noble Earle or valiant Cavallier. (para. 1) Mil-horse Despise me not thou Cavallier War-horse For though to live I take an idle course, Yet for the common-wealth I always stand; And am imploy’d for it, though I am nam’d A Mill-Horse, I am free and seem not under Malignants that doe townes and houses plunder, Transported on thy back, while thou must be Halfe guilty of their wrong, and injurie. (para. 2) From A Dialogve betwixt a horse of warre and a mill-horse, 1643

This anonymous poem from the English Civil War period features a dialogue between a cavalier’s warhorse bragging about his life of chivalry, fighting in battle for honour and glory and a countryman’s millhorse that takes pride in contributing to the long-term welfare of

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Figure 1.1

Frontispiece of A Dialogue.

the commonwealth and declares himself free and content with his predictable, albeit hard, routine of everyday life away from the noise and chaos of war. The political leanings of the author are hard to discern:

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25

was he (or possibly she) a pacifist, a royalist, or merely a poet without a cause? His intentions, however, are clear: as the subtitle of the work suggests, he sought to prove that ‘the content and safety of an humble and painfull life, is preferred above all the noyse, the Tumults, and Trophies of the Warre’ (A Dialogue, 1643, title page; italics in original). The dialogue anticipates the coming of a radical new civic and political ethic arising from the ashes of the Civil War, the gradual passage from a military society to an industrial society (Spencer, 1875 [1862]: para. 134; Elias, 2000, vol. 2), and the shift from might to right (Durkheim, 1957 [1900]: 65–76, esp. 71–3). The choice of horses as the narrative vehicle of the poem is itself significant (Figure 1.1). They are each an instrument – of living and fighting – separated from, speaking on behalf of, or indeed, substituting for, their human owners. They represent life at its barest and most basic, a life transformed into labour power, into the instrument of warfare and welfare. The life of each horse, its meaning, value, social significance, and achievements is measured in terms of its function and contributions: the glory of war and the welfare of society. The construction of an analogy that would explain the chaos of the Civil War in terms of the alternatives of warfare and welfare and by resorting, primarily, to our most basic animalistic desires, instincts, and fears also appealed to Thomas Hobbes, who believes that the only viable solution to the Civil War – and more generally, to the possibility, threat, and will to war – is the articulation of an instrumentally rational system of politics and ethics in which a life of hard work in the service of one’s own needs and of the commonwealth is held to be superior to the ‘vainglorious’ pursuit of truth or glory. The political and ethical urgency of this intellectual endeavour was underlined by the brutal reality unfolding across the kingdom. As political and spiritual disputes merged to the point of becoming indistinguishable, violence emerged not as a final resort for settling differences but as an honourable and glorified pursuit on its own: ‘It seemed to many among both the Roman Catholics and the reformers, to the increasingly large number of persons who held strong convictions on behalf of their religious beliefs, that there was nothing to do but settle their differences by force. Some men persuaded themselves, or let others persuade them, that any means of persecution and killing, no matter how frightful, were justified by the purpose of bringing all to adopt their worship, their recipe for eternal life’ (Nef, 1963 [1950]: 115).

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The path to truth and salvation was bloody: it created a reign of personal insecurity and economic stagnation that was felt especially in England where the war had been preceded by a period of comparative peace, technological advancement, and economic growth under the long and relatively stable rule of Elizabeth I and James I (Nef, 1963: 10–12, 116). Yet Hobbes’ project to deconstruct the vainglorious passions for pride, truth, and salvation and to highlight the moral value of dedication to hard, productive work cannot be interpreted as merely an attempt to rechannel energies back towards the economic sphere, as Sheldon Wolin (1960) has claimed. Rather, Hobbes aspired to the more ambitious goal of laying the conceptual ground for an entire political economy of life and death in which peace and order have priority over truth, glory, and salvation, and the quest for this-worldly happiness, prosperity, and pleasures takes precedence over the pursuit of eternal bliss. Hobbes’ work inaugurates modern Western political philosophy but also, and related to that, it plays a constitutive role in the emergence of the modern discursive ordering of mortality. By making a systematic connection between the manner in which people die and the possibility of sociopolitical order, Hobbes offers a blueprint for a social contract founded on the moral and political commitment to refrain from killing and to value life as the highest good. Hobbes was not the only or even the first thinker to draw a connection between death and politics. Anthropological evidence and sociological analysis indicate a near-universal mutual conditioning of death by politics and of politics by death (see Seery, 1996: 21–2; Hertz, 1960; van Gennep, 1960). On the one hand, death can be properly understood only within a social and political context. As Hannah Arendt has pointed out, death and birth are uniquely human events, and they can only occur in the polis, the political world into which humans are born and from which they depart.1 Outside this world, life and death are reduced to an animalistic, cyclical, and repetitive recurrence, not birth and death but mere appearance and disappearance. The common political world from which we depart gives meaning, uniqueness, and dignity to death: every death will be mourned and remembered as the loss of a unique person (Arendt, 1958: 96–7; also see Seery, 1996: 13). On the other hand, historically, political power itself is defined and delimited by its relationship to death. Among Western political 1 Following Aristotle, Arendt holds that ‘the political,’ rather than ‘the social’ is the central category of human communities (Arendt, 1958: chapter 4).

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27

philosophers from Hobbes to Schmitt, moral philosophers from Benjamin to Derrida, and sociologists from Weber to Agamben, sovereignty is defined in terms of the ability to establish an exclusive right to kill or to make live. Yet the significance of Hobbes rests in the fact that he gave a crucial prominence to the question of death not merely as an instrument of power but as a source and foundation of political morality. Arendt argues that Hobbes has the distinction of being ‘the only political philosopher in whose work death ... plays a crucial role’ (1970: 68); in her own work, as in other standard interpretations of Hobbes, however, the Hobbesian conception of the relationship between death and politics is perceived in only negative terms: the menace of death is the instrument of politics. Hobbes’ Leviathan is often seen as a figure of absolute sovereignty, one who exercises authority over subjects through a monopoly over the means of violence (Lloyd, 1992: 6; van Krieken, 2002: 258–9, 270n5; Seery, 1996: 8). This misinterpretation of Hobbes, or narrow interpretation at the very least, is particularly characteristic of the work of Michel Foucault, whose legacy has revolutionized contemporary thinking about the operational mechanisms of power. On several occasions, Foucault points out that to understand how modern political power is exercised it is necessary to go beyond the Hobbesian model of sovereignty, which, according to Foucault, rests on the sovereign’s exclusive power over death (1984, 1988a, 1990, 1991, 2003). The Leviathan is, in Foucault’s reading, associated with the now-archaic symbols and instruments of violent power over death: the sword, blood, and the scaffold (1990: 147). Yet, as this chapter demonstrates and contrary to Foucault’s portrayal, Hobbes conceives of political order as resting not on the threat of violent death but rather on the ethical principle of respect for life as an absolute value and as the ultimate foundation for peace, stability, and prosperity. His work draws the outlines of a political economy founded on the minimization of the chaotic threat of death, the neutralization of death’s symbolic power, a radical separation of the world of the living from that of the dead, and the maximization of the potentials of life. Hobbes’ political thought rests entirely on the assumption that, for any form of political order to be established and for economic prosperity to be expected, individuals must give up their ‘natural right’ over the life of others – or over their own death – and abandon any value system outside the law that might incite them to commit violence or to endanger their own lives; instead, they must commit

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themselves to making their own lives more peaceful and the ‘commonwealth’ more prosperous. Writing within the context of the English Civil War, Hobbes posits the value of life as the highest ethical principle and as the ultimate guarantee against the threat of a war of all against all. Here lies the lynchpin of modern Western discursive ordering of mortality: the preservation of life against the threat of death is not merely an issue for the individual but, rather, a collective political and moral project. Hobbes made it possible to study death not as a subject of metaphysical or existential contemplation, but as a topic of objective, scientific problematization. Whereas ancient and medieval philosophers founded politics on the ethical requirements of a ‘good life,’ Hobbes finds the ultimate guarantee of political order in our instinctual desire to live – and to live comfortably – and in our equally natural and instinctual fear of death, especially the fear of unpredictable, violent death at the hands of one’s own fellow citizens. Succeeding generations of liberal political theorists, from John Locke to John Rawls, have denounced Hobbes’ absolutist theory, yet they have upheld his view that life is an ultimate end in itself. This tendency is evidenced by the fact that liberal thought takes the point of view of the living – in the words of John Rawls (1971) ‘the original position’ – rather than that of the dead (the afterlife) as the primary reference position for determining ‘the good’ (Seery, 1996: 162–7; see also Rhodes, 2000). What follows is not an attempt to reassess Thomas Hobbes in light of, or against, the 350 years of developments in political thought since the publication of his works. Similarly I do not engage directly or extensively with such canonical Hobbesian scholars as Schmitt, Strauss, or Macpherson. Whereas much of Hobbesian scholarship focuses on his contribution to the Western tradition of thought on sovereignty, power, and politics, here I am interested primarily in Hobbes’ theoretical interventions on the subject of death. I focus on particular key passages, mainly from The Leviathan (1978 [1651]), which illuminate Hobbes’ contributions to the formation of the modern ordering of mortality. This underappreciated contribution can be identified in three persistent and original themes in his work: (1) the reconceptualization of politics as a project to minimize the chaotic threat of death and to maximize the prospects of life; (2) the establishment of life as the primary good and death as the primary evil; and (3) a reinterpretation of religion diminishing the importance of other-worldly eternal life in favour of emphasizing worldly pleasures and corporal punish-

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29

ments. These correspond with Leviathan, Part I, ‘Of Man’; Part II, ‘Of Common-Wealth’; and Parts III and IV, ‘Of a Christian CommonWealth’ and ‘Of the Kingdom of Darkness,’ respectively. These themes were instrumental in the formation of a political economy founded on the maximization of life’s potentials and on the suppression of the symbolic meanings of death. Concurrently with the above, they helped promote a politically and economically instrumental approach to the knowledge of life and its contents. Death and the Prudent Man So that every man, especially those that are over provident, are in an estate like to that of Prometheus. For as Prometheus, (which interpreted, is, The prudent man,) was bound to the hill Caucasus, a place of large prospect, where, an Eagle feeding on his liver, devoured in the day, as much as was repayred in the night: So that man, which looks too far before him, in the care of future time, hath his heart all the day long, gnawed on by feare of death, poverty, or other calamity; and has no repose, nor pause of his anxiety, but in sleep. Leviathan, xii: 169

Thomas Hobbes has the reputation of being antibourgeois, a charge that finds support in his Behemoth (1990 [1889]) – where he blames the urban bourgeoisie and the Protestant clergy for playing a role in the English Civil War. Nevertheless, notable philosophers have considered Hobbes’ work to be central to an understanding of the intellectual origins of bourgeois morality and political philosophy (Rousseau, 1754; Strauss, 1936; Arendt, 1966; Macpherson, 1962; cf. Hayes, 1998). Hannah Arendt, for instance, regards Hobbes as ‘the only great philosopher to whom the bourgeoisie can rightly and exclusively lay claim’ (1966: 139). This assertion finds justification in Hobbes’ theoretical formulation of a prudential civic order that acts as a limit to anarchy and ruthless competition (Strauss, 1936: 72; Hayes, 1998). From this perspective, prudence demarcates civilized man from the ‘brute of the nature’: ‘civil man is ... the man who has found a reasonable means to express (if not to satisfy thoroughly) the passions that he self-destructively exhibits in the natural condition: he ceases to be selfdestructive’ (Herbert, 1989: 22). The essence of this prudential order is the natural desire to live and the equally natural fear of death, which alone constitutes the ‘chiefest of natural evils’ (De Cive, I, 7: 47; cf.

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Strauss, 1936): the death anxiety should be inflamed rather than quenched because death is the most primordial and, as we will see, the most moral fear in men. Indeed, death anxiety is the source of all morality because it rationally inclines men to peace (Leviathan, xiii: 88). The fear of death is particularly powerful because it follows not from learning or culture but from the inviolable laws of nature: ‘for every man is desirous of what is good for him, and shuns what is evill, but chiefly the chiefest of naturall evils, which is death; and this he doth, by a certain impulsion of nature, no lesse then that whereby a Stone moves downward’ (De Cive, I, 7: 47). The use of impulsions instead of motives, as well as the elaboration of a theory of human behaviour in terms of the physical laws of motion that govern everything in nature, are both politically significant. They emphasize that which is rationally discernible from the material laws of nature and is, therefore, likely to result in consensus, peace, and order as opposed to that which originates in human subjectivity and leads, therefore, to dispute, discord, and war. This choice of words becomes meaningful within the context of early modern scientific debates between vitalists and mechanists wherein questions regarding chaos and order, justice and injustice, and the right resolution to the Civil War were closely tied into the hotly disputed questions of optics, motion, light, and generally, of matter (Rogers, 1996: 2–3; cf. Latour, 1993; chapter 2; Shapin, 1996: chapter 3). Mechanism and vitalism, as Rogers (1996: 2–3) has argued, were both homologized and homologizing models that explained all facets of life and existence (organic as well as inorganic, physical as well as political) in terms of the ‘universal laws of nature.’ Without attempting to renarrate this familiar episode in the history of science, I would like to point out two basic aspects of the mechanistic theory of motion that are central to Hobbes’ treatment of the fear of death as the main factor in the political-moral dynamics of human action. In contrast to vitalism’s Aristotelian belief that matter is governed by essence, a fundamental feature of all mechanistic views is the idea that to understand the properties of natural bodies it is necessary to understand the causes of their motions. Motion itself was considered to be nothing but a change of place caused by the competition between bodies to replace one another. This definition implies that, rather than volition and sympathy, ruthless and blind competition among atomistic entities rules the behaviour of atoms, inorganic matter, animals, humans, and the social and political worlds alike: life is nothing but the constant motion of atomistic particles,

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while death is simply the absence of motion. Man’s impulsion to dodge an oncoming peril and a stone’s impulsion to roll down a hill are both governed by the same mechanical laws of motion. The human body, the body politic, and a stone atop a hill are all bodies that seek to be in constant motion. The prudent, death-fearing man is a machine-man, to paraphrase the eighteenth-century mechanist, Julien la Mettrie (1996 [1748]), working in accordance with the physical laws of mechanics. Moreover, the body politic, or the Leviathan, is governed by the same mechanical laws of motion that govern the human body: the Leviathan’s ultimate goal is to avoid death because death is nothing but the absence of motion. The Leviathan is an ‘Artificiall Man,’ for whom ‘the Sovereignty is an Artificiall Soul, as giving life and motion to the whole body; The magistrates ... artificiall joints; Reward and Punishment ... are the Nerves ...; The Wealth and riches of all the particular members, are the strength; Salus Populi (the peoples safety) its Business; ... Concord, Health; Sedition, Sickness; and Civil War, Death’ (Leviathan, Introduction: 81). The human body and the body politic are both defined as machines comprised of body parts designed to operate harmoniously towards one end: keeping in motion, which requires avoiding death (at the individual level) and avoiding civil war (at the level of the body politic). All human bodies naturally strive to avoid death, and all bodies politic should strive to avoid civil war because the alternative is a state of war of all against all with no other consequence than death and destruction both for individual bodies and for the body politic (ibid., xiii: 185, and xiv: 190). Death thus conceived is a personal and a political nemesis. The class and gender assumptions underlying Hobbes’ rational, mechanical depiction of life and death did not stay hidden from his early critics. Jean-Jacques Rousseau (1754: Book I) famously argues that Hobbes’ ‘state of nature’ is nothing but a depiction of the state of the emerging bourgeois society in which ruthless and egoistic competition is the only law. Less known is the criticism of Margaret Cavendish, who portrays Hobbes’ understanding of human nature as crude and devoid of the finer human qualities, representing nothing but the ‘Opinion of some wise and Learned Men … that all Exterior Motions, or Local Actions or Accidents proceed from one Motion pressing upon another and so one thing Driving and Shoving Another to get each other’s place’ (1664: 95; 1655, quoted in Rogers, 1996: 188). Cavendish is particularly critical of the notion that motion is created

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by stronger bodies exerting force on weaker ones, ‘as a man doth a wheel-barrow, or a whip a horse’ or ‘by reactions, as if men were at foot-ball or Cuffs’ (ibid.). Such criticisms notwithstanding, Hobbes’ mechanistic approach to life and death bears significantly on his political morality. He observes that the natural desire to preserve life has tragic consequences: the same physical laws of nature that compel men to avoid death also drive them to violence. Out of each person’s unlimited desire for life and felicity arise egoistic competition and the potential for violence. The pursuit of welfare naturally leads to warfare (Leviathan, xiii). Put in the language of the mechanical laws of motion, since life is nothing but motion, and motion is the result of an attempt by one body to replace another, the desire to keep in motion (i.e., to preserve life) necessarily results in violence, as each body (whether an atom, a person, or a commonwealth) tries to replace another body. The natural tendency to preserve life implies the equally natural tendency towards competition, violence, and death, leading Hobbes to conclude that human beings are doomed, by their nature, to be destructive, create chaos, and undermine peace and order (xiii: 186). Yet although the tendency towards violence is located in the natural constitution of mankind, its manifestations depend on a variety of both natural and social triggers. In a key passage of Leviathan, Hobbes identifies three principle causes of violence: (1) competition for gain, (2) diffidence or the fear of being pre-empted by others, and (3) glory or the want of reputation (xiii: 185). Underlying all three is the desire to survive either by outmuscling and outwitting the competition or by attaining immortal glory. This natural destructive tendency is the more dangerous because it presents itself in even the most civilized states of life: ‘Warre consisteth not in Battel only, or in the act of fighting; but in a tract of time, wherein the Will to content by Battel is sufficiently known’ (II: 88). Hobbes’ fundamental problem, therefore, is not the actual existence of war but rather, as Foucault (2003: 92) has pointed out, the ever-present possibility of war within the civilized world. Hobbes is concerned with the theatrics of war, with the ‘unending diplomacy between rivals … in a relationship of fear in which there are no time limits’ (ibid.). What worries Hobbes is not actual physical violence necessarily but the ‘signs, emphatic expressions, wiles, and deceitful expressions … traps, intentions disguised as their opposite, and worries disguised as certainties’ (ibid.)

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Whether theatrical or physical, whether in the state of nature or in civilization, the untamed unleashing of violent impulses results in a ‘Warre of every one against every one’ (xiii: 185) in which ‘there is no place for Industry; because the fruit thereof is uncertain: and consequently no Culture of the Earth; no Navigation, nor use of the commodities that may be imported by Sea; no commodious Building; no Instruments of moving, and moving such things as require much force; no Knowledge of the face of the Earth; no account of Time; no Arts; no Letters; no Society; and which is worst of all, continuall feare, and danger of violent death; And the life of man, solitary, poore, nasty, brutish, and short’ (ibid., xiii: 186). The last sentence of the above excerpt is significant not only for its tragic elegance, which alone would account for its long-standing currency in the English language, but also because it is where Hobbes clearly ties the conditions of life outside civil society (‘solitary, poore, nasty, brutish, and short’) to the circumstances of death (violent and chaotic) and both of these to the absence of a political will, the covenant, to ensure peace and security. Life outside a civil order is undesirable because it is short and because it is qualitatively and materially lacking. In a war of all against all there is no guarantee of living out a normal lifespan nor any assurance of enjoying prosperity and other fruits of ‘propriety’ (xiii: 188 and xiv: 190). Political stability and economic prosperity are mutually interdependent; consequently, it is not sufficient for the sovereign merely to invoke the natural fear of death in his subjects. Rather, he must also appeal to their passion for the comforts of life, that is, to their ‘desire of such things as are necessary for commodious living’ and ‘a hope by their industry to obtain them’ (ibid., xiii: 188), for safety does not imply ‘a bare Preservation, but also all other Contentments of life, which every man by lawful industry, without danger, or hurt to the Commonwealth, shall acquire to himself’ (ibid., xxx: 376, also xxiv). Wisely channelled, these natural passions for life and its ‘contentments’ and the natural aversion towards death can be used to stave off other equally natural but deadly human passions that lead to war. In Leviathan, life, private property, and sovereign power forge an alliance against death, poverty, and chaos. No longer the arbitrary imposition of might, politics is now conceived as the prudent exercise of power in the interest of the preservation, protection, and most importantly, enrichment of the life of each and every individual. This novel conception of political ethics resonates with the basic tenets of a new science of political

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Figure 1.2 The Destruction of the Leviathan (Gustave Doré, 1865). ‘In that day the Lord with his sore and great and strong sword shall punish leviathan, the piercing serpent, even leviathan that crooked serpent; and he shall slay the dragon that is in the sea’ (Isaiah 27.1).

economy that emerged immediately following the English Civil War, especially in the work of Hobbes’ disciple, Sir William Petty, wherein the art of governing and the art of living, the security and prosperity

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of the body politic and the security and longevity of the individual citizen are entwined (see Chapter 2). The close interrelationship between life, politics, and the economy, or rather, between the human body and the body politic is illustrated in the frontispiece of the book, where the Leviathan is depicted as a giant-king who embodies his subjects. In the emblematic literature of the period the Leviathan is a large marine animal (often a whale, taken from the Book of Job). For Hobbes it simply stood asan ‘emblem of a well-ordered community in which the only abnormal characteristics were super-human size and strength – more typical of a magnus homos than of a monstrous being’ (Farneti, 2001: 336). With the publication of the book, and at the hands of Hobbes’ enemies, however, the Leviathan myth underwent a radical transformation and the sea creature became a monstrous serpent, ‘the savage embodiment of political evil’ (ibid.: 367). As illustrated in Gustave Doré’s 1865 biblical engraving, the Leviathan became a fierce dragon or a sea monster who stands as a symbol of chaos, death, and destruction (Figure 1.2). Interestingly, Doré’s engraving appears in the Book of Isaiah (27:1) where, unlike in the Book of Job, the Leviathan is presented as a malevolent creature to be ultimately destroyed by God. In contrast, the frontispiece of the original edition of Leviathan shows a peaceful and seemingly prosperous land (with rivers, roads, and farms) and a fortified citadel (see Figure 1.3). As a reminder of the myth of the biblical whale, the Leviathan standing in the background resembles an enormous sea creature surfacing from the water. The hills in the foreground likewise resemble waves. With outstretched arms and what seems to be a smile on his face, the Leviathan reflects the benevolent and protective aspects of the sovereign, guarding a prosperous and peaceful land (cf. Gorski, 2003: 1–2 and 157). Most importantly, the body of the Leviathan consists of many subjects all facing him, and his face is the only one that can be seen from the reader’s vantage point. Hobbes’ Leviathan is equivalent to those who comprise it: a people unified in life and not piled up together in death. We can begin to see now that, contrary to Foucault’s characterization, Hobbes does not found power on the threat of violence and death. Consequently, it is not necessary to ‘abandon the model of Leviathan,’ as Foucault invites us to do (2003: 34; 1990: 91), as a precondition of articulating a biopolitical theory of power. A theory of power as biopolitics is, in fact, rooted in Hobbes’ highly original articulation of a life-oriented system of sociopolitical order, in which life is

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Figure 1.3

Original frontispiece of Leviathan (1651).

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an ultimate value and not an instrument of power, and which therefore, distances itself from the vocabulary, laws, and culture of blood. Hobbes calls for prudence towards the conduct of life as an ultimate end in itself and as an absolute value that must be protected from death, violence, and anarchy by means of an alliance between the subjects and the sovereign. The ‘good’ is decided from the point of view of the living, of life, rather than from the metaphysical point of view of what lies beyond death. From this perspective, the original act of covenant commits Hobbes’ Leviathan, the benevolent giant, to the protection of life and to minimizing the chaotic threat of death in the interests of peace and prosperity. Life can be managed, maximized, and regulated precisely because the sovereign establishes a monopoly over the right to kill, thereby limiting the use of violence. Truth, Death, and Power The reconfiguration of mortality vis-à-vis political order and peace has a bearing on the relationship of power and knowledge. The Civil War highlighted the urgency of creating an objective and indisputable science of politics in which peace and order are regarded as the ultimate goals. This project called for innovations in both the structure of presentation and the content of political and moral philosophy. As for the former, Hobbes uses Euclidian geometry as a model, both in De Cive and later in Leviathan, in the hope of making his arguments immune to the influence of human subjectivity: ‘For were the nature of human actions as distinctly known as the nature of quantity in geometrical figures, the strength of avarice and ambition, which is sustained by the erroneous opinions of the vulgar as touching the nature of right and wrong, would presently faint and languish; and mankind should enjoy such an immortal peace, that … there would hardly be left any pretense for war’ (De Cive, Epistle Dedicatory: 25, italics original). As for the content, classical and scholastic ethical theories had to be discarded because they held a romanticized view of human nature and subordinated ethical-political judgment to metaphysical questions concerning the end of life, life beyond death, morality, and justice. Aristotle, Seneca, Plato, Cicero, and Plutarch preached vanity in the name of happiness, their misguided notions of justice undermined political security, order, and the obedience owed to a legitimate sovereign by his subjects (Leviathan, II, 31: 407). Hobbes, in contrast, maintains that the ‘good’ should be decided from the point of view of the

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living, of life, rather than from the metaphysical point of view of what lies beyond death. A comparison between the ethical theories of Aristotle and Hobbes demonstrates this point. Hobbes made significant revisions to Aristotle’s ethics in order to promote virtues that are driven from ‘rationalistic,’ ‘objective,’ and presumably undisputable forces within human nature, and to demote or renounce aspirations towards ‘idealistic’ and ‘subjective’ notions of truth or happiness; for instance, where in his list of things ‘good,’ Aristotle puts happiness first and ‘life only in the penultimate place’ (Strauss, 1936: 132), Hobbes puts life first and avoids attributing any merit to ‘vanity’ (such as the pursuit of honour or salvation). A comparison with Jean Bodin’s Six Books of a Commonweale (1962 [1576, 1586, 1606]), another seminal book on politics and ethics written against the background of religious conflict (this time in France), highlights the revolutionary nature of Hobbes’ innovations. Bodin’s work was praised for having ‘gathered the fruits of ... two thousand years of political experience’ since Aristotle and for reaching ‘conclusions more in keeping with the structures of sixteenth-century society’ (editor’s introduction, in ibid.: A28). Thomas Hobbes, on the other hand, could be credited with a fundamental and more or less comprehensive deconstruction of the basic premises of the 2,000-year legacy of Western political thought, which Bodin seeks to synthesize. This distinction is best demonstrated by the observation that where Bodin starts, following Aristotle’s model in Politics, with a theory of the state or commonwealth as ‘a lawful government of many families’ (Six Books, I: par. C), Hobbes begins Leviathan with a scientific exploration of the nature of man as a living and dying machine. Hobbes’ distaste for Greek philosophy finds additional justification in his reservations about the latter’s role in perpetuating a culture that glorified self-sacrifice in the interests of personal and national pride. Underlying the Greek approach to self-sacrifice was perhaps what Arendt (1958: 96–7) describes as an inherently political understanding of life and death characteristic of the Greek ideal of citizenship, whereby birth and death find their uniquely human meaning only within a political context. Accordingly, death and finitude are redeemed in the immortality of the polis. The potentially destructive ethical and political consequences of this cultural attitude towards death are illustrated in Thucydides’ cool-headed account of the Peloponnesian War, which Hobbes translated from Greek to English (Thucydides (1839 [1629])) as his first scholarly project, and which is said to be

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the only Greek work that exerted a lasting influence on him (Schlatter, 1975: xx–xxviii). Thucydides’ text contains several powerful passages that analyse how the war had given rise to a new moral code, which legitimized and glorified the willingness to suffer death for a just cause, as perceived through the lenses of nationalistic feelings and political affiliations. These include Pericles’ famous funeral oration in 431 BC for those fallen in the first phase of the Peloponnesian War, many of whom died during the lootings of the coasts of the Peloponnese ordered by Pericles himself (Hobbes, Thucydides, Book Two: par. 24–33). Pericles eulogized the dead not by directly addressing their virtues – as he admitted they were not necessarily the most virtuous citizens – but by praising Athens for which they had sacrificed their lives: ‘Such is the city for which these men, thinking it no reason to lose it, valiantly fighting have died. And it is fit that every man of you that be left, should be like minded to undergo any travail for the same. And I have therefore spoken so much concerning the city in general, as well to show you that the stakes between us and them, whose city is not such, are not equal; as also to make known by effects, the worth of these men I am to speak of; the greatest part of their praises being therein already delivered’ (ibid.: par. 41–2). The most redeeming quality of these men, who were motivated both by the pursuit of wealth and by vengeance against the enemy, was that when faced with defeat they chose an honourable death in battle over cowardly retreat to safety: Yet there was none of these, that preferring the further fruition of his wealth, was thereby grown cowardly; or that for hope to overcome his poverty at length and to attain to riches, did for that cause withdraw himself from the danger. For their principal desire was not wealth, but revenge on their enemies; which esteeming the most honourable cause of danger, they made account through it both to accomplish their revenge and to purchase wealth withal; putting the uncertainty of success to the account of their hope; but for that which was before their eyes, relying upon themselves in the action; and therein choosing rather to fight and die, than to shrink and be saved, they fled from shame, but with their bodies they stood out the battle; and so in a moment, whilst fortune inclineth neither way, left their lives not in fear, but in opinion of victory. (ibid.: par. 42–3)

For the Greeks, as Arendt (1958) argues, speech and action together constituted the essence of life in the polis, where speech provided

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direction to action, giving a grave weight to rhetoric and to motivational orations such as that by Pericles. Hobbes puts action, as reflected in humble, productive work, over speech. He commends Thucydides for noting ‘the emulation and contention of the demagogues for reputation and glory of wit’ and for pointing out that the inconsistency of resolutions put forward during the war was due partly to the ‘power of rhetoric in the orators; and the desperate actions undertaken upon the flattering advice of such as desired to attain, or to hold what they had attained, of authority and sway among the people’ (Thucydides: xvii). Following the ethical and intellectual model provided by Thucydides, Hobbes takes it upon himself to expose the irrationality of the passions for glory, vanity, and truth that unfolded during the English Civil War. He finds death a proper place in relationship to political life and articulates a new, more ethical approach to human mortality that stems from prudent fear rather than from irrational anxieties or vain fantasies. At stake was not merely the meaning of mortality but the possibility of politics itself. In ancient Greek thought, philosophy is seen as an art of living, of contemplating the meaning and purpose of life and death (Heidegger, 1997: 10–11). From this point of view, knowledge cannot be put in the service of strictly utilitarian purposes (Kemple, 1997: 12; 1995: 174). In contrast, Hobbes asserts that ‘the end of knowledge is power’ (De Corpore, 1: 6; see Ahrensdorf, 2000: 586). Ethical and political philosophy must serve the end of peace, submits Hobbes, by reminding the sovereign and his subjects of their absolute duties of sovereignty and obedience, respectively. The following chapter will demonstrate how this new approach to knowledge as an instrument of power is directly incorporated by Sir William Petty, Hobbes’ disciple, in founding the science of political arithmetic (a precursor to political economy), wherein the exact knowledge of the land and its population – including demographic trends in births and deaths – is considered indispensable to the art of governing in the service of peace and prosperity. The Denial of Immortality Hobbes’ project to radically revise moral philosophy in the interests of common peace and order encountered a major obstacle: the fear of this-worldly death and the desire for this-worldly life – the ultimate guarantors of peace and order – could be, and all too often were,

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dwarfed by the fear of damnation and the yearning for immortality. Hobbes finds it problematic that the power of God should appear greater than the power of the secular sovereign and that eternal life should appear more desirable than earthly life, and likewise that eternal damnation and torments should be feared more than violent or premature earthly death (Leviathan, xxx: 384; xxxi: 407–8; and xlvi). Belief in the immortality of the soul points beyond the objective laws and necessities of nature and awakens unearthly yearning in men that cannot be satisfied or controlled by any earthly means. It, thus, offers incentives to embrace anarchy in the name of truth and salvation: ‘The maintenance of Civill Society, depending on Justice; and Justice on the power of Life and Death, and other lesse Rewards and Punishments, residing in them that have the Soveraignty of the Common-wealth; It is impossible a Common-wealth should stand, where any other than the Soveraign, hath a power of giving greater rewards than Life; and of inflicting greater punishments, than Death’ (ibid., xlii: 478–9). To resolve the conflict between the pursuit of truth (as advocated by religion and philosophy) and the pursuit of peace, Hobbes not only subordinates the former to the latter but goes so far as to claim that there can be no truth that is contrary to peace: ‘And though in matter of Doctrine, nothing ought to be regarded but the Truth; yet this is not repugnant to regulating of the same by Peace. For Doctrine repugnant to Peace, can no more be True, than Peace and Concord can be against the Law of Nature’ (ibid., xviii: 233). The failure to bring the pursuit of truth in line with the requirements of peace results in nothing but the continual threat of civil war: ‘For those men that are so remissely governed, that they dare take up Armes, to defend, or introduce an Opinion, are still in Warre; and their condition not Peace, but only a Cessation of Armes for feare of one another’ (ibid.). Hobbes presents a new interpretation of the Bible so as to deny the possibility of eternal damnation and to demonstrate that divine punishment is not necessarily graver than the sovereign’s power of death or any more intolerable than the pain inflicted by wars and violence. Returning to the Book of Job, Hobbes argues that the immortality of the soul is not ‘of Nature, but of Grace’ (ibid., xliv: 644), that is, reserved for the faithful who are saved and for the sinners who are redeemed. For the rest, there is no immortality (in heaven or in hell) but rather only eternal death. Hell and hellfire, accordingly, are to be taken metaphorically to signify everlasting death and should not be taken to mean everlasting agony and burning (ibid., xxxviii: esp.

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483–4; xliv: 644). These assertions may be taken to imply that obeying a secular sovereign in the interests of peace and order, even if it is against one’s conscience, would not necessarily have grave consequences for the soul: at worst, one could expect eternal death but not eternal condemnation to hellfire. Socrates defines the difference between philosophers and nonphilosophers in terms of their attitude towards death: the former are single-mindedly devoted to contemplating death (Ahrensdorf, 2000: 586). Stoic and Epicurean traditions diminish the fear of death in favour of an attitude of acceptance or resignation towards fate. In contrast, Hobbes surmises that the contemplation or acceptance of death could potentially unleash chaos. The state must implement educational reforms and introduce readings that would remind everybody of the perils of war. The leisurely world of philosophy, which often produces nothing but ‘absurdities,’ must be denounced in favour of science, that is, in favour of ‘the knowledge of Consequences’ and of facts (Leviathan, v: 113–15; xlvi: 683), and the awareness of death must be replaced by the sheer fear of death. As Ahrensdorf (2000: 582–3) puts it, the purpose of education ‘is to make human beings who are secure feel insecure, so that they may properly appreciate their security and thereby continue to be secure.’ The prudent man is not only a ‘machine man’ but also a fearful one: ‘The modern state was based not on humans’ hope for salvation or their desire to fulfill their political natures, but on their fear of death and desire for self-preservation. The thesis of Hobbes in particular is that this desire for security is the most reliable and rational desire of our nature, and any state based on satisfying that desire is, unlike pre-modern forms of political organization, fully in harmony with human nature and hence fully capable of solving the problem of anarchy’ (ibid.: 579). The need to found a state transforms the moral alternatives of good and evil into the political alternatives of peace and war. Left on its own, human will leads not to peace but to its opposite: a war of action against action and of intent against intent. Conscience is not, as Hobbes had already submitted in 1640, ‘a judge of good and evil,’ rather, ‘it is the source of evil itself’ (Elements of Law, II, 7: 2; cf. Koselleck, 1988: 27). The result is an earthly domain of sovereignty that can neither be challenged by God nor justifiably resisted by its subjects. As the tale of the dialogue between the two horses cited at the beginning of this chapter suggests, Hobbes’ work was not an isolated effort, even though it was denounced vehemently during and after his life-

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time. He drew the outlines of a newly emerging political economy of blood in which the prevention and avoidance of the threat of death, especially of violent death, was to become the ultimate goal to which man’s brute physical force, as well as his desire for glory, truth, and salvation, had to be subordinated (Leviathan, xv: 216). In this new order, the aristocratic principle of honour is replaced with the bourgeois notion of prudence (Strauss, 1936: 112–13 and 129), the pursuit of immortality with the pursuit of mundane pleasures, the yearning for glory with hard work, the habit of excess with rational moderation, the philosophical contemplation of death with the fear of death: all in the hopes of attaining security, prosperity, and longevity. The Leviathan gives the absolute gift of life: a gift that can neither be refused nor taken back without the expectation of resistance. The modern state becomes a life-giving and death-defying state, or as Foucault puts it, a state less defined by its power to take life than by its power to ‘make live’ (2003: 247). In Hobbes we see the early signs of an attempt to institutionalize the separation of life from death, the life beyond from the life here and now. Herein lies an origin perhaps of the exclusion of symbolic exchange between life and death that Baudrillard (1993) pointed out more than two centuries later. No other doctrine should be taught than that which affirms the value of life, no other law should be imposed than what the sovereign sees as necessary for the protection of order, and no other truth may be sought by means of worldly violence. ‘Death and Us’: The Ever-Present Threat of Death Hobbes’ writing is rife with conceptual ambiguities that frustrate any attempt at a straightforward interpretation of it in terms of a chronological progression from the brutish and nasty state of the war of all against all in nature to the peaceful state of civilization. Indeed, Hobbes was aware that the civilized man of the polis is as inclined to violence as is the brutish man of the state of nature: if the latter kills for life’s necessities, the former kills for fame, glory, truth, meaning, and salvation. As Agamben (1998: 105) has noted, ‘the state of nature is not a real epoch chronologically prior to the foundation of the City but a principle internal to the City’; it is a state of exception always looming as a possibility. Nonetheless, standard readings of Hobbes often ascribe to him the binary opposition between the state of nature, which is presumably riddled with violence and fear, and the state of civiliza-

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tion, which is presumably orderly. This simplistic reading also characterizes the standard sociological interpretation of Hobbes, especially since publication of The Structure of Social Action (1937), by Talcott Parsons, where the ‘Hobbesian problem of order’ is introduced as the fundamental problematic of sociology and articulated in terms of this binary opposition (see van Krieken, 2002: 258–61; Macpherson, 1962: 22; Flathman, 1993: chapter 5; cf. Foucault, 2003: 94–7; Agamben, 1998: 105). Perhaps by overlooking Hobbes’ view that the inclinations of the man of civilization are at least as deathly as those of the brute of nature, these commentators have sought to salvage some coherency out of Hobbes’ thought at the expense of attending to its nuances. The result is the denial of the presence of deathly and violent impulses in ‘civilized’ societies. In classical and contemporary social thought violent death is routinely exoticized and externalized: it is attributed to the savage, to non-Western societies, the medieval period, and fanatical cults. Major social thinkers have described the distinction between what is ‘modern’ and what is ‘premodern’ or ‘traditional’ in terms of a more-or-less linear historical and geographical divide in which the ‘modern’ is associated with a life-affirming and peace-oriented cultural order while the ‘premodern’ and the ‘traditional’ are often associated with the politics of blood. Emile Durkheim (1978 [1889–1900] and 1984 [1893]) makes a distinction between two penal systems: a retributory system in which punishment is violent and deadly and a restitutive system which relies primarily on pecuniary penalty and imprisonment, a distinction that is incorporated (but also revised) by Michel Foucault, specifically in his Discipline and Punish (1977). Similarly, Max Weber (1993: 51–2, 87–8) draws on this historical distinction in his observations about the relationship between economic rationalization and the ethics of world religions, where he attributes what he considers to be the absence of ‘economic rationalization’ in Islam to the dominance of the warrior class with its ritualized and symbolic order of honourable and meaningful death. The notion of a historical change in the relationship between how we die and social order is prominent in the work of Norbert Elias, who has left two powerful depictions of the conditions of death and dying in his works: The Civilizing Process (2000) and The Loneliness of the Dying (1985). The latter concludes with a discussion of ‘Scenes from the Life of a Knight,’ in which violence, wars, and plunder are associated with a less-civilized state of sociopolitical development characterized by

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the public presence and visibility of violent death in daily life. The Loneliness of the Dying (1985), in contrast, illustrates the conditions of dying in contemporary Western societies where, Elias submits, violent death has become less of a daily occurrence, the social experience of death is sequestered and largely confined to private space or to hospitals, and where dying and seeing others die has become an increasingly uncommon experience. Sigmund Freud, in a talk given to the Jewish community entitled ‘Death and Us,’ later published as ‘Our Attitude toward Death’ (1985 [1915]), stands against this trend by reminding his audience, as he later reminded Einstein (1985 [1933]), that the tendency towards death and destruction is latent in the sociopsychological conditions of modern life. He accepts Hobbes’ assumption that civil society can to some extent rein in deathly impulses but in the final analysis the propensity to kill is as ‘human’ as the desire to live. Zygmunt Bauman’s Modernity and the Holocaust (1989) and Giorgio Agamben’s Homo Sacer (1998) are among the more recent reminders that modern societies are, indeed, capable of violence on a scale never seen in history, which cannot be attributed to psychological or instinctual forces but rather to institutionalized and routinized mechanisms. Conclusion: The Sanctity of Life and the Duty to Live If sovereignty has an absolute duty to protect life, what do we make of the power of the state to impose death lawfully, as in the death penalty and in putting its citizens in harm’s way by waging wars? A contradiction arises in which the modern state, which has the ultimate goal of protecting life and warding off death, is also equipped with the legitimate means to inflict death. Noting this persisting salience of state monopoly over the legitimate use of violence, Giorgio Agamben has argued that political power is demarcated by its exclusive right to define homo sacer: life that may be taken with impunity (1998: 6 and 8). In this respect there is no distinction between medieval monarchs or modern liberal democracies (ibid.: 9). Hobbes, however, argues that while the sovereign’s authority should be absolute, he does not have an irresistible power over death. In particular, the natural law of self-preservation overrides all other contractually agreed upon rights and responsibilities, including the duty to obey the sovereign at the expense of one’s own life. Thus, Hobbes places one significant restriction on the otherwise unlimited

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power of the sovereign: the sovereign cannot order anyone, even if justly condemned, to submit to death without resistance or to kill or wound or maim himself: ‘for by allowing him [the sovereign] to kill me, I am not bound to kill my selfe when he commands me’ (Leviathan, xxi: 269, italics original). Following the same logic, a person cannot be expected to confess against himself nor can he be expected to submit to the executioner without resistance. The right to resist assault on one’s life also includes the right to resist lawful punishment, since although committing crimes is a breach of the covenant and therefore unjust, defending one’s own life is not unjust (ibid., xxi: 270). Even if a person seems to grant an unconditional power over his own life to the sovereign, ‘he is not to be understood as if he meant it, or that it was his will; but that he was ignorant of how such words and actions were to be interpreted’ (ibid., xiv: 192). Similarly, Hobbes comes to the defence of those who would rather live in shame than die with honour: it is dishonourable, he argues, but not unjust to desert the army out of fear of death because ‘there is allowance to be made for natural timorousness, not onely to women ... but also to men of feminine courage’ (ibid., xxi: 269–70). This apparent discrepancy between the individual’s absolute right to defend one’s own life and the sovereign’s lawful right to impose death as a punishment is likely only a logical outcome of the belief that life is the primary natural and moral good. The unlimited and absolute right to preserve one’s own life, even against a lawfully imposed sanction, is the outcome of a new-found appreciation for life as the most absolute value at the dawn of the modern era, where self-preservation takes precedence, time and again, over all other social, political, spiritual, and rational considerations. The state’s power over death is articulated as an exception, an aberration of the law of the covenant, which commands the preservation, rather than the intentional and consensual destruction, of life. As Leo Strauss (1936: xii) has pointed out, Hobbes’ originality lies in the fact that he was the first modern natural law theorist to redefine natural laws in order to deduce from them not duty or obligation – as philosophers and political thinkers from Aristotle and Plato to Grotius had done – but rights. Among all rights, the right to life, and by extension to property, were taken to be given and self-evident and as having primacy over law, virtue, and social convention. Hobbes’ placement of life at the heart of political morality demarcates the dawn of an era in Western political life in which the gravitational centre of the sanctity of

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life is displaced from the community to the concrete individuality of each human person, creating what Durkheim memorably called ‘the cult of the individual’ (Suicide: 337; Shils, 1975: 229). The life of each person is regarded to be a sacred project whose prolongation becomes a personal and public commitment and whose safety and preservation intertwines the personal, medical, legal, and political regimes of governing life and death. This ‘natural’ right is tied into a new political culture in which the meaning of personal autonomy shifts from the autonomy to express oneself through one’s own honourable death (as exemplified by Seneca or Socrates) to the more basic, animalistic, and instinctual struggle for the preservation of one’s own life. Thus, whereas Pericles glorifies those who preferred death to cowardice, Hobbes argues that allowance must be made for those of ‘timorous character’ to desert the army. Leviathan marks the end of death as a moral, supra-individual event, the end of death insofar as it has a supra-natural meaning, a symbolism beyond nothingness, beyond the physical reality of a biological ‘stoppage’ and of decomposition. There have been attempts to revive death, the symbolism of death, and its extraordinary potential as a source of morality (Kierkegaard, 1939), as the ultimate symbolic gift (Levinas, 2000; Derrida, 1995), and as a path towards the discovery of one’s identity and uniqueness (Heidegger, 1997; Freud, 1922; Simmel, 2007). Marcel Mauss (1967: 67), for instance, argues that work is the sacrificial gift of life that the worker gives to society. In another context, Marx (1968 [1849]) establishes a fundamental relationship between death and capitalism by arguing that capital is nothing but the accumulation of dead labour power exerted in the past by the living worker and accumulated in the present by the capitalist. Labour power, he argues, is nothing but part of the life, the flesh and blood of the worker, which he gives in exchange for wages. Nonetheless, the Leviathan stands tall as the embodiment of the most enduring conception of the place of death in the modern sociopolitical order. With the birth of the modern right to life, life becomes an individual project and each person is given formal legal autonomy to possess and master this project (Macpherson, 1962). Yet, as I hope to show in the following three chapters, from the moment death is recognized as the ‘chiefest of natural evils,’ life is only one step away from becoming not just our most precious right but indeed our obligation, a duty that we owe ourselves – and, implicitly, society. The right to life becomes a life sentence: Thou shalt not sacrifice thyself. In the wake of Hobbes’

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secular interpretation of the value of life, the commandment ‘thou shalt not kill’ acquires a double meaning: we become subject to a negative sentence that forbids us from both killing and dying violently and a positive one, a life sentence that condemns us to life, that is, to the care, preservation, and prolongation of our own lives. In Hegelian terms this amounts to a slavelike relationship towards one’s own death, a notion that underlies Baudrillard’s rereading of the Marxian view of worker-capitalist relationships not merely in terms of mental and physical exploitation but in terms of the symbolic denial of death: the master is privileged in that he can gamble with his life while the slave has to live and labour. By being condemned to live, each person becomes a slave, sheltered and overprotected, but nevertheless in a slavelike relationship towards his or her own life and death (see Baudrillard, 2003: 70; Kemple, 1995: 91–102). The concept of the sanctity of life is a philosophical and religious notion that predates modernity. But the modern reincarnation of life as the highest value originates less in sacred religious beliefs than in the secular Hobbesian problematic of order which was tied, on the one hand, to the particular necessities of law and order at the dawn of the modern era and, on the other, to a mechanical understanding of the body and of the body politic, thus bringing together the existential question of survival and the political question of security under one comprehensive conception of political order. This secular notion of the sanctity of life is the connecting tissue that links our first modern right – the right to life – to our latest right: the right to die. Thomas Hobbes took the first path-breaking step in this area by problematizing violent death in strictly secular terms. His legacy was carried on in the immediate aftermath of the English Civil War and into the twentieth century as other forms of death, including premature death (Chapter 2), suicide (Chapter 3), and undignified death (Chapter 4), were each problematized as harmful, unnecessary, irrational, wasteful, and avoidable. Each of these successive forms of the problematization of death applied and perfected the main Hobbesian principles of taking a secular approach towards life and death; of debasing death’s socialsymbolic significance as a repository of meaning, identity, and salvation; of treating the knowledge of life and death as an instrument of power rather than as a means of existential contemplation; and of framing the question of life and death within the broader context of concerns with security and order. As the next chapter demonstrates, Hobbes’ lasting contribution to

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this political culture of life is attested to by his crucial influence on the generation of British and French writers (see Skinner, 1966) that emerged immediately after the English Civil War and who were predominantly responsible for the birth of biostatistics, public health, and political economy as branches of science concerned with the role of the state in the management, regulation, and prolongation of life. Most notable is the work of John Graunt (1662), the father of statistics, and his friend William Petty (1687, 1690, 1691, 1699), who explicitly professed his indebtedness to Thomas Hobbes and who followed the master in rejecting philosophical and metaphysical approaches to life and death in favour of objective and instrumental observation (1927, I: 219, cited in Buck, 1977: 78). These two late seventeenth-century figures took Hobbes’ work to the next level, creating a science of ‘political arithmetic’ in which the study of the trends of birth, longevity, and mortality are presented as integral aspects of ‘the Art of Governing, and the true Politicks’ (Graunt, 1662: 395).

Recto Running Head

2 Thou Shalt Not Die Prematurely: The Political Economy of Death

Prologue: The Post-Hobbesian Quantification of Mortality the gardener and death1 A Persian Nobleman: This morning my gardener, discoloured with unease, Entered my residence: ‘Lord, Lord, a moment please! Off in the rose-garden I trimmed branch on branch I glanced behind and there stood Death. Startled, I hurried to the other side Yet still just to see his threatening hand Lord, your horse, to say at once our journey began Before nightfall I will have reached Isfahan!’ This aft (long since had he departed) In the cedarpark ’twas Death I regarded. ‘Why,’ asked I, as he in his patient silence more deaden, ‘Did you this morning my servant so threaten?’ Smiling he replied: ‘ ’twas no threat Before which your gardener fled. I was startled, When this morn I saw here still at work to my regret Him whom at dusk in Isfahan I was to get.’ P.N. van Eyck (1887–1954)

1 I received a copy of this poem in Dutch from Winnie Schrijvers, a librarian at the Department of Legal Theory, University of Groningen, the Netherlands. I owe the English translation to Alexander Harmsen.

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The story of the Gardener and Death seems to have travelled East to West and found its place in the modern Western imagination within the context of a cultural obsession with the conflict between fatalism and free will (see Sobel, 1998: 55). It portrays Death as a speaking figure who can be seen in one’s private garden or, in another version of the story, in the marketplace in Baghdad. The story alludes to a time, real or fictional, when death speech, that is, talking about death publicly and without inhibition, was common, and when death was present in the midst of everyday life or in the hustle and bustle of the market. By contrast, our time is often characterized, rightly or wrongly, as a time in which our death, like our sexuality, has been silenced. It is often argued that ‘Occidental’ death, unlike its ‘Oriental’ counterpart, has been muted; that in modern Western societies loneliness surrounds death; that there is a taboo on speaking about death, most notably in the presence of children; and that people have become accustomed to denying death at any cost to the point of inventing sophisticated cultural strategies for forgetting death (e.g., Becker, 1973; Bauman, 1992, 1998; Baudrillard, 1993; Elias, 1985; Kübler-Ross, 1971). Accordingly, social thinkers offer us an invitation to liberate death, to break the silence that shrouds death, and to fight taboos against public mourning (Freud, 1985; Heidegger, 1962; Simmel, 2007; Leviton, 1995; cf. Arnason and Hafsteinsson, 2003). Yet, this only amounts, at best, to a story half-told.2 Rather than merely silenced or denied, death, similar to life itself, has become an object of interest, inquiry, demystification, quantification, surveillance, and regulation primarily through risk information gathering. Starting in the late seventeenth century, death has been made to speak systematically about itself and about life. It has been asked to unveil the mysteries of life hidden in the statistical tables of demographers as well as the filthy deathbeds of paupers’ children, in coroners’ offices and surgery rooms, in the anatomy and autopsy classes of medical schools, and in physiologists’ laboratories. Hence, we encounter a sudden multiplication in statistical and medical writings on death. Shortly after the end of the English Civil War, it became increasingly evident that violent death, so common throughout the seventeenth century, had only been one among many problematic forms of death. In England and France, and later on in the German-speaking regions, physicians, environmental epidemiologists, philanthropists, and statisticians 2 For works that challenge the notion of the denial or suppression of death see Parsons and Lidz (1967); Walter et al. (1995); Arnason and Hafsteinsson (2003).

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highlighted as problematic deaths caused by accidents, epidemics, malnutrition, and negligence. Although no specific term was used to designate these deaths, what they all had in common was that they were now deemed to be unnatural, that is, ultimately avoidable and therefore, in a sense, ‘premature.’ They included any form of death that could be considered preventable, depending on the state of medical knowledge and public health, as well as on the extant cultural expectations of longevity. Unnatural death was implicitly contrasted to the notion of a timely death that happened at the end of a fulfilled life and resulted from ‘natural’ causes, which meant from conditions associated with old age. At the same time, however, the limits of old age were pushed by medicine, science, and technology. Ultimately, the existence of natural death itself was questioned. The Marquis de Condorcet (1795) dreamed of a paradise brought about by reason and education in which death can be indefinitely postponed, resulting in worldly immortality. His English contemporary, William Godwin (1798), believed that at least premature death would disappear with social progress. Within the course of the eighteenth and nineteenth centuries, biologists, botanists, and zoologists discovered evidence showing that all death, even death from old age, is ultimately a violent and premature contingency caused by the intervention of external organisms (see, e.g., Metchnikoff, 1904). Thus, a process that started with the problematization of violent death by Hobbes led to the categorization of all deaths as violent and, therefore, as premature or avoidable. The public, political, and medical concern with death became so prevalent that Dorothy George, author of London Life in the Eighteenth Century (1925), saw fit to start her book with a chapter entitled ‘Life and Death in London,’ in which she describes advancements in hygiene, public health, medical services, and the effects of ‘moral reform’ on the health of the lower classes. This revolutionary transformation can to a large extent be credited to John Graunt, a London merchant and father of statistics. In his pathbreaking work, Natural and Political Observations … Made upon the Bills of Mortality (1662), Graunt presents the oldest existing statistical tables in which records of mortality as well as major causes of death are tabulated. He highlights epidemics, common illnesses, and a variety of lifestyle choices as among preventable causes of death that had hitherto been accepted with fatalist resignation. In addition, Graunt and his friend Sir William Petty – a direct disciple of Hobbes (Skinner, 1966: 157) and author of several influential books on political arithmetic –

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articulated a series of techniques for measuring mortality rates in terms of various preventable socioeconomic factors, making it possible to bring a degree of analytical certainty to the seemingly unpredictable and arbitrarily predestined reality of death. From Aristotle to Bacon, Western thought had been concerned mainly with the natural or divine limit of human life, as philosophers and scientists alike grappled with factors that determined longevity or the existence of a fixed limit to vitality (Le Bras, 1983: 32). With Graunt, however, premature death constituted the preferred semantic field for the scientific, objective, and instrumental studies of mortality. Until the seventeenth century, death was treated as an awesome display of God’s unchangeable providence, and the manner in which one died was taken as a sign of the believer’s other-worldly fate to come. God spoke to humanity through death. He set unchangeable limits to human life, three score and ten, beyond which He only allowed a select few to live (Psalm 90:10). One could intervene in predestination and hasten one’s own death but the horrifying treatment of the suicide’s body bore testimony to the community’s belief in the inviolability of divine laws (see next chapter). The transition from a cultural outlook that regarded mortality as a predestined fate, following immutable divine or natural laws, to a statistical view that made death an object of instrumental calculations did not take place easily or decisively. Prior to the publication of Graunt’s Observations, age-old beliefs among theologians and natural law theorists regarding the length of human life were still influential and hindered any attempt to quantify life and death experiences. Significantly, the biblical story of King David – whose decision to count the people of Israel is presented as a sin provoking the wrath of God (2 Samuel: 24) – had issued a taboo on empirical investigations into the numerical size of the population. By his own account, Graunt had for several years been ‘frighted, with that mis-understood Example of David, from attempting any computation of the People of [London]’ and did not pursue the idea before he finally examined and was satisfied of the ‘lawfulness of making such Enquiries’ (Observations: 59, italics original). By transcending this cultural dilemma, and by quantifying the existential experience of mortality, Graunt played a crucial role in the development of statistical techniques for the study of other subjective and/or social experiences that are widely used in quantitative sociology today. The work of Graunt and other early modern political economists and statisticians transformed death from a fate, a predestined moment

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around which one could prospectively build one’s whole life, into a manageable contingency or, into what amounts to the same thing, a risk. ‘Social constructionist’ theorists of risk have argued that modern societies reconstruct previously taken-for-granted aspects of life as risks that can be managed and controlled: events that had been previously described as accidental or unavoidable are now construed as preventable risks (Lupton, 1999: chapter 1; Dean, 1999: 182; Green, 1999). Death presents the prime example of an aspect of life that had for a long time been regarded as unavoidable or predestined but, with the late seventeenth century, came to be treated as a form of risk, that is, as an avoidable, indeterminate, and manageable contingency. The construction of death as a preventable risk entailed an overt ‘instrumentalization’ of the knowledge of mortality, making death amenable to political management (as in public health projects) and even economic profit-making (as in life insurance calculations). Consequently, this discursive transformation created an attitude of intolerance towards death and towards those segments of the population deemed to be at risk or high risk. As Dean (1999: 182) has argued, risk can be seen as among the ways in which we are required to know and to act upon ourselves and others in a range of moral and political programs and social technologies (see Lupton, 1999: 28–33). The conceptualization of death as a manageable risk has a normative bearing on how we live our lives or require and expect others to live theirs. Starting with Graunt, preventing unnecessary death and staying healthy gradually developed into a political necessity, a public duty, a sign of moral health, and a measure of progress and strength within national borders. Thus, death ceased to be a verdict or to give a verdict, as it had in the Persian tale. Little by little death became less fatal and more avoidable, to be treated less as a predestined fate and increasingly as a manageable contingency. But as death gave up its menace of the judicial sentence (an irresistible divine verdict), it became capable of exerting a discursive power that shifted expert and lay perceptions of human mortality by weaving together medical, moral, political, and economic concerns within the institutional settings of public health, life insurance, and the census. Graunt and Petty not only discovered ‘avoidable death’ as a subject of systematic, scientific problematization but also took it as their civic, political, and moral duty to suggest methods of combatting it. Similarly, for Johann Peter Frank (1786: 262), the renowned founder of social medicine and an advocate of

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public health, the contemplation of our ‘natural end’ is useful in improving not only the physical well-being but also the ‘moral state of man.’ For Frank, such contemplation is of utmost political concern in that it involves the interests of the state in the numbers and health of its citizens. In this context the European fascination with the encounter between the Persian Gardener and Death finds its full meaning: the Oriental tale has the exotic intrigue of an imagined time and place where Death still makes its own irresistible and fatalistic laws. Since the eighteenth century the speaking figure of Death, who arrives when it has to and takes a person’s life according to a predestined divine sentence (fate), began to lose ground in the modern Western imagination. It is significant that in some English versions of the tale, the encounter is described as an appointment between a person and Death, as in W. Somerset Maugham’s play Sheppey (1933), which inspired John O’Hara’s novel Appointment in Samarra (1934). The shift from an encounter to an appointment seems to correspond well with the emerging Western European conception of the linear time of life and death and with the discursive construction of timely death – as opposed to premature, accidental, and avoidable deaths – in statistical, medical, and public health literature. Sociologists and social thinkers often lament the loss of meaning in death, blaming this primarily on medicine’s obsession with prolonging life with no simultaneous attempts to define a meaningful place and function for death (Weber, 1958 [1919]; Parsons, Fox, and Lidz, 1999 [1972]; Becker, 1973; Bauman, 1992, 1998). This chapter, however, focuses primarily on early modern biosocial statistics, in part, because of its neglected but pioneering role in the transformation of death from an accepted part of life into a preventable risk. Moreover, early modern statistical writings arguably constitute a significant part of sociology’s own genealogical roots in that they made it possible, for the first time, to treat seemingly ‘personal troubles’ (to paraphrase Mills, 1959), including death, poverty, and illness, as ‘social issues’ open to intervention, surveillance, and prevention. Measuring Mortality: Death as a Manageable Contingency In recent decades, influential scholars have addressed the origins of mathematical and statistical approaches to understanding social life

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and argued that in modern Western societies the statistical problematization of poverty, illness, mortality, suicide, and hygiene are closely connected with questions of political stability and economic prosperity (Foucault, 1984, 2003; Rose, 2001; Poovey, 1998; Rusnock, 2002; Porter, 1996; Johansson, 2003; Buck, 1977; Hacking, 1975; Daston, 1988). But this literature often ignores the work of John Graunt, as Foucault (2003: 244) has done when he traces the genealogy of the concern with morbidity back to only the late eighteenth century. When he is not ignored, Graunt is placed among other founding fathers of probability, including Christiaan Huygen, Johan de Witt, Johan Hudde, Abraham de Moivre, and Edmond Halley, who are famous for their interest in actuarial risk calculations for the purpose of estimating annuity prices (see, e.g., Daston 1988; and Hacking 1975). Graunt’s originality, however, is that he goes beyond simple probability calculations of the chances of death for each age group and, instead, presents premature death as a preventable socioeconomic and political issue. In breaking with tradition and applying methods common among merchants, such as double-entry bookkeeping, to the human experience of mortality, Graunt aspires not simply to estimate the probability of death (as others had done) but, more importantly, to help improve the health, productivity, and size of the nation. Graunt’s work emerged out of early ‘bills of mortality,’ which were introduced in sixteenth-century England as a measure to contain the plague (see Figure 2.1). In 1538 Henry VIII, who had broken with the papacy and declared himself earthly head of the Church of England issued an injunction binding all parsons, vicars, and curates to keep an account of all weddings, christenings, and funerals (Farren, 1844: 8). For about a century, the bills came into and fell out of use with periodic plague epidemics. In London information gathered from various parishes was centrally collected and printed on a weekly basis. The idea was to enable the few who could afford the yearly subscription fee to follow the pattern of plague recurrences and take extra precautions, such as moving away from areas where the plague was becoming epidemic. Merchants found the information useful, as it helped them determine the patterns of need in the marketplace. Later on the causes of death were added to these bills, albeit with some reluctance because of concerns that such details might offend the sensibilities of ‘fine’ readers (ibid.: 15). Although death itself was a common and public event, providing exact information about its causes still went against accepted etiquette. A surveillance circuit

The Political Economy of Death

Figure 2.1

London Bill of Mortality 1603.

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was established between searchers (women who examined the corpses to confirm death and determine its causes), parish clerks (who organized, printed, and sold the information), rich families or businessmen who bought the information, and the state, which originally instituted the mortality bills. Using London bills of mortality from as far back as the 1590s, Graunt privately tabulated the trends for many years before he finally published them as a scholarly essay in 1662: the result is a work that not only founded the science of statistics but also proved, for the first time, that numbers could be systematically applied to human life. Unhappy with the inefficient and episodic application of the mortality bills, Graunt put them to a better, more comprehensive use. He felt that a greater picture not only about mortality but also about life generally could emerge if disparate numbers were put together, random upward or downward swings were factored out, and long-term figures of deaths and births (spanning several years) were considered in the aggregate. Graunt constructed several statistical tables that show the trends of burials and christenings, track the outbreaks of the plague, and identify the most notorious diseases. He extrapolated conclusions regarding population trends in London and elsewhere, the proportion of males and females, living conditions in London, the number of taxpayers, the proportion of men of fighting age, the insufficiency of roads leading to and within London, and so on. Observations contains several tables (Figure 2.2) which are striking because of Graunt’s method of arranging data into two columns: christenings and burials. This arrangement reflects the tradition of recordkeeping in the Church, where the biological incidences of birth and death were treated and recorded as sociobiological events of christening and burial. Although Graunt stayed with the sociobiological and ritual-symbolic tradition of the Church in using christenings and burials as his main organizing categories, his methods and style of presentation already anticipated the secularization of the methods of registering births and deaths. It took nearly two more centuries and much pressure from physicians, statisticians, and actuaries for this language to change. In 1837 a new law regarding civil registration came into effect in England, which separated church records of christenings and burials from official registrations, while at the same time making it mandatory to report all births and deaths to the local registrar by the next of kin, even in the case of a stillbirth or the death of a very young child (Glass, 1973: 128–9). Secular registration was deemed to be more

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exact, comprehensive, and free of religious prejudice. The failure to comply was punishable by fines. Among the initial opponents of the bill was the Archbishop of Canterbury, who questioned the onus put on the poor ‘to gratify the statistical fancies of some few philosophers, in order that they might know how many were born in a year.’ He suggested that interested ‘philosophers,’ and not the poor, should pay for the information they need (quoted in ibid.: 129). A Protestant merchant at the time (although he later converted to Roman Catholicism), Graunt was influenced not only by religious conventions but also by the double-entry bookkeeping technique. In the Epistle Dedicatory of Observations, Graunt points out that the book ‘depends on the Mathematiques of my Shop-Arithmetique,’ with the implication that it had enough credibility to be accepted and sponsored by the Royal Society (Observations: Epistle Dedicatory; see also Kreager, 1988: 133). Classical scholars of economic history, such as Max Weber (1878 [1927]), Werner Sombart (1953), and Joseph Schumpeter (1950), credit double-entry bookkeeping, which became popular among European merchants in the late Middle Ages, with revolutionizing finance and accounting and, therefore, playing a major role in the modern, rational organization of large-scale commerce and factory production in Western Europe (see Carruthers and Espeland, 1991; Poovey, 1998: xvii). Double-entry bookkeeping entails the systematic recording of financial information into two columns: credits and debits, where each transaction is assigned a monetary value and recorded in both columns: once as a positive entry and once as a negative entry. Similarly, in Graunt’s tables, church records are distributed into two columns representing christenings and burials, or put more crudely, additions and subtractions (see Figure 2.2). The parallel between debits and credits in financial bookkeeping and births and deaths in Graunt’s mortality tables is striking in that commerce thereby provides a model on which life and death can be thought of: birth is presented as a credit or an addition, while death becomes a debit or a deduction. Death is no longer an event that has meaning or positive social significance. Rather, it is registered in the negative, as a debit – with no return. This model served as a basic template to which other information regarding sex, age, social class, geographical location, and historical period could easily be added. The inclusion of these factors not only expands the double-entry model but also brings demographic tables a step closer to a form of Foucaultian panopticon: a visual device for omnipresent surveillance

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Figure 2.2 Table of Christenings and Burials (Graunt, 1662: 72, partial facsimile reproduction; original table includes the years 1636–64).

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Figure 2.3

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Chances of Survival for Each Age Group (Graunt, 1662: 58).

that renders a vast portion of the population visible while keeping the observer invisible and out of reach. With the emergence of systematic actuarial calculations, which transformed life insurance from a form of gambling on lives to a massmarketed product, the influence of commercial models on socialstatistical studies of life and death became even more profound and explicit: it was now possible to assign an exact quantitative (demographic as well as monetary) value to a person’s life and to make an estimation of potential profits in light of the statistical likelihood of that person’s premature death (Zelizer, 1979: 63; Clark, 1999; see also Ericson and Doyle, 2004: chapter 2). Graunt himself is credited with drawing the oldest existing ‘life table’ (see Figure 2.3) in Western scholarship wherein the life expectancy of each age group is calculated (Farren, 1844: 18; see Observations: 62). This technique would later become the basis of all actuarial calculations for life insurance and annuity purposes. Such previously unthinkable developments in the calculation of birth and death rates for a wide variety of applications give another layer of meaning and significance to Graunt’s original hesitation about publishing his mortality tables. Perhaps as a Puritan and a merchant, Graunt was torn between the text of the Bible and the appeal of rational, instrumental quantification. For centuries life and

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death were seen to be governed by divine providence; Graunt made it possible to measure the value of life and death in the profane terms of gain and loss, credit and debit. Death would no longer be a chance encounter, or even a predestined appointment, but rather, a loss that could be measured and predicted in the aggregate. That Graunt overcame his religious fears after he was convinced of the utilitarian uses of mortality rates (Observations: 59) is a significant indication of the way in which the tension between religious-symbolic and rationalinstrumental orderings of mortality was generally resolved on the intellectual (perhaps even cultural) level. Even without life insurance, Graunt’s work was already a giant step towards establishing the quantified knowledge of life and death as a useful instrument for more efficient political and economic governance. His work on mortality awakened the realization that the order, prosperity, and security of the state hinges on a thorough and minute knowledge of the population. Here we can see the first signs of the category of ‘population’ emerging as an object of biopolitical analysis, regulation, and management: ‘That whereas the Art of Governing, and the true Politiques, is how to preserve the Subject in Peace and Plenty, that men study onely that part of it, which teacheth how- to supplant and over-reach one another, and how, not by fair out-running, but by tripping up each other’s heels, to win the Prize’ (ibid.: 72, original italics). In place of egoism and unfair competition ‘the Foundation or Element’ of Graunt’s ‘harmless Policy’ was ‘to understand the Land, and the Hands of the Territory to be governed, according to all their intrinsick and accidental differences’ (ibid., original italics). For Graunt, as for Hobbes, the telos of the art of governing is to limit the blind pursuit of self-interest and preserve peace and prosperity for all. An integral aspect of this art is knowledge of the dynamics of the population, which entails an intimate understanding of the population not as a homogeneous mass but as a dynamic body governed by its own laws. If it is necessary for the state to know the size, shape, and productivity of its lands, it is ‘no less necessary to know how many People there be in each Sex, State, Age, Religion, Trade, Rank, or Degree, etc. by the knowledge whereof Trade, and Government may be made more certain, and Regular; for, if men knew the People, as aforesaid they might know the consumption they would make, so as Trade might not be hoped for where it is impossible’ (ibid.). As a first step in arriving at a systematic understanding of the population, Graunt uses his mortality tables to estimate the population of London, basing his calcula-

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tions, in part, on the assumption that, on average, no more than three deaths per eleven families (or one death in thirty people) occur each year in the city (ibid.: 62). Therefore, to obtain an estimate of the size of the population, he needed to know only the number of people who had died in a certain year. Given that there had been about 13,000 burials in London annually, Graunt argues that the city has only 384,000 inhabitants and not six or seven million as commonly thought at the time. Graunt’s statistical objectification of population trends is central to the history of the discursive problematization of premature death as a risk because he abandoned the idea that population gain should take place through either higher birth rates or the subjugation of foreign populations. Instead, Graunt’s work is underpinned by the ingenious realization – albeit not quite fully articulated – that reducing the rate of premature death is a far more efficient means of increasing the size of the population. This innovation places the role of statistical objectification of mortality in the rationalization of the art of government in the West on a parallel level, if not on a par, with the role that Max Weber ascribes to the systematic organization of free labour in the rationalization of capitalistic enterprise. In both cases, the main locus of political-economic gain shifts, even if only theoretically, from the uncertainty of conquest to the more calculable act of objective, quantitative, and rationalized management of existing assets. To this end, Graunt produced several tables to demonstrate the impact of various mortality risk factors as an aid to the state and its citizens to prevent or avoid them and, thus, to increase life expectancy across the population (ibid.: 23). This great invention, the precursor to statistical medicine and epidemiology, was made quite accidentally. Graunt had originally intended to tabulate and analyse the common causes of death not out of an interest in these causes but, rather, as part of a larger plan to scrutinize official figures of deaths from the plague. His goal was to statistically demonstrate that during plague years, plague-related casualties are deliberately deflated while other casualties are inflated.3 Yet, midway in his project, he seems to have realized that figures of non–plague-related casualties are valuable on their own. Graunt notes that whereas casualities related to epidemics are random and differ 3 This was because of the stigma associated with the plague and the fact that some searchers were bribed to avoid reporting plague-related casualties.

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from year to year, other casualties occur at a stable rate year in and year out, making it easier to establish statistical regularities as well as devise preventative measures against them. To demonstrate these statistical regularities, Graunt constructed a longitudinal table of casualties over twenty years, as well as two smaller tables, one showing the ‘more formidable, and notorious diseases’ and the second deaths from accidents (see Figures 2.4 and 2.5). Headache, rupture, gout, bleeding, drowning, suicide, poisoning, grief, and fright are listed among the most common causes of death worthy of attention and precautionary measures. These simple tables deconstruct death into many objective and measurable causes of dying, thus anticipating the soon-to-emerge practice of nosology, that is, the indexing and description of diseases, which, in turn, led to the compilation of lists of causes of death for the purposes of official registration (see below; Hacking, 1990: 53; 1991: 183). Graunt exhibits an attitude of tolerance and acceptance towards some causes of mortality – unimaginable from the point of view of the contemporary hysteria over mortality rates and causes of death. He points out that our fear of some categories of mortality is often exaggerated, just as is our fear of snakes: most people are frightened of them while few can attest to their danger based on first-hand experience (Observations: 23). Graunt even exhibits an attitude of resignation towards certain causes of mortality, arguing, for instance, that some accidents are not worthy of analysis or concern because they happen too randomly or are an inevitable outcome of particular jobs: ‘We shall say nothing of the numbers of those, that have been Drowned, Killed by falls from Scaffolds, or by Carts running over them, &c. because the same depends upon the casual Trade, and Employment of men, and upon matters, which are but circumstantial to the Seasons and Regions we live in; and affords little of that Science, and Certainty we aim at’ (ibid.: 23). Nonetheless, Graunt is quick to emphasize that his analysis is not meant to lull people ‘into security and belief of Impunity.’ His bills, he argues, are not intended to ‘be onely as Death’s-heads to put men in minde of their Mortality, but also as Mercurial Statues to point out the most dangerous ways that lead us into it, and misery’ (ibid.: 23). One of these ‘dangerous ways’ is association with ‘common women.’ Graunt points out that ‘French Pox’ (syphilis) is greatly feared but chronically underreported: only 392 of 229,250 deaths over a twentyyear period (1629–36 and 1647–58) are attributed to this disease, giving the incorrect impression that it happens infrequently. Graunt chal-

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Figure 2.4 Table of Notorious Diseases (for London for the years 1629–36 and 1647–58; Graunt, 1662: 15).

Figure 2.5 Table of Casualties (accidental causes of death, for London for the years 1629–36 and 1647–58; Graunt, 1662: 16).

lenges this false sense of security by demonstrating through statistical analysis that ‘French Pox’ is often recorded as ‘consumption’ (ibid.: 24). Mortality tables also shed light on the state of the human condition in London. Graunt observes that the danger of death for beggars is ‘acceptably’ low and that, generally, they seem to be living in healthy

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conditions (ibid.: 19). He takes the low proportion of deaths caused by starvation to be a sign that in London there is no shortage of food or the means to get it. Breastfed infants constitute the only exception to this general rule, but their high mortality rate is squarely blamed on ‘the carelessness, ignorance, and infirmity of the Milch-women’ (ibid.). Graunt’s brief but path-breaking venture in the area of mortality statistics convinced him of its immense political significance, prompting him to recommend that the state gather even more detailed information on the population. He predicted that such statistics would confirm that the majority of people, especially women and children, live their life idly, spending their time doing nothing; that of those who actually work, many are ‘meer Voluptuaries,’ ‘meer Gamesters,’ living by ‘Ministeries of Vice, and Sin’; and that only a few are ‘employed in raising, and working necessary food and covering’ or pragmatically studying ‘Nature, and Things’ (ibid.: 74). Echoing Hobbes’ mistrust of non-utilitarian knowledge, Graunt finds it troubling that too many of the ‘speculative men’ live on ‘puzzling poor people with unintelligible Notions in Divinity, and Philosophie’ (ibid.). Writing in the immediate aftermath of the English Civil War, Graunt invokes the Hobbesian connection between truth and security, stating that the objective, statistical knowledge of the population could help prevent civil strife, partisanship, and unrest: ‘I conclude, That a clear knowledge of all these particulars, and many more, whereat I have shot but at rovers, is necessary in order to good, certain, and easie Government, and even to balance Parties, and factions both in Church and State’ (ibid.; see Buck, 1977: 73; Poovey, 1998: xvii). In Graunt’s work, for the first time perhaps, death is made to reveal a necessary and useful truth to power. His mortality tables, which gained instant popularity, abstract the embodied, temporal experiences of vitality (longevity) and mortality into a numerical distribution spread across geographical areas (cities, districts, parishes) and/or social space (age groups, classes, ethnicities). Death, which had previously been treated as a tragedy of personal and social history, now became a public issue of political and economic geography. The personal embodied space-time of mortality is translated into the impersonal, abstract, and aggregate space-time of mortality tables and, for political and economic consumption, packaged into the numerical averages of life expectancy. The contribution did not go unnoticed. Upon the recommendation of the king, Graunt was made a member of

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the Royal Society even though he was a ‘shopkeeper’ and not a scientist by profession (Farren, 1844: 16). Slowly, an entire political economy of death began to emerge out of the details of mortality bills, mortality tables, and hospital records, which also figured prominently in the rivalries of the great European powers, as significant and celebrated figures followed John Graunt. Between the 1670s and the end of the seventeenth century, Sir William Petty, fellow of the Royal Society and a friend and relative of Graunt, published several essays in political arithmetic containing the results of his own studies of populations in England and Ireland. Petty’s views on the relationship of power and knowledge were greatly influenced by Hobbes and Graunt. In a letter to a friend, Petty (cited in Buck, 1977: 78) acknowledges his intellectual indebtedness to Hobbes, noting that his view of such concepts as ‘Sovereignty’ and ‘Empire’ is shaped by the conviction that they should ‘signify even as large a power as Mr Hobbes attributes to his Leviathan.’ Like Graunt and Hobbes, Petty regards mathematics as a source of knowledge free from ‘opinion’ and divisiveness by virtue of being unaffected by ‘passion or interest, faction or party’ (‘Political Arithmetick’: 313). For Petty, the act of quantifying is a source of self-discipline because it requires controlled and careful analysis (Buck, 1977: 73). ‘Political arithmetic,’ a name Petty himself coined, carries the promise of promoting ‘Industry, Unity, and Obedience’ in its practitioners, as well as ‘common Safety’ and ‘particular happiness’ for each individual person (Petty, ibid.). Petty observes that poverty, if augmented with plagues, fire, crop failure, or economic crisis, can lead to chaos and violence. But he also maintains that, although neither poverty nor other associated contingencies can be completely eradicated, political arithmetic can prevent violence and chaos by providing the objective and value-free facts necessary for good governance and the preservation of order on the basis of rational principles that everyone can agree on (Buck, 1977: 76–7). For Petty, as for Graunt, an intrinsic aspect of political knowledge is exact information about the size and character of the population: ‘to practice upon the Politick, without knowing the Symmetry, Fabrick, and proportion of it, is as casual as the practice of Oldwomen and Empyricks’ (‘Political Anatomy’: 129). Haphazard and random ways of doing things, associated with blind trial and error, feminine ignorance, and the infirmities of old age, have to be replaced with an exact art of governing aided by political arithmetic

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or the systematic and quantitative knowledge of the population. An integral aspect of this knowledge is gathering detailed and comparative data on the categories of fatal disease, a task that Petty undertook in order to promote understanding of ‘how the different Situation, Soil, and Way of living in each Parish, doth dispose men’ to different causes of death (Several Essays: 49). An objective estimation of the size of the population constitutes another integral component of political arithmetic. Petty uses burial figures between the years 1683 and 1685 to reach an estimate of the population of London (‘Two Essays’). Believing that the size of the population is a sign of the health and greatness of a nation, and writing within the context of early imperial rivalries between France and England, Petty takes such details as the number of people who have died in each city to ‘prove that London hath more People and Housing than the Cities of Paris and Rouen put together, and is also more considerable in several other respects’ (ibid.: 505). At the time, it was believed that Paris was the larger city since the court of Louis XIV had been more splendid than that of Charles II (ibid.: ed. notes, 505); Petty, however, takes the greater overall number of deaths in London as his main evidence for the contrary. Given the annual estimate established by Graunt – that no more than one person died out of thirty – Petty argues that the greater number of deaths in London compared with Paris is proof of the former’s larger population. Yet, a greater aggregate number of deaths is not always indicative of a larger population, especially if such a number merely reflects a greater risk of death threatening the existing population. In a comparative examination of deaths occurring in hospitals, Petty interprets the greater number of deaths in the hospitals of Paris, especially in the reputable La Charité compared with London’s lowly St Bartholomew, as an indication of the superiority of the English medical care system because ‘out of the most poor and wretched Hospitals of London there died fewer in proportion than out of the best in Paris’ (‘Two Essays’: 511). Thus, while London hospitals let people die by ‘natural necessity,’ the ‘evil administration’ of some Paris hospitals caused people to die ‘unnecessarily to the damage of France’ (ibid.: 511 and 512). More to the disgrace of the French, Petty’s numbers show that ‘although there be more People in London than in Paris, yet there went at London not so many People to Hospitals as there did at Paris, although the poorest Hospitals at London, were better than the best at Paris; which shews that the poorest

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People at London have better accommodation in their own houses, than the best Hospital of Paris affordeth’ (ibid.). Having demonstrated that about 3,506 persons die unnecessarily in La Charité every year, Petty calculates the damage to France to about £210,369 at £60 per head (the price of ‘Argier slaves’). He argues that, given the cost of raising one of the king’s subjects to maturity, and given the value of such a subject to the wealth of the nation, the state must protect the lives and health of its subjects and invest in combatting fatal disease because such investment would be much more profitable, by way of saving money, than investing in a lucrative business. Among his admirers William Petty’s work was seen as a further confirmation of the practical utility of mathematics as applied to the human sciences, and of the newly emerging notion that quantitative analysis is the most suitable method for studying human affairs. In a promotional abstract published in the prestigious Philosophical Transactions, Petty pitches his ‘Two Essays’ as a work demonstrating that ‘Mathematical Reasoning, is not only applicable to Lines and Numbers, but affords the best means to Judging in all the concerns of human Life’ (1686: 152). This appeal to quantitative analysis resonated with other late seventeenth- and eighteenth-century authors from diverse backgrounds. Physicians, environmental epidemiologists, and philanthropists took interest in mortality trends in the general population, and especially among the urban poor, as quantitative analysis promised to unveil the causes of illnesses and point towards the proper methods of their prevention through medicine or social and moral reform (Poitras, 2000: 201–3; Riley, 1987). John Arbuthnot, James Jurin, Francis Clifton, Thomas Short, and John Haygarth examined the existing bills of mortality to establish the trends of morbid causes such as smallpox. Robert Hooke, Roger Pickering, and John Lining, among others, studied the influence of environmental and meteorological factors on mortality rates. Lining measured his own urine, stools, heartbeat, and weight every day for a year, beginning in March 1740, and then used his connections to publish the results in the Philosophical Transactions (1742, 42: 491–509), insisting that if taken seriously they might yield insights into the effects of climate changes on epidemiological patterns (see Riley, 1987: 63–6). Before delving into these various fields of the statistical quantification of mortality as a calculable risk, it is worth noting that belief in

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divine providence continued to cast doubts on any efforts to articulate the laws of demographic dynamics in terms of socioeconomic factors, such as poverty or administrative incompetence. This belief was bolstered by the advent of Newtonianism in the early decades of the eighteenth century. Whereas Hobbes and Petty subscribe to a version of mechanistic philosophy that projects an image of chaos and conflict onto the universe, compatible with the reality of the English Civil War, Newtonian mechanism posits a view of the universe as a coherent and harmonious system that reflects an image of order and stability in the social world that is similar to the order of the natural universe (Buck, 1977: 83). Seen from this view, the length of human life is regulated by the laws of mechanics, which ‘cannot be altered either by surfeits or by famines … neither differences of race, climate, nutrition nor supplies can make any difference to the length of human life’ (Buffon, 1792: 188, quoted in Le Bras, 1983: 32). Yet, in light of the developments under way in public health and medicine, it was difficult to hold onto this view and at the same time explain the undeniable increase in the average lifespan. In the late eighteenth and early nineteenth centuries this paradox would define the work of Thomas Malthus, driving him to develop his Principles of Population (1798), almost in spite of himself. As a conservative writing in the aftermath of the French Revolution, Malthus found himself at home among the new naturalists, who argued that radical change in the human condition is neither possible nor desirable, given its cost. It is no surprise that Malthus was reluctant to endorse the idea that social progress can affect longevity: such beliefs were, after all, the product of the naive minds of the radical and atheist philosophes, such as Condorcet, and responsible for the atrocities in France. In the introduction to his book, Malthus explicitly criticizes scientific optimism and sets himself the task of proving that climate, epidemics, famine, and a shortage of land, among other things, limit the growth of population: these factors make premature death a rule and act against a disproportionate increase in population. Malthus postulates that high population density is the principal cause of misery and poor health, and he emphasizes the constraint imposed by the laws of population on efforts aimed at manipulating a population’s size or its rate of growth (Porter, 1986: 26). In a circular fashion, however, Malthus ultimately acknowledged what he had set out to refute: that the length of human life is an outcome of human action rather than of divine providence. Having

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observed that the mortality rates of children depend on the income and social standing of their parents, Malthus argues that ‘a decrease of mortality at all ages is what we ought chiefly to aime at’ (Principles, 1992: 320) and that the low mortality of children is an indication of better government and a sign of greater happiness among the population. This contradiction, which did not escape the attention of the more optimistic William Godwin (1820: 540), is somewhat resolved by Malthus’ assertion that although the average duration of human life is variable, its natural duration remains constant (ibid.: 57; see Le Bras, 1983: 37). This implies that, although we can improve and increase the average duration of human life by preventing premature death, the natural limit on the length of life would remain the same as that set by divine law. In any case, for Malthus a true understanding of the principles of population requires gathering quantitative information, especially on the lives of the masses of the urban poor, in the interests of constructing a history of all mankind against the traditional bias of focusing primarily on the history and details of the lives of the higher classes. Over time, and despite setbacks and hesitations, the study of mortality risk factors, pioneered by Graunt and Petty, branched out and became closely integrated into economic calculations in actuarial studies of mortality, for example, and in the area of statecraft, the newly emerging science of medical police – both of which played major roles in the eighteenth and nineteenth centuries’ policing of death as a contingent risk. Developments in these two fields were so closely interrelated that reformist physicians and philanthropists often found themselves working together with actuaries and vice versa. Dr John Haygarth (1740–1827), a physician and champion of sanitation, demography, and inoculation against smallpox, fought side by side with Dr Richard Price (1723–91), a statistician and actuary, as well as a Congregational minister, advocating improvements in the health and mortality rates of the working poor and the establishment of registrations of births, marriages, deaths, and the causes of death in the United Kingdom to replace spotty and scattered parish registers (Lobo, 1990: 230). As an esteemed and authoritative actuary, Price found such information indispensable for a more exact valuation of reversionary payments and life insurance policies (cf. Glass, 1973: 53). These two fields are examined below, based mostly on historical evidence from England, with supplementary information from

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German sources. For historical reasons England remained more enthusiastic about statistics in the eighteenth century than France or any other European country (Porter, 1986: 37; Hacking, 1990: 4 and 127–32), while the German states developed a keen interest in the science of public health (see Rosen, 1974: 61–78 and 142–56). Public Health: Policing Death in the Body Politic The management of death as a risk required policing the causes of mortality, that is, detection, surveillance, and fight against major causes of morbidity afflicting the body politic. This involved a leap in political imagination, making it possible to use the population as a new medium or a new level of intervention in the everyday life of the people. Mortality statistics had already demonstrated that the population, unlike the body politic or the mass of subjects, has its own categories and each category its own dynamics: men and women, children and adults, youth and the elderly, the rich and the poor are not all equal before death. Once this giant leap had been made, it was only a matter of time before statistics was applied to medicine, giving rise to the science of medical police, whose main objective was the discovery, monitoring, and management of the causes of death. Graunt and Petty paved the way for this new science by compiling comparative data on the categories of fatal diseases in several parishes in order to examine local and regional variations in the major causes of morbidity. In the late eighteenth and early nineteenth centuries, concerned philanthropists, reformers, and statisticians, such as Richard Price, John Haygarth, and Arthur Young, championed the use of statistics and the creation of a system of comprehensive registration as necessary means for investigating the relationship between mortality rates, health, the environment, and personal status. Haygarth (1774: 67) asserts that knowledge of such facts ‘must be of the most important consequence, to the politician, the philosopher and the physician, in their several endeavours to relieve the miseries, and promote the happiness of human nature.’ Johan Peter Frank, the late eighteenth-century Prussian pioneer of social medicine, goes a step further and recommends ‘a system of complete medical police’ (which is also the title of his book) to be built on the alliance of ‘the power of the state’ and ‘the knowledge of the physician’ (Medical Police, 1976 [1786]: 4). It should be noted that Frank’s use of ‘police’ is consistent with the German usage of the term,

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as illustrated in Hegel’s theory of civil society, which contains a section on police as an institution entrusted not only with the safety of people and property but also with public health and hygiene (Hegel, 1952 [1821]: par. 236–48; cf. Foucault, 1977: 213). Frank’s goal was to take medicine beyond the traditional role of the physician as confined to ‘making others healthy in the republic’ and expand it into a profession in which ‘the influence of medical science in the well-being of the states would attain a new splendor’ (Medical Police: 4). Frank includes the science of medical police under the rubric of general police science, the objective of which he describes as ‘the internal security of the state’ (ibid.: 12). The entrenchment of public health duties within the mandate of police science entails the institution of a comprehensive system that ‘has as its subject the general health, care and appropriate order in it’ and is intended to ‘acquaint persons in authority with the necessities of the nature of their subject and with the causes of their physical ills’ (ibid.). Above all, medical police is ‘an art of defense’ against death: ‘Medical police, like all police science, is an art of defense, a model of protection of people and their animal helpers against the deleterious consequences of dwelling together in large numbers, but especially of promoting their physical well-being so that people will succumb as late as possible to their eventual fate from the many physical illnesses to which they are subject’ (ibid.: 12). Frank quickly found a following in England and the rest of Europe, and his ideas are echoed in the nineteenth-century works of such eminent medical statisticians, philanthropists, and actuaries as Florence Nightingale, William Farr, and Edwin Chadwick. The main objective of this science (or ‘art,’ as the two are used interchangeably in the above extract and in Frank’s entire work) is to make the care for the health of the population a permanent subject of intervention, even in the absence of the traditional major causes of mortality such as plagues, because ‘the country’s loss [was] the same when its citizens died by the thousands because of various specific diseases and bad conditions, and when they were lost due to a single epidemic’ (ibid.: 13). A century earlier, John Graunt had disregarded certain accidental causes of mortality as unworthy of attention because they do not occur on a regular basis. Drowning or falling from the scaffold, and in general, deaths caused by occupational, seasonal, and regional factors afford ‘little of that Science, and Certainty’ that Graunt was aiming at (Observations: 23). For Frank, by contrast, it is a political imperative to prevent ‘the numerous accidents to which people in

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every community are exposed either by their own carelessness or by the incautious behavior of their fellow citizens, through the nature of their ordinary actions or through violent physical causes’ (Medical Police: 13). The ultimate goal of Frank’s medical police is nothing other than a total conquest of accidental death. Frank regards health and longevity both as constitutive parts and as signs of the more general civilizing process. Like Graunt and Petty, he attempts to exoticize premature death, to banish it to the backward stages of civilization or to uncivilized pockets within the civilized world, because its occurrence is a source of shame and an indication of failure for advanced societies. Poisoning, for instance, is attributed to ignorance and to the prevalence of ‘the Asiatic way of life’ among the courtiers. Likewise, a variety of other causes of death are attributed to the persistence of irrationality, ignorance, and immorality in the dark corners of civilization. These include the use of ‘irrational’ methods of childbirth by a ‘contemptible crowd of superstitious’ midwives, promiscuity, abortion by young girls, foundling hospitals, insufficient food, preventable injuries, apparent deaths that are not prevented because of superstitious taboos against touching a dead body, brawls, and self-killing, which is itself an outcome of celibacy, secret vices, reading poisonous novels, and the abhorrent teachings of the Stoics, debauchery, idleness, and irreligion (ibid.: 238 and 241). Yet, there is hope that the spread of ‘manly feelings of the rights to mankind’ and the progress of science will moderate religious or political prejudice and replace depravity by enlightenment and tolerance (ibid.: 230–1). The policing of preventable death, therefore, entails moral restrictions on gambling, a ban on praising suicide on the stage, and efforts to curb debauchery. It also requires taking positive steps, such as the introduction of gymnastic games and other amusements, to keep the body healthy, to alleviate the misery of the poor, and to cure melancholia in places of safety (ibid.: 243). The implementation of these disciplines of the soul and of the body make death the exclusive domain of physicians, the possessors of the art of medical police (ibid.: 201). Interestingly, among Frank’s categories of accidental death is an entry called ‘found dead at home’ – implying that only a death foreseen, supervised, or sanctioned by a physician is worthy of the name natural death; all other deaths are possibly only ‘apparent deaths’ (reflecting the newly emerging idea that a person can appear to be dead while, medically speaking, she or he is still alive) or in any

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case, suspicious, morally shameful, and the result of ignorance or of insufficient policing. Frank’s concept of medical police was influential among many early nineteenth-century English writers whose work was facilitated by the already strong tradition of statistical investigation in England. The eminent English statistician and actuary Edwin Chadwick is of interest here because he systematically bridges the field of medical police with actuarial analysis conducted for the purposes of life insurance (see below). Chadwick’s studies of differential mortality rates among social classes illustrate the moral, political, and economic implications and utility of the new knowledge of mortality and call for the creation of a public office of health charged with the responsibility to determine the number of deaths from preventable causes and entrusted with the power to take any measures necessary to keep mortality rates in check (1844: 29). The Board of Health was established in 1848 and Chadwick himself served as its commissioner until its abolishment in 1858. Among Chadwick’s goals was to buy off porteurs d’eau, cheffoniers, and food scavengers, who had a hold on water delivery and garbage collection in France, England, and America, because he saw them to be barriers to the improvement of water supplies to houses and to the use of mechanical equipment for cleansing cities (ibid.: 31). Chadwick recounts with disappointment the story of ‘profound statesmanlike men’ in New York, who refused to buy a mechanical sweeper because it would have required laying off thirty to forty workers and thus losing potential votes. The interest in saving and preserving lives, evident in the works of Chadwick and Frank, might be a reflection of the increasing popularity of the idea, originally broached by Graunt, that longevity rather than a high birth rate was the best source of population growth. Relying on the first General Sanitary Report of the United Kingdom (1965 [1842]), which he himself drew, and similar studies of New York and Philadelphia, Chadwick concludes that population gain through longer lifespans, instead of through higher birth rates, has the advantage of increasing the proportion of mature and working adults in the whole population as opposed to the ‘youth and passionate,’ who are economically and morally burdensome (ibid.: 27): birth was at most a precarious source of population growth because the infant mortality rate was still very high, especially among the poor, who were losing one out of two babies (as compared with one out of four among the

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gentry), suggesting that the children of the poor often died from preventable causes (ibid.: 9). This new-found interest in population health intersects with the age-old question of morality. In the work of Chadwick, as in that of some of his contemporaries, a direct relationship is constituted between mortality, hygiene, and morality. Chadwick asserts that living in ‘undrained, uncleansed, filthy, and badly ventilated abodes,’ regardless of employment or wage, results in higher mortality and lower morality (ibid.: 10 and 25–6). Hygiene, thus, became the standard and the signifier of a morally and physically healthy life. Work was likewise associated with lower mortality risks, as is evident in Chadwick’s preference for the adult, working population over ‘the young and passionate,’ and in his conviction that the risk of death is lowest among robust working men compared with children, women, the sickly, and the feeble, who presumably did not work (ibid.: 10). This morbid classification of social groups along moral lines resonates with the new capitalist work ethic: a life of hard work holds the promise of a life long lived. For most political arithmeticians of Chadwick’s generation, and especially for those who established the first ‘statistical’ societies in England in the mid-1830s, and later on in France, premature death is a consequence of ignorance and filth which, in turn, lead to disease, crime, and domestic turmoil (Porter, 1986: 34). What gives this discourse a pronounced class edge is that many members of these early statistical societies were industrialists, close relatives of industrialists, or ‘improving’ employers (cf. Cullen, 1975: 144n32), who too often were willing to blame the low life expectancy of the poor on their use of alcohol and their moral degeneracy, rather than on the inhumanity of early modern industrial society and its alienating and chaotic tendencies. The mathematical (re)construction of death as a contingent risk, then as now, had a normative function. As the well-documented history of health reforms in the eighteenth and nineteenth centuries shows, improvement of the population’s health and prevention of ‘unnecessary death’ called for systematic monitoring of specific segments of the population that were found to be prone to illness and premature death because of biological (e.g., age, sex) or socioeconomic (e.g., lifestyle, living conditions, economic class) factors (see Foucault, 1984; Rose, 2001; George, 1951 [1925]). This statistical system of surveillance helped label certain populations, such as the ‘milch-women,’ ‘strangers,’ the working class, the elderly, and the

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‘feeble,’ as high risk or simply at risk. At a time when a large and productive population was thought to figure prominently both in national economies and in the rivalries among European nations (Poovey, 1998: xvii; Glass, 1973: 55), it became imperative that the poor become healthier and live longer, not necessarily because of the intrinsic value of their lives but because, unbeknownst to them, their vitality and mortality are now tied to the grandiose schemes of the state’s political economy. The poor must be fed and kept healthy not only out of a sense of noblesse oblige or common obligation to humanity but also to conform to the cold calculations of instrumental utility. All of this is in part because it was now possible to put death into numbers, to place order on death in increasingly sophisticated tables, and to treat death as a mathematically calculable contingency. Life Insurance: Longevity as Economic Capital The creation of risk categories associated with premature death had an immediate economic impetus, most significantly in actuarial studies for life insurance and annuities purposes. Insurance against death had for a long time existed in England, first in the form of gambling and speculation on lives, that is, betting on the length of a person’s life by third parties, and later in the form of ‘benefit clubs’ and ‘friendly societies’ that admitted members on a fixed fee basis (Clark, 1999: chapter 1). Both the gambling and the non–profitoriented models were characterized by their lack of interest in or ignorance of various risk factors that could affect the duration of a person’s life. But the discovery of mortality risk factors made it possible to devise a system of pecuniary provisions ‘against the evil of premature death’ as differentiated by factors such as age, sex, economic class, and place of residence (Farren, 1844: 28). As life insurance went beyond voluntary societies formed by and for the gentry and professionals (such as the clergy) and moved towards early forms of profitoriented policies marketed to a wider base of clientele, it became even more important to take account of the differences in mortality rates across social groups and, therefore, to weed out or penalize those who were at a higher risk of dying prematurely. The most basic and essential technique in actuarial calculation is the creation of life tables, credited to Graunt, wherein the chance of survival for each age group is statistically determined (see

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Figure 2.3). Such tables, as well as Graunt’s more general epistemological innovation in quantifying mortality in terms of various sociostatistical and medical categories, laid the conceptual foundations for actuarial analysis of mortality rates as differentiated by various biographical, socioeconomic, and environmental factors. Following this model and relying on the bills of mortality, Edmond Halley (1693), Abraham de Moivre (1725), and Richard Price (1771) attempted to determine the price of annuities on lives by means of an estimation of the risk of death and, hence, the chances of survival for each age group (see Hacking, 1975; Daston, 1988). Graunt’s original life table, however, relies too heavily on guesswork since the mortality bills that he had at his disposal did not cite age at death. In 1693 Halley used data from the German city of Breslau, which were gathered between 1687 and 1691 and recorded age at death, to arrive at a more accurate estimate of survival for each age group. He then used this life table to calculate the purchasing price of life annuities for any person of a given age, based on the probability for that person to survive and continue receiving annual instalments. With his calculations Halley shows, for instance, the ‘Advantage of young Lives over those in Years; a Life of Ten Years being almost worth 13 ½ Years Purchase, whereas one of 35 is worth but 11’ (cited in Farren, 1844: 28). Apart from age, social class was also soon taken into account as a risk factor influencing the chances of survival. From early on at-risk populations and their unusually high mortality rates were given special consideration in mortality tables, but as far as life insurance is concerned, it was Edwin Chadwick who pioneered the use of systematic methods of accounting for the differences in mortality rates across social and geographical space. In a paper originally presented at a meeting of the Statistical Society of London, Chadwick warns against the dangers of overgeneralization across social space and historical time, arguing that average life expectancy cannot be calculated merely by taking into account ‘the proportions of deaths to population.’ Rather, detailed information-gathering based on local ‘experiences of mortality’ should replace abstract generalizations across neighbourhoods, regions, and countries: ‘There is no general law of mortality yet established that is applicable to all counties or to all classes, or to all times, as commonly assumed; that every place, and class, and period has rather its own circumstances and its own law, varying with those circumstances; that the actual experience of

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any class, place, or period … is a safer guide than any insurance table deduced from the experience of another people living at another time and place, or any assumed general law’ (1844: 8). To start with, Chadwick suggests that factors such as age and economic class – as reflected in living standards, sanitation facilities, nutrition, access to medical care, and above all, employment in hazardous occupations – be taken into account (see Table 2.1). Chadwick’s own preliminary investigations indicate that the average lifespan among working class individuals was about half that among the higher classes in London, mostly because of overcrowding and stationary accommodations (ibid.: 5). Factors such as family medical history, body weight, previous illness or surgery, occupation, living conditions and environment, sex, and possible exposure to ‘moral hazards’ at home or work were also taken into consideration from the early days of commercial life insurance (Davis, 1944: 99–108). A story in Louis-Sebastien Mercier’s Tableau de Paris (1999 [1782]) provides a vivid illustration of the methods commonly used by early life insurance underwriters and annuities purchasers for estimating individual risk factors and chances of survival. The story involves what Mercier describes as a typical encounter between a buyer of annuities and a woman trying to sell her interest on annuities for ready cash. Since the interest will only be paid for as long as she is alive, the amount of cash the woman can get depends on the prospects of her lifespan. The buyer, therefore, has to take into account a number of risk factors that may cut short the seller’s life. Age is the first risk factor considered, and perhaps anticipating the question, the seller has brought her birth certificate along as proof of her age. At the time the prospects of living for each age group were estimated based either on actuarial calculations or on popular beliefs regarding mortality patterns (cf. Clark, 1999: 118). The woman in question is forty-seven years old, beyond the critical age believed to have the highest risk of mortality. ‘If you had been forty-two,’ the buyer tells her, ‘I should have refused having any dealings with you’ (Tableau, ibid.: 137). Next they discuss a variety of socioeconomic and lifestyle factors. The woman has to prove, not only that she is from the right social class and in good health (indicated by natural, white teeth and good physical build) but also that she lives ‘very regularly; no heavy suppers, no late nights’ (ibid.: 137). Reiterating what seems to have been a common belief at the time that ‘women who have had children live the longest,’ she mentions that she has four children, ‘not

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Figure 2.6 Mortality table for London districts for the year 1839 (based on Chadwick, 1844: 34–5).

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too many not too few’ (ibid.: 138). Yet her lifestyle is the most persistent concern for the buyer, even above her physical condition and medical history. The buyer justifies his inquisitiveness by saying, ‘I’ve got to have my security; I can’t buy from everybody. For instance, I never buy from a man; there is too much pleasure-seeking, nowadays. So I’ve made a rule only to buy from the ladies’ (ibid.). The supposed moral prudence of women puts them in a lower risk bracket, but it does not erase all concerns: The Buyer: Yesterday, madame, I had the offer of buying up four thousand francs a year; but I didn’t accept. Why? Because I’d heard that the lady in question was for ever going to balls. One night’s dancing may be deadly. Might I enquire what your occupation is? The Seller: Housekeeping; and when that’s done I read, except that I always take the air for an hour or two every day. Now, monsieur, you see I lead a regular existence; how much will you give me for my twelve hundred a year? The Buyer: … Women are delicate creatures; late nights, too much good food, too much wine – the question of diet’s most important. Cards, even, are bad for the health. The Seller: I never play, and I live most carefully. (ibid.)

From the early eighteenth century, the application of actuarial methods transformed life insurance from a form of ‘betting on lives,’ which implied speculation on the time of a person’s death, into a prudential investment in lives. It required knowing when people die, why they die, and whether the risk of their ‘premature’ death could be minimized. Actuarial calculations were supplemented by external surveillance as well as the cultivation and internalization of healthy habits, practices that have persisted and expanded since then (Davis, 1944: 99–108). Such techniques produced various advantages: they not only made the speculative business of life insurance more systematic and profitable but also contributed to the constitution of healthy subjects, thereby promising to promote social security and moral rectitude (Clark, 1999: 85). By the mid-nineteenth century, the success of for-profit, actuarially based life insurance was so obvious that the House of Commons in England called for making it more widely affordable, which resulted

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in the creation of industrial life insurance, that is, life insurance policies designed for and mass-marketed to lower income families (Davis, 1944: 5). As Doran (1994) shows, the eventual dominance of massmarketed life insurance based on mundane, actuarial techniques of risk management came at the expense of the discourse of benevolence and brotherhood used by community-based life insurance schemes offered by friendly societies and burial clubs, schemes that had been in place at least since the seventeenth century and whose primary goal was lending a hand to other participant members in their time of need. As the advantages of mortality statistics became more apparent, the culture of life insurance came rapidly under the sway of profit motives. Although the notion of putting a monetary value on lives was rather self-evident for actuaries, it took a long cultural battle to prepare potential clients to treat their own lives or those of their loved ones in this way. Studies of the history of life insurance for working-class men and children in the United States (see Zelizer, 1979, 1985) and in Europe (Clark, 1999) throughout the eighteenth and nineteenth centuries show that insurance companies faced widespread cultural and legislative resistance early on. Life insurance was regarded as sacrilegious and insurance money was seen as ‘dirty money.’ Wives did not want to receive ‘blood money’ for their husbands, and some even thought that buying life insurance was inviting one’s own death (Zelizer, 1979: 48–53). The history of actuarial life insurance industry, therefore, reveals an interesting battle between cultural values and the scientific-rational quantification of the value of life. In constructing death as a risk to be calculated and managed, life insurance companies transformed life and health into a commodity: a form of capital which, in the words of Solomon Huebner, a prominent twentieth-century life insurance underwriter, can be organized, managed, and conserved by applying ‘the same scientific treatment that we now use in connection with property’ (Huebner, 1924: 18, cited in Zelizer, 1979: 63). Huebner defines death from a strictly pecuniary perspective as any event that results, not necessarily in the termination of life, but in the termination of the stream of profit that a company can make off a person in the form of monthly premiums. These events include premature death, casket death, living death (disability), and economic death (retirement). Huebner portrays premature death as a waste of money and recom-

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mends annual medical check-ups for an expert inspection and for taking an ‘inventory’ of one’s own body, as one would do of one’s own property (Huebner, 1964: 18). From Graunt to Chadwick (and still today), the quantification of mortality as a calculable economic loss has had the effect of subjecting the day-to-day moral sensibility of working-class families to the rational ethos of modern capitalist enterprise. Attempts to moralize the everyday lives of policyholders have continued, as life insurance companies still use systematic methods of moral and lifestyle surveillance, especially when reviewing new applicants, to guarantee the maximum longevity, and thus profitability, of the insured for the insurer. Insurance companies have also spent large sums of money on extensive studies of matters affecting the well-being of their policy holders, on educating them on issues related to their health, and on participating in public health campaigns (Davis, 1944: 116). As early as 1871, the Metropolitan Insurance Company published health hints in its policyholders’ magazine, and in 1892, in cooperation with the Health Department of New York City, it prepared and distributed a popular circular on cholera. In 1898 a booklet entitled ‘A Friend in Need Is a Friend Indeed’ containing health information was published for its Canadian policyholders (ibid.: 116 and 294). As the result of this long process spanning more than two centuries, life insurance has become, if it was not from its early days, just that: life insurance and not death insurance. Whereas benefit clubs and friendly societies were designed to provide support in times of crisis – a family member’s death – life insurance is oriented towards managing the life that goes on before such a crisis happens. Actuarial concerns with longevity and health-risk factors are now complicated by the uncertainties of the market and by constantly changing criteria of medical risk assessment, all of which work to further tie the meaning and value of life to the dynamics of market economy (Ericson and Doyle, 2004: 46–59). Moreover, from the point of view of the consumer, rather than merely being a provision for survivors, life insurance has become an investment for life, especially for old age, and quite similar to pensions (ibid.: 73). As such, life insurance constitutes another step towards the separation of the afterlife from life here and now, towards the suppression of economies of gift exchange (between the dying and their survivors) in favour of market economies, and towards redrawing the boundaries between life and death.

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Conclusion: Governing Death in the Aggregate ‘Father I’ve often thought that life is very short.’ ‘It is short, no doubt, my dear. Still the average duration of human life is proved to have increased of late years. The calculations of various life assurance and annuities offices, among other figures which cannot go wrong, have established the fact.’ ‘I speak of my own life, father.’ ‘O indeed? Still,’ said Mr Gradgrind, ‘I need not point out to you, Louisa, that it is governed by the laws which govern lives in the aggregate.’ Charles Dickens, Hard Times

It might be unfair to compare Graunt, Petty, Halley, Chadwick, and other inventors of the ‘modern fact’ to Dickens’ no-nonsense protagonist, Mr Gradgrind. Graunt and those who followed him were undoubtedly often motivated by humanitarian sentiments. Their aggregated statistics drew attention to social injustices as reflected in differential mortality rates among social classes. Yet, their work also contributed to the formation of a scientific outlook according to which life, its meaning, and its content are to be interpreted from the perspective of aggregate numbers if such an interpretation is to be at all credible. For, as Poovey (1998: 27) has pointed out, the business ethic of the early modern merchants contributed to the establishment of a link between credibility, credit, facts, and numbers, one which was then imported uncritically into the terrain of science. Mr Gradgrind’s exaggerated obsession with the numerical laws that ‘govern life in the aggregate’ as the only plausible way of interpreting life finds a more benign and subtle echo in Halley’s reflections on the uses of life tables: ‘It may perhaps not be an unacceptable thing to infer from the same tables how unjustly we repine at the shortness of our lives, and think ourselves wronged if we attain not old age; whereas, it appears hereby that the one half of those that are born are dead in seventeen years time, 1238 being in that time reduced to 616’ (1693: 654). The mathematical reconstruction of death as risk led to changes in cultural approaches towards death and in doing so also created new social divisions. The new scientific death speech is part and parcel of the modern technologies of moral and hygienic surveillance of the body and of the body politic. Health and longevity are used as vari-

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ables to determine the productivity and the moral integrity of different segments of the population. The physical body and the body politic become the bearers of new binary variables, which, in the words of Foucault (1984: 278–9), include not only those that separate ‘the healthy and the sick, the strong and the weak, the rich and the poor’ but also those that distinguish ‘the more or less utilizable, more or less amenable to profitable investments, those with greater or lesser prospects of illness or death and with more or less capacity for being usefully trained.’ Mortality rates, when used in public health and actuarial calculations, create statistical norms: risk categories are defined as those in which the actual mortality rate deviates from the ‘normal’ mortality rate in the standard population. As Deborah Lupton (1999: 114) points out, the ‘at risk’ label tends either to position members of these social groups as particularly vulnerable, passive, powerless, or weak, or as particularly dangerous to themselves or to others. In both cases, there are often calls for directing special attention to these social groups, subjecting their lives to outside scrutiny and intervention. The profound and enduring effects of this legacy are evident in contemporary epidemiological and health-risk journals, where Graunt’s ‘milchwomen’ and Frank’s debauchers have been replaced by other constructed risk categories, such as drug-dependent populations, foreign residents, infants with no father’s name on their birth certificates, drug users with no legal income, overweight people, sex-workers, gay men, and so on (see Green, 1999; Forde, 1998; Skolbekken, 1995; Fielding, 1987). In this light, and in view of the use of mortality statistics in actuarial calculations, the contrast between the discursive and quantitative death speech emerging from mortality tables and the enigmatic and mysterious death speech of the old Persian tale takes on additional moral, social, and political dimensions that go beyond the simple replacement of fatalism with calculated predictions and risk management. The new scientific death speech is part and parcel of the modern technologies of moral and hygienic surveillance of the body and of the body politic that bear witness to the persistence of the Hobbesian Leviathan as a metaphor for the organization of personal, social, and political relations. For, the Leviathan, as we saw, stands for a body politic in which sovereignty and its subjects, the mythical body of the king and the corporeal body of citizens, come together, the health and

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safety of the one ultimately determined by and determining the health and safety of the other. For us, the inheritors and the products of this centuries-long process, not only death but also life itself has become a different reality. In 1662 John Graunt emerges from the shadows of a culture for which life and death follow God’s immutable providence, and tries to ‘put men in mind of their Mortality’ and to ‘point out the most dangerous waies that lead us into it and misery’ (Observations: 356), lest people submit to death unnecessarily. Graunt’s work contributed to a legacy of fascination with health and longevity, and an obsession with finding new hazards and risks conveyed in both the modern media and in professional public health investigations (Bauman, 1992, 1998; Becker, 1973; Green, 1999). As Forde (1998: 1158) has noted, risk awareness is a necessary foundation for increased health awareness and a desirable impetus for people to take responsibility for their own health through making behavioural changes. Yet, such awareness not only makes us more dependent on health care consumption, but more profoundly, it changes the way we think about health, disease, and death. Ultimately or at least potentially, it will also alter our outlook on life more generally as we learn to adopt a rationalistic life perspective, in which maximizing control and minimizing uncertainty is seen as a superior goal (ibid.). Sociology has often focused its analytical reflexivity on medicine and epidemiology at the expense of investigating the role of the social sciences themselves in the formation of a culture obsessed with controlling mortality and mortality risk factors. If, however, the ‘sociological imagination’ consists in the ability to recognize aggregate dynamics that underly seemingly individual episodes (Mills, 1959), the discursive transformation of death, from a tragically inevitable fate into a manageable ‘issue’ addressable through policy interventions, may be considered to be an early modern example of this imagination. In light of this proposition, we need to examine whether the discipline of sociology, which has been commonly associated with the social anxieties of urban areas in the full-blown industrial age of the nineteenth century, might instead be rooted in the security concerns of the early modern nation-state building phase. If so, it would seem that both the recognition of anarchic, uncontrolled mortality as among the most serious threats to social and political order, as well as the realization that statistical objectifica-

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tion carries the potential of taming this threat, played a significant role in mitigating these security concerns. This currently marginal chapter of sociological prehistory would constitute a crucial extension of the discipline’s genealogy worthy of inclusion in our historical canon.

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3 Thou Shalt Not Kill Thyself: The De-moralization of Suicide

Prologue: The Descent to Divinity In 1823 a London jury returned a verdict of felo de se (guilty of suicide) after hearing the case of a twenty-two-year-old law student named Abel Griffiths. Following the ruling, his unwashed, bloodied body was wrapped in Russian matting and dropped into a hole at the crossroads of Eaton Street, Grosvenor Place, and the King’s Road. Other ignominies could have been imposed on his body, as was customary in earlier times, such as throwing lime over it or driving a stake through it. But the jury spared the body additional humiliation. At the time, opposition to crossroads burials, and to the criminal status of suicide in general, was mounting and negative religious and cultural attitudes towards suicide were being questioned. It happened that on that particular day the carriage of King George IV was held up by a crowd of spectators watching the desecration ritual, drawing further attention to the issue at the highest political level (Annual Register and Chronicle, 1824: 82; retold in Gates, 1988: 6). The ignominious burial of Abel Griffiths became the last of such rituals that the curious London crowd would see. Fifty years earlier, Thomas Chatterton (1752–70), the exemplar of the doomed and underappreciated romantic poet, killed himself in poverty and despair. Just a few months shy of his eighteenth birthday, too poor to pay for his tiny London attic, and abandoned by his potential patron, Chatterton tore his papers to shreds and swallowed arsenic. He ‘laid a violent hand on himself,’ to use the parlance of the time, but this was the romantic period and his death was destined to become beautiful even if it was, in reality, messy, gruesome, and

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Figure 3.1 Death of Thomas Chatterton (Henry Wallis, 1856, © Tate Gallery, London 2007).

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painful. In a painting accomplished between 1855 and 1856, Henry Wallis immortalized Chatterton’s dead body as the most seductive male corpse of the nineteenth century (see Figure 3.1). Chatterton made young death so fashionable that John Keats and Lord Byron aspired to die young like him, and William Wordsworth made him a symbol of ‘resolution and independence’ in a poem by the same title. The romanticization of Chatterton’s death, albeit decades after it had actually happened, sheds light not only on the general intellectual and artistic mood of the early nineteenth century but also on the profound changes in attitudes towards suicide, especially among the elite. By the end of the century, when Émile Durkheim wrote his celebrated monograph on the topic, Suicide (1951 [1897]), it had become a wellestablished belief among many elites and intellectuals that suicide was neither immoral nor criminal. Most Western European states had either decriminalized suicide or abandoned the enforcement of punishments for it. Thus, it came as a surprise when Durkheim contended that, from society’s point of view, suicide is indeed immoral and it will become even more morally abhorrent as civilization progresses. For Durkheim, the history of suicide is governed by the ‘law of increasingly strict prohibition,’ which implies that the rigour of anti-suicide laws increases with the growth of individual rights vis-à-vis the state (ibid.: 332–7). Accordingly, societies go through two stages with regard to suicide. In the first, society (and not the individual) has authority over suicide, as it maintains the right to compel certain people to sacrifice themselves, especially for ceremonial, symbolic, and religious purposes; in the second, neither the individual nor society has that authority (ibid.: 332), except perhaps in extreme situations of military combat. The pervasiveness of the ‘cult of human personality’ in modern societies implies a toughening of moral attitudes towards suicide. This cult entails neither the worship of egoistic individualism nor moral permissiveness towards egoistic acts (such as egoistic suicide) but an attitude of reverence and protection towards the sacredness of the ideal humanity as manifested in the individual (ibid.: 337). The sacrosanct dignity of the individual is not the property of the state, the society, or the individual. It places the person above oneself and above society, ascribing a quality to the individual that is reserved in every religion only for its gods (ibid.: 334). Suicide offends the collective conscience of ‘higher’ societies because the strongest sentiment that holds them together is offended. The cult of individuality elevates man to the status of a god, and like all gods, he is to be deprived of the

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authorship of his own death (ibid.: 332–3). In the first century AD, Pliny argues that suicide is ‘the supreme boon that nature has bestowed on man among all penalties of life,’ because to take one’s own life is a privilege that the gods do not have (Natural History, 2: 27, in van Hooff, 1990: xii). In the nineteenth century, Durkheim realizes that our ascendance to divinity is, simultaneously, a fall from humanity. The first objective of this chapter is to tell the story of this fall. Critics such as Westermarck (1917: 263–4) and Marra and Orru (1991: 273) argue that Durkheim is wrong in his assertion that suicide is a graver crime in individualistic societies, because, clearly, both suicide and attempted suicide have been decriminalized. Such criticisms notwithstanding, the second objective of this chapter is to demonstrate that the abolishment of punishments is by no means indicative of a lack of moral and legal regulation. Rather, what has changed is the form of legal and moral sanctions, as anticipated by Durkheim’s own argument, in ‘Two Laws of Penal Evolution’ (1978 [1889–1900]) and in The Division of Labor in Society (1984 [1893]), namely, that the forms of moral regulation and legal sanction evolve in a demonstrable relationship to the evolution of the society. This change is further elaborated in Foucault’s (1977) discussion of a general shift in Western modes of social regulation from practices that are mainly juridical and punitive to those that are mainly disciplinary and regulatory, from those that target the body to those that target the soul. Accordingly, and as was the case in other public spectacles of physical punishment, ritual desecration of the body of felo de se gradually disappeared, giving way to imprisonment and medical treatment aimed at reforming the mind of would-be suicides. In the nineteenth century the biopolitical and discursive interest in regulating how, when, and why people die found a new but elusive target in suicide, a form of death that is not only violent and premature, but also self-inflicted. Previously, moralists, monarchs, and ecclesiastical authorities had sought to condemn this highly symbolic and subjective form of death, they had not dreamt of effectively predicting or preventing its occurrence. The new-found interest in knowing and preventing suicide was not devoid of moral content. In the seventeenth and eighteenth centuries, biostatisticians such as Johann Peter Frank (1786) had established a link between morality and mortality, arguing that a morally undisciplined life was a life constantly flirting with the risk of death. In the nineteenth century, when statisticians took an interest in suicide, such moral concerns grew even more pro-

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nounced: suicide was considered to be not merely a consequence of other immoral acts, but also in itself a manifestation of a morally condemnable will to die. This was a time of widespread anxiety over moral decline and degeneration, especially in England and France, and the perception that suicide rates were rising, perpetuated by medical and social statisticians, fit convincingly within that general psychological mood (see Hacking, 1990; Nye, 1984; Pick, 1989; Oberschall, 1986). Suicide posed an intriguing challenge for nineteenth-century statisticians interested in making systematic predictions on the basis of fixed, objective, and knowable factors. Whereas the statistical trends of other avoidable causes of death might, to a large extent, be explained in terms of ‘objective’ biological, social, and economic factors outside the scope of individual volition, suicide emanates from, or gave the impression that it emanates from, an individual’s free will. Overcoming free will, so to speak, became central to the medical, sociological, and legal discourses that developed around suicide in the nineteenth century, – a development similar to what Mariana Valverde (1998) has decribed in her study of alcoholism. Madness eventually provided the key to the statistical objectification of suicide: mental maladies and, subsequently, social malaise were seen as objective, measurable, and preventable forces capable of explaining the enigma of suicide. The result was the discursive transformation of suicide from an individual act belonging to the category of morality and free will to a social and medical problem resulting from external, objective forces that are amenable to control, management, and prevention. These developments bore on how suicide was to be controlled. Suicide had been a crime deserving of condemnation and even punishment until, in the nineteenth century, the attribution of suicide to madness and malaise (psychological and social) resulted in the weakening of such ancient sanctions. The abandonment of ritual punishments of the suicide’s corpse may have promised a new era of tolerance – but only at the cost of undermining, suppressing, and denying the symbolic meanings inherent in the act of self-killing. The modern Western imperative to subject suicide to scientific objectification stripped the self-killer of any claim to subjective meanings and intentions: if he killed himself, he was merely driven by social or physiological forces. This chapter examines the role of statistics in relocating suicide from the domain of law and morality into that of positivistic scientific inquiry, with particular attention to the various ways in which such

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discursive relocation led to the silencing of the symbolic and subjective meanings of suicide. The Age of Sermons: The Logic of Punishments The degradation of the body of one found guilty of suicide was a timehonoured custom among the ‘savage’ as well as the ‘civilized.’ Provisions for the ritual degradation of the body of felo de se came to be included in the legal codes throughout Western Europe, from around the thirteenth century, supplemented by pecuniary punishments such as forfeiture of land and chattels (Fedden, 1938: 141). These punishments were especially severe in France, where in 1670 suicide was made a grand crime and existing suicide laws were made even more severe (ibid.: 142; Crocker, 1952: 50). Yet, the ignominious treatment of the corpse originally had little or no basis in legal sanctions but seems rather to have been imported into the law from a variety of existing cultural practices. From ancient times, and in various European societies, popular belief had attributed macabre characteristics to the suicide corpse and to associations with it. Individuals who killed themselves had diabolical powers that were denied to the living and the naturally dead. For instance, their ghosts, like the ghosts of the murdered, were believed to wander around seeking vengeance on those deemed responsible for their misery or violent fate (Murray, 1998: 37). Consequently, customs and rituals were developed for handling the suicide corpse for the purpose of containing its diabolical powers. In Athens, for example, it was customary to cut off the hand of the suicide, while at Metz, the whole body was put in a barrel and floated down the Moselle River, away from the territory in which the ghost was believed to want vengeance. Burial at a crossroads, with a stake driven through the suicide’s chest, was presumably designed to confuse the ghost and prevent it from finding its way back home (see Murray, 1998: chapter 1; Gates, 1988: chapter 1; Fedden, 1938: chapter 3; MacDonald and Murphy, 1990: chapters 1 and 2). While some rituals were devised to prevent or contain the harm that the suicide’s corpse was believed to be capable of, most were of a more strictly symbolic nature, designed to humiliate the soul and the body. For instance, the corpse was often dragged face down through the city, hung from the heels, burned, and dumped into the town’s waste pit or a well. Hanging the body upside down, sometimes between the bodies of two dogs, was reportedly used in Bordeaux towards the end of the Middle

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Ages (Murray, 1998: 32). It is as if the medieval and early modern imagination deliberately attempted to devise ever more creative ways to maximize the humiliation to be imposed on the corpse of a suicide. The survival and codification of customs and rituals against suicide in the Middle Ages, the persistence of such rituals well into modern times, and the still-existing, unspoken taboos that make suicide a shame and a social ill, not to mention the great reluctance with which anti-suicide laws were finally removed from law books well into the twentieth century, all suggest that there might be a factor, more vital than religion, superstition, or economic interest, underlying the negative cultural (legal, medical, and sociological) treatments of suicide. Why did the collective conscience in the West (as in many other places in the world) feel so compelled to devise ever more elaborate rituals to maximize the humiliation of the suicide’s corpse throughout much of human history and well into modern times? Why was suicide a sin graver than homicide (as Saint Augustine asserts) when intuitively it seems to entail a lesser harm, if any, and the Bible does not explicitly make suicide a sin? Some historians argue that suicide was harshly punished because it represented a political and economic liability, especially during the Middle Ages when peasants were the property of landowners or the king and thus their suicide constituted an economic harm (MacDonald and Murphy, 1990: 15–28, 109–125). But the question remains whether the suicide of a ‘village idiot’ or of a law student living as a freeman in London, such as Abel Griffiths, constituted enough economic harm to warrant such severe punishment. Might it be that the harsh responses to suicide stemmed from the profound symbolic challenge that it made to the collective conscience? Could we perhaps regard suicide, in both its most religious and most secular symbolism, to be a ceremonial gesture: a ritual offering in exchange for vengeance or sympathy? Is not suicide often a symbolic act of protest against a real or perceived injustice? The ritual punishment of suicide is striking because it seems so archaic and inhumane today but, more importantly, because it is just that: a punishment. At the very least, and all other objections aside, it would seem illogical to punish a dead person. But this is exactly where the logic of antisuicide laws becomes manifest: these seemingly irrational rituals are nothing but symbolic punishments imposed in retaliation for a symbolic act. The object of punishment is not the body – even if the punishment is inflicted on the body – but the soul, which is believed to be affected by what happens to the body through the mediation of a system of symbolic exchange

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between the world of the living and that of the dead: the soul will be barred from heaven if the body is desecrated and interred without religious rites. Ancient and medieval moral philosophy took note of the peculiar symbolic challenge inherent in the act of self-killing. It condemned suicide as an affront to God, to natural law, and to society. Saint Augustine asserts that to take one’s own life is to pervert God’s law and the natural law of self-preservation: it goes against reason and disrupts the rational natural harmony and continuity of the universe (see Burgess-Jackson, 1982: 57). The individual is still the centre of the universe and has to pay a price for preserving this status by conceding his liberties with regard to his own life. Enlightenment philosophers, on the other hand, brought man back to earth. We are, according to them, too small for our actions to have any effect on divine providence or on the laws of nature, neither can our departure constitute a significant social harm (Beccaria, 1963 [1764]). To kill oneself is no more a perversion of the laws of nature than is diverting the course of the Danube River (Hume, 1894 [1777]: 157), neither is it more consequential to the providential order than making a ball square (Montesquieu, 1964 [1721]: 130). We must appreciate ‘our insignificance’ and give up our unrealistic wish ‘to be counted in the universe and to figure prominently in it’ (ibid.). Added to this was the revival of Epicurean atomism in the midst of debates about suicide. It was argued that the elemental stuff of life is imperishable and continues to play a role in the grand scheme of the universe independently of the individual it once was part of (MacDonald and Murphy, 1990: 162). In other words, atoms and matter, but not the person, would survive an individual’s death and continue a life of their own. Self-inflicted death is, therefore, inconsequential for the order of the universe, neither does it beget the other-worldly wrath of God. The idea seemed convincing, at least to some of the better educated. In 1732 a financially ruined London bookbinder by the name of Richard Smith and his wife Bridget killed themselves. Their suicide note brushed away the horrors associated with desecration of the body, arguing ‘with naturalists’ that human bodies are constantly changing, making it difficult for divines to decide which one of our bodies to resurrect and punish (Gentleman’s Magazine, 1732: ii; cf. MacDonald and Murphy, 1990: 157–8). Thus, man must give up his central place in the universe, as well as his conception of himself as a unique individual entity, before he might claim the moral right to do away with his life.

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Yet, a greater price was to be paid. In the nineteenth century the selfkiller began to be commonly portrayed as a madman, and the act of suicide to be rendered symbolically insignificant. Rather than possessing diabolical forces, or posing a threat to the order of the universe, the self-killer was now a pitiful soul suffering from insanity. This development resulted from the dominance of medical and statistical arguments in debates about suicide. Throughout the seventeenth and much of the eighteenth centuries, suicide was addressed from a moral perspective, whether religious or secular. This was still the age of sermons when one could approach suicide as an inherently good, evil, or neutral act. The result was the formulation of two moral stances on suicide: from antiquity to the end of the eighteenth century, theology, law, and philosophy had either condemned suicide as a sin, a crime, and a violation of the laws of nature (e.g., Saint Augustine) or condoned it as a neutral or even praiseworthy act (e.g., the Stoics, Hume, Montesquieu). In the nineteenth century, however, the age of sermons with its moral arguments for and against suicide was overtaken by the emerging positivist movement. The study of the morality of suicide gave way to the study of causes of suicide in the hopes of finding ways to prevent it (see Fedden, 1938: 352). A class of emerging physicians, psychologists, psychiatrists, statisticians, and early sociologists saw the debate over the morality of suicide as too tangled in metaphysical or theoretical assumptions to be productive. It was time to look at objective facts in search of a way to diminish suicide rates, which appeared to be on the rise. What characterizes this new domain of analysis is that it stripped of free will the author of the suicidal act. The grand felon who betrayed the king by taking his own life now became a mere victim of self-murder caused by biological or social forces that went beyond his personal choice and compelled him to take his own life. It seems as if modern Western Europeans could tolerate suicide, but they could not tolerate or even conceive of any symbolic meaning, rationality, or subjectivity inherent in the act itself. The individual may have gained the right to kill himself, but in the process, he lost the status of author of his own acts. If he killed himself, he was simply too incompetent to know what he was doing. The old punishments were abandoned, but they were quickly replaced by new preventative measures that nullify the subjective meanings of suicide and cancel out the symbolic challenge that it poses to the existing social order. This trend has been tied, throughout modern times, into a peculiar

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‘strategy of naming’ (Bourdieu, 1991a: 107–26). The hitherto prevalent notions of ‘self-murder,’ ‘self-homicide,’ ‘laying a violent hand on oneself,’ or their equivalents in French and German, se tuer soi-même, être homocide de soi-même, and Selbstmord, are overloaded with religious and legal connotations that associate self-killing with sin and murder. In the early 1650s, when killing oneself was still a punishable crime in much of the Western world, Walter Charleton became a pioneer not only in making moral arguments in favour of the act but also in coining and popularizing a new name for it as well. His most famous argument comes within the context of his translation of and commentary on the Ephesian and Cemmerian Matrons (1668 [1651 or 1652]), in which the term suicide is believed to have been coined. The story of the Matron of Ephesus, first told in Gaius Petronius’ (~27–66 AD) Satyricon, concerns a soldier appointed to guard the hung body of a convict and prevent the relatives from taking it down and giving it a proper burial. The soldier, however, is distracted from duty by a beautiful widow mourning the death of her own husband in a nearby tomb. The soldier does finally return to duty but only to realize that the convict’s body has been stolen from the noose. Facing the humiliation of a public punishment, he finds death as his only honourable escape: ‘Dye I must by Sentence of the Magistrate; why there should I defer to fall by my own hand? To Vindicate ones Self from extream, and otherwise inevitable Calamity, by Sui-cide is not (certainly) a Crime, but an act of Heroique Fortitude’ (Ephesian and Cemmerian Matrons: 73). The word suicide derived from Latin and its etymological roots were unknown enough to the average person to make the new construct much more morally neutral compared with the strongly negative phrases common at the time. David Daube (1972: 422), who has done an extensive study of the etymology of ‘suicide,’ argues that ‘suicide,’ translated according to strict Latin rules of word building, means the killing of a pig (see also Williams, 1957: 252). But the neologism became popular, especially among those, like Sir Thomas Brown (1963 [1636]) and Voltaire (1739), who were interested in a morally neutral name for the act (Daube, 1972: 425). In an essay entitled ‘No One Commits Suicide,’ Dorothy Smith (1990) has argued that practices of naming such as the use of the expression ‘committing suicide’ instead of ‘killing oneself’ – or the recent euphemistic Pentagon parlance of ‘non-hostile, self-inflicted drug overdose’ (Hurst, 2004: F3) – are indicative of a bureaucratized approach to the facts of everyday life, often created, incorporated,

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and/or perpetuated by sociologists. For Smith, the dissociation between ‘the original and fundamental location of consciousness, of knowing, in an experiencing individual,’ on the one hand, and ‘an abstracted system of representing “what actually happened / what is,”’ on the other, results in cancelling out the subject ‘in favor of expressions such as suicide’ (1990: 143). Smith explains the dynamics behind this dissociation in terms of the conceptual practices of power: the abstracted mode of knowing and the reciprocal circulation of vocabularies between state bureaucracies in charge of collecting data (coroner’s office, clinical records, government statistics, etc.) and the academic intelligentsia (ibid.: 144–5). But abstracted concepts such as ‘suicide’ or ‘non-hostile, self-inflicted drug overdose’ or the numerical aggregation of self-killings in terms of ‘suicide rates’ do more than silence the subject in the interest of data-gathering and record-keeping. They are not simply instruments of power and knowledge in the hands of the elite. They are, above all, culturally authorized strategies of naming that work to neutralize and nullify the symbolic challenge that is inherent in suicide as an act of protest, a gesture that, in the manner of a fait accompli, closes the doors on any response. The Age of Numbers: The Paradoxical Moral Status of Suicide Throughout the nineteenth century, as the focus of the debate gradually shifted from prohibition to prevention and its locus moved from moral philosophy to medicine and statistics, subjective motives for suicide were increasingly ignored. Instead, objective causes of suicide, which were often placed outside individual consciousness, became the centre of attention. In the works of Adolph Quetelet (1842), AndréMichel Guerry (1833), and Etienne Esquirol (1838, 1845), as well as in the more sociologically oriented writings of Henry Morselli (1879), Thomas Masaryk (1881), and Harriet Martineau (1838), suicide was attributed to madness, climate, time of day or night, season, race, heredity, sex, age, social and economic conditions, religion, marital status, ‘alcohol poisoning,’ masturbation, gambling, type of occupation, and so on – but not to the free will or thought of the individual. Durkheim stood out to some extent by asserting that suicide is merely an exaggerated form of genuine virtue and that it is, therefore, connected via a chain of graduating acts to moral conduct (Suicide: 371, and see below). But this was a weak swim against the strong current of the de-moralization of suicide – that is, the trend towards relocating

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the debates over suicide from moral philosophy to medicine and statistical sociology. To argue that suicide was de-moralized does not indicate that suicide was no longer treated as a subject of moral philosophy or that it was no longer seen as being morally wrong. On the contrary, as we will see below, statistical studies of suicide gave rise to a new form of utilitarian moralization, wherein moral standards were determined by statistical averages and by the extent of social harm that suicide was thought to impose. In essence, this amounts to what Ulrich Beck (1999: 51) calls ‘ethics without morality,’ that is, a form of ethical problematization that is not rooted in a belief in individual responsibility (at least not officially) and that substitutes the ‘categorical imperative’ pertaining to the question of good and evil with statistical rates that indicate the likelihood of harm. We cannot speak of a drive to de-moralize suicide or a plan to make it symbolically meaningless. Instead, what the historical record shows is a series of intellectual events in the domains of medicine and social statistics that, in hindsight, can be said to have led to such results. We have already seen in the previous chapter that the knowledge of population, especially of mortality rates and average lifespans, became a significant part of the science of political economy in England and gave impetus to the rise of statistics as an autonomous discipline (Porter, 1986: 31–2). The quantification of suicide was an extension of the more general trend of quantifying mortality. In addition, throughout the nineteenth century, anxieties over national degeneration were on the rise, especially in England and France, where liberal capitalism had created an army of urban poor who were far too visible and proximate to the privileged to be ignored (Oberschall, 1986: 70). These anxieties ran especially high in France, where a history of social and political turmoil dating back to the 1789 revolution had created major concerns about the nation, leading to the immense popularity of moral statistics among French scholars. Moral statistics, as André-Michel Guerry (1833) argues, refers to studies of the mind, passions, and customs. In Guerry’s view, moral statistics encompasses moral philosophy, politics, and religion. Yet, it seems more accurate to say that it circumvents moral philosophy and religion in favour of a focus on quantitative data useful for social, economic, and political governance. In effect, the telos of moral statistics was to shift the criteria of morality from ‘ultimate ends’ to normal statistical distributions. Accordingly, a moral problem is any socially, politically, or economically harmful (but not necessarily evil) act or incident that occurs on an

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alarmingly increasing scale, with the definition of ‘alarming’ depending on a variety of cultural and social-psychological factors. In any case, the basic premise is that moral facts can be subject to the same methods of observation as material facts, if we observe them not as individual cases but in the aggregate (Oberschall, 1986: 73). The result was the collection of a large, albeit unsystematic, body of numerical data, unprecedented in Western history, on what were perceived to be problematic trends emerging in crime, legitimacy, suicide, church attendance, pauperism, schooling, and charitable donations (ibid.: 69 and 72; cf. Hacking, 1990, 1991). In the process, there emerged a ‘will to quantify everything,’ as Louis Chevalier (1973) has put it, possibly because of the sheer enormity of urban problems and the intriguing challenge of finding statistical regularities in areas that had hitherto been thought to be governed by chance. Curiously, the fascination with numbers had little to do with the lack of alternatives. While some major scholars were compiling statistical data, others such as Karl Marx, who published a little-known article on suicide (1999 [1846]), and Frédéric le Play, who authored a series of comparative works on everyday life in the mining regions of Lüneburg and the Harz Mountains in Hanover (1982 [1855, 1864, 1870, 1871]), were making substantial contributions to the qualitative study of the human condition, sometimes with the empirical support of such statistical data. In both England and France statistics and the art of the state (from which the German Statistik and the English statistics and the French statistique derive) were often regarded as interrelated. It is worth noting that, as we will see with Guerry, the accumulation and synthesizing of statistical data regarding suicide were often initiated by emerging social scientists and medical statisticians, rather than by state agencies, and were then presented as a matter worthy of state or public attention. The links thus established between the state and social scientists were organic but sporadic and uncertain. It was sometimes hoped but never guaranteed that such statistics would be read, accepted, or acted upon by the state (cf. Porter, 1986: 55–70). From early on, presumed-to-be rising rates of suicide were cited, portraying suicide as an urgent problem. The increase was believed to have started at the beginning of the nineteenth century in ‘the civilized countries of Europe and the New World’ (Morselli, Suicide, 1881: 15). Medical vocabulary was sometimes used to interpret alarming suicide statistics, suggesting the existence of a pathological state (Nye, 1984: 136–8).

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Suicide was a ‘fatal plague of our time,’ Morselli argued, citing statistics from France, Austria, and Germany: that Norway, Denmark, and England had experienced either a decrease in suicide rates or only a slow increase was simply brushed aside as insignificant (Suicide: 23). It is true, he argued, that the frequency and increase of suicide in England was not as serious as commonly thought, but the general law of increases was justified because crude numbers indicated a steady rise exceeding the ‘geometrical augmentation of the population and of the general mortality’ (ibid.: 23–4 and 29). In any case, most moral statisticians avoided debates over whether suicide as such was an immoral act and, instead, cited ‘objective’ aggregate rates to show that it was indeed a social problem because its rate was on the rise. Yet, behind the mask of objectivity there lay a profoundly subjective judgment regarding suicide and perhaps a deep-seated anxiety regarding its presumed spread, which even those sympathetic to suicide shared. Enlightenment philosophers advocated tolerance towards suicide, but physicians, psychologists, and psychiatrists, such as Esquirol, Falret, Lisle, Brierreode Boismont, Cazanvielh, and Tarde, as well as statistically minded sociologists and social thinkers, such as Guerry, Morselli, Quetelet, and Durkheim, reproblematized suicide as a major social and medical issue that poses a threat to the health and moral integrity of society. The philosophical articulation of the right to kill oneself coincided with the scientific invention of new techniques to take away that right. In the spirit of the nineteenth-century project of ‘taming chance’ (Hacking, 1990), it was generally hoped that statistical objectification could furnish an understanding of suicide and its causes and help devise measures to prevent it. This objectification took place by attributing suicide to either mental or societal malaise, leading to the first division of labour in suicide studies: the medical camp insists that suicide is a result of mental maladies, while the sociological camp stresses social and cultural malaise. Suicide is a disease either of the individual or of civilization; its pathology afflicts either the individual body or the body politic. What was not put in question is the assumption that suicide is, indeed, pathological and nothing more. Mental Malady: Suicide and Medicine The medical discourses of the nineteenth century played an indispensable part in the constitution of the intellectual milieu within which suicide was conceived as a ‘problem’ – rather than an im/moral act or

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a sin – predetermined by factors outside of the individual will. Thus, while the medical claims about suicide were entirely different in nature from those of sociology and social statistics, the former foreshadow the sociological and sociostatistical claim that suicide can be studied in the aggregate and in terms of objective sociopathological forces. Medicine objectified suicide in two ways: first, by claiming that suicide is an outcome of physiological abnormalities or of insanity; and, second, by using statistics to keep track of the epidemiological trends of suicide. George Burrows’ 1820 book An Inquiry into Certain Errors Relative to Insanity is a pioneering work on both fronts: it associates suicide with insanity and presents comparative statistics showing that France had higher rates of suicide. Throughout the Middle Ages and up to the seventeenth century, Christian beliefs regarding the influence of diabolical inspiration had created the impression that the self-killer is not in full control of his mind. This view was reinforced by the Protestant practice of allowing a religious burial for people who had killed themselves while insane (see Giddens, 1971: 37). But the idea that suicide, in general, is an effect of madness is a creation of modern medicine. Etienne Esquirol, the celebrated French author of the highly influential Mental Maladies (1838), argues that medicine has a right to the guardianship and treatment of suicide because suicide is a result of madness which is, in turn, a proper subject of medicine. Esquirol uncritically accepted the popular belief of his time that suicide is a melancholia anglica, a belief that originated in the assumption that there were more suicides in London than in any other European city. Outraged at George Burrows’ argument that there were more suicides in France than in England, Esquirol assigned to his student Falret the task of refuting this assertion. The latter came up with numbers showing that there were more lunatics in England which, in turn, ‘proved’ the ‘obvious fact’ that there were more suicides in England. This work set off a debate in France and England, starting in the 1820s and lasting until the 1830s, over the comparative rates of suicide in each country (see Hacking, 1990: chapter 8). The medical debate on the connection between madness and suicide had significant legal implications. In 1835 Bristol physician James Prichard revolutionized medical attitudes towards criminal insanity in cases of suicide and murder by arguing that the presence of ‘moral insanity’ renders the individual susceptible to instinctive and involuntary impulses, leaving him incapable of any control over his behaviour

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at the moment of committing a crime. Prichard defines moral insanity (or emotional impairment, as opposed to the impairment of the intellect) as ‘a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses’ (1835; cited in Gates, 1988: 13). The afflicted individual becomes ‘incapable ... of conducting himself with decency and propriety in the business of life’ (Prichard, ibid.). Others relate suicide to the physical appearance of the brain, such as the presence of bloody points indicative of brain disease. Throat slitting, for instance, was seen to be an impulsive attempt to relieve pressure caused by excess blood in the brain (Gates, ibid.: 15). Henry Maudsley (1874) and his followers argue that suicide is a result of the ‘morbid perversion of feelings’ associated with a disordered state of the ‘nerve-element.’ This perversion creates a suicidal impulse in people who can otherwise seem very rational. These writers pleaded for judicial reform, arguing that emotions rather than the reflective mind are the cause of insanity leading to suicide. William Wescott (1885), on the other hand, suggests that melancholia, despair, and misery rather than madness are at the root of suicide (Gates, ibid.: 17 and 19). In general, whether derived from physical attributes of the brain or from emotional impulses, suicide was seen to follow not from reflection but from impulsive emotions or forces. By the midnineteenth century, suicide was so closely associated with mental maladies that medical authorities began to wonder if suicide in itself was not sufficient evidence of insanity (ibid.: 16). In establishing the suicidal personality as physiologically or psychologically troubled, and in erasing the question of motives, medicine and psychiatry made the offending person (dead or alive) into a non-person: an individual without motives and, unaware of what he is doing, a mere victim of biological forces. Foucault (2003: 210) has described the ‘psychiatrization of criminal danger’ in the nineteenth century as involving the creation of a category of murder committed without motive, in the domestic space, and attributed to a newly invented category of mental disease called ‘homicidal monomania.’ This categorization created ‘a pathology of the monstrous’ as well as a monster: the criminal, who is not responsible for his own actions, and who, therefore, should be exempt from punishment and, instead, be submitted to psychiatric care. Despite some similarities, however, the psychiatrization of suicide seems to have followed a logic of its own. To begin with, although Foucault describes a great amount of resistance on the part of prosecutors to the

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psychiatrization of homicidal monomania, documents from this period suggest that the judicial system often embraced the psychiatrization of suicide with unusual enthusiasm (see below). Moreover, while in most cases of homicidal monomania the motives of the perpetrators were unknown and indiscernible (ibid.), in most cases of suicide the motives were known but either ignored or deemed irrelevant. Since the seventeenth century, long before medicine showed a sustained interest in suicide – coroners’ juries in many Western European countries had been looking for ways to spare the suicide’s body and the surviving family the cruelty of ritualistic and pecuniary punishments. The degradation of the body and the forfeiture of inheritance by the king or local lords were seen to be excessive. A convenient alternative was to rule the ‘victim’ non compos mentis (mentally incompetent). In England, the number of such verdicts increased from 6.9 per cent of all suicide verdicts in the early 1660s to as high as 44 per cent in the early 1700s (MacDonald and Murphy, 1990: 121–5; Minois, 1999: 191–2). By the first half of the nineteenth century, when physicians lent their authority to the claim that suicide was rooted in madness, they only helped institutionalize a trend that was already well on its way. As the desire to punish the act of suicide receded, the criteria of madness expanded. Juries coming from the middle classes adopted the medical opinion and broadened its scope (MacDonald and Murphy, 1990: 114 and 125). There is, for instance, the story of a jury hesitating over whether a certain man who killed himself in Bath was a lunatic. The Times of 9 April 1790 reports that a tailor sitting on the jury panel argued that the man must have been mad because the day before his suicide ‘the deceased paid him the amount of a bill which had been due only three months.’ This alone convinced the jury that he had, indeed, been a lunatic and, therefore, non compos mentis 1 (cf. MacDonald and Murphy, 1990: 142). Madness provided an easy exit out of an embarrassing penal history, which by the eighteenth century most European countries were ready to put behind them. The medical debate became so dominant and so popular that many English coroners routinely sought the opinion of physicians regarding the physical 1 This case is interesting not only because of how easily the jury was convinced that the deceased was a lunatic but also because of how easily they could have reached a verdict to the contrary. If the man paid back his debt the day before his suicide, one could argue he was actively contemplating suicide and was trying to put his affairs in order before killing himself.

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conditions of the brain in order to determine the relative health of the mind. Where the physical appearance of the brain was not suspect, the possibility of insanity was carefully examined, nevertheless. In 1735 city officials in Geneva declared that all suicides be treated as cases of insanity and all punishments be abandoned, except in cases where criminals killed themselves after receiving a death sentence (ibid.: 197). While posthumous juridical punishments were gradually abandoned, suicide was subjected to a new medico-legal disciplinary regime aimed at criminalizing and punishing attempted suicide. An unprecedented verdict in 1854 created the offence of ‘attempted suicide’ in England, which was later adopted in numerous other cases. This new offence was often punished by imprisonment, in the hope that spending time in jail would help the suicidal person to put life in perspective (Williams, 1957: 274). In the early twentieth century, this practice was officially replaced by a variety of other measures such as putting the ‘offender’ on probation, assigning him to the care of family, friends, the Salvation Army, or more routinely, to medical care (ibid.: 278–9; see also Neustatter, 1953: 68). In 1921, in England, imprisonment and corporal punishment for attempted suicide were replaced by confinement to a mental hospital as a legal requirement (Williams, 1957: 278). Indeed, starting in the nineteenth century, mental institutions had already created a new category of inmates called ‘suicide patients,’ consisting of people who were believed to be prone to suicide and had to be put on suicide watch. Restrictive and authoritarian measures were commonly put in place to stop suicide patients from killing themselves, although a minority of physicians, such as prominent nineteenth-century alienist G.H. Savage, advocated the encouragement of self-reliance in suicide patients in the hope that it would ‘allow them the exercise of self-control essential to their survival’ (Gates, 1988: 20). Attempted suicide officially remained a criminal offence in many Western countries, including Canada, until recent decades (and still remains an option in some U.S. states), but in practice, medicine had already taken over from the law in most places by the mid-twentieth century. Although the law’s hold on suicide and attempted suicide gradually weakened, medicine portrayed itself as having a better chance of preventing attempted suicide and of ‘correcting’ its impacts. Legislative acts in most Western countries, such as the Criminal Justice Act of 1948 in England, have institutionalized probation with the condition that the reprobate submit to mental treat-

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ment as an option for dealing with suicide attempts. Medicine now had the confidence to predict the likelihood of suicide and the necessary means and know-how to change the thoughts and moods of suicidal individuals. A Malaise of Civilization: Suicide and Sociology In the nineteenth century and before the emergence of sociology, moral statistics briefly functioned as a discursive framework within which socially significant moral issues, such as suicide and marriage rates, were quantitatively examined. In this context, the medical claim that suicide is a result of mental or emotional troubles, rather than an act of free will, was both echoed and countered by the sociological claim that high suicide rates are a symptom of a troubled social psyche or a sign of the weakening of social mores. What made suicide an especially fascinating subject for moral statistics, and later for sociology, is that, long before Durkheim, suicide provided the possibility to explain a seemingly individualistic act in terms of collective factors. The challenge was to show that voluntary acts like suicide are as regular as the unconscious phenomena of natural forces and thus to establish the unity of forces in both objective nature and the subjective activities of the human mind (Morselli, Suicide, 1881: 33 and 35). Consequently, it was necessary to show that the individual ‘will’ (if it was believed to exist at all), as well as individual thought and action, are all reflections of social and environmental forces outside the individual (ibid.: 114). Most early sociologists and moral statisticians did not hesitate to take up the challenge. André-Michel Guerry’s Essay on the Moral Statistics of France (1833) is a pioneering work in this area. The French lawyer had been instrumental in transferring the task of recording vital statistics from parish priests to city governments in 1792 and was, therefore, already familiar with gathering and centralizing scattered statistical data. The ability to acquire and work with such large datasets proved critical when Guerry decided to amass statistics on suicide based on court records from across France. For Guerry, suicide was a highly urgent moral-statistical (as opposed to a moral-philosophical) question (ibid.: 121). In fact, suicide seemed more serious than crime, as it took place more frequently and deprived the country annually of 2,000 individuals in the prime of their lives (ibid.: 124). Guerry’s principal contribution to the sociostatistical history of suicide, and to the history of soci-

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ology more generally, lies in his systematic effort to focus on objective facts rather than on moral or metaphysical causes. Guerry demonstrates statistical regularities between suicide and disordered morals, domestic troubles, abject poverty, illness, and disgust with life. Yet, he argues, the most important task is to find ‘the frequency and importance of each of these causes relative to all the others,’ as well as the variation of this influence by ‘age, sex, education, wealth, or social position’ (ibid.: 131). For Guerry suicide notes could be useful sources as long as one reduces the ideas expressed in them to ‘a smaller number of categories, representing them by conventional algorithmic symbols, and then assigning numeric values to each category’ (ibid.: 131–2). Guerry uses a variety of visual-statistical methods to illustrate his argument. Quoting Alexander von Humboldt’s Political Essay on the Kingdom of New Spain, he submits that ‘statistical projections [graphs] which speak to the eye without fatiguing the mind have the advantage of fixing attention on a great number of important points’ (ibid.: 3).2 The shift from the brain to the eye resonates with the shift from understanding to surveillance as the new main objective of reflection on suicide. So organized and tabulated, what looks arbitrary and random (e.g., the choice of method of suicide) can be made predictable (ibid.: 132). Table 3.1, for instance, displays the ratio of the number of suicides to population in each region for four consecutive years. This numerical aggregation, by itself, represents a level of abstraction from the real and individual cases of suicide. These ratios are then used to redraw a map of France, applying increasingly darker shades to represent the increasingly higher rates of suicide in areas that are closer to Paris, which itself has the highest suicide rate in the country (see Figure 3.2). The map puts regional statistics in a national perspective and, thus, intentionally or not, draws attention to the political ramifications of suicide rates. The political significance of this method did not escape the attention of the review committee appointed by the French Academy of Sciences to examine the merits of Guerry’s work. The committee put forward a positive recommendation, noting that the facts provided by Guerry ‘could in and of themselves enlighten the government’s choice of the most efficient means of creating or improving all kinds of institutions capable of exerting some kind of influence 2 This is the only external source cited by Guerry, which highlights the significance of von Humboldt’s statistical argument for him.

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Table 3.1 Ratio of the Number of Suicides to Population (one suicide out of every … inhabitants) (Guerry, 1833: 125). Region

1827

North East Central West South

11,257 24,542 29,766 23,060 35,752

1828 N E W S C

10,376 21,714 26,751 26,964 27,005

1829 N E C S W

8,470 19,667 25,935 32,177 32,448

1830 N E C S W

9,742 21,553 27,145 28,559 32,150

Average N E C S W

9,853 21,734 27,393 30,499 30,876

on national public or private morals’ (Report to the Royal Academy of France, published as part of Guerry, 1833: xlix). Guerry himself was aware of the political importance of statistics. He boasts receiving no support from any ‘theory’ or ‘systematic spirit’ because to do so would reveal philosophical short-sightedness in sacrificing the interests of a country to a doctrine (Guerry, ibid.: 3). Guerry’s statement echoes Hobbes’ belief that scientific ‘objectivity’ is a political duty (see Chapter 1) and resonates with Graunt and Petty who associated statistical work with mental discipline (see Chapter 2). The idea that statistical analysis is objective, neutral, and virtuous was taken for granted with little or no concern about the bias that it may perpetuate in favour of the quantification of human experience and the resulting disregard for subjective states of being or knowing. Not surprisingly, in the haste to establish moral statistics as a legitimate and objective scientific enterprise, free will itself was questioned. Adolph Quetelet (1973 [1842]: 80) finds it puzzling that the belief in free will can be logically sustained at all, when individual choices are shown to fall under statistically invariable patterns and, therefore, to follow general laws. To him, ‘moral laws’ are analogous to the laws of classical mechanics in that both influence their objects like forces with varying magnitude and direction. Family pride, egoism, and selfpreservation direct our actions in the same manner as gravity directs the movement of cosmic objects (Oberschall, 1986: 73–4). Instincts coupled with secondary (or impulse) forces, such as human will and peer influence, create a point of equilibrium called the ‘moral centre of gravity’ which, in turn, determines a disposition to crime, suicide, or marriage in each individual. Although Quetelet’s notion of the statistically average man and his crude application of natural determinism to human behaviour came under criticism from later sociologists, the

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Figure 3.2 Suicide Map of France (Guerry, 1833: 129, © Michael Friendly, see Friendly, 2007). Guerry does not clarify but he seems to have used average ratios for the years between 1827 and 1830 in constructing this map.

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idea that external forces determine or shape human behaviour was incorporated into a sociologically more sophisticated formulation in the work of Morselli and Durkheim. In late nineteenth-century Europe, any systematically statistical study that showed suicide to be the result of anything but free will was sure to be greeted with enthusiasm, and in the highly competitive political and intellectual atmosphere of that period, it could only help its popularity if a work provided comparative statistics that promised to settle the dispute over which country had the higher rates of suicide. Enrico Morselli’s highly influential 1879 book Il suicidio, which was translated from Italian to English under the title Suicide: A Study on Comparative Moral Statistics (1881), meets both criteria: it is comparative and the author’s intention is to make it an ‘objective demonstration of modern determinism’ (ibid.: vi). Morselli’s methodology conforms in every respect with the intellectual fads of his day. His main objective, he states at the outset, is to do the opposite of what philosophy has done – gather facts, unite them, and compare them (ibid.: 2). For him, the benefit of studying suicide statistically is tautological: on the one hand, statistics enables one to discover the invariable laws behind increasing suicide rates beyond the apparent randomness of the act, and on the other, the increase in suicide rates established by statistics justifies the value of statistics as a branch of social science (ibid.: 10–11). Although Morselli recognizes certain shortcomings and inaccuracies in suicide statistics (ibid.: 5), he maintains that it is important to stay with facts and avoid doctrines. Not surprisingly, when asked by his publisher to shorten his book for the English edition, Morselli opted to cut out the theory parts that synthesized his data while keeping the statistical facts because to him the latter have explanatory value on their own (ibid.: author’s preface, vii). Morselli’s study bridges the rigidly statistical work of Quetelet and the more strictly sociological material of Durkheim, paving the way, as we will see below, for the latter’s innovative, sociological synthesizing of the suicide debate in the nineteenth century. Il suicidio is perhaps the most sociologically sophisticated book on the subject written prior to Durkheim, who directly reproduces some of Morselli’s tables (e.g., ‘Suicide and Fertility,’ 1888: 179) and cites his to be among the most useful general texts on the subject (Suicide, 1897: 53, see also 163 and 166). Morselli’s originality stems from his realization that it is important to systematically separate the motives from the causes of suicide, an idea that exists vaguely in Guerry but is pursued explicitly and

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deliberately by Morselli. This analytical division, as we have seen, is essential in distinguishing scientific studies of suicide from moral and philosophical expositions and in making suicide an objective external fact of the natural or social world, rather than a subjective act or a symbolic gesture by the individual. Following this line of argument, Morselli asserts that moral action (i.e., action motivated by individual conscience) ‘does not escape the law of causality which rules over all phenomena, and hence also over the human conscience’ (Suicide, 1881: 268). If a personal motive is so strong as to lead an individual to suicide, it is then a cause and not a motive. Among all objective external influences, those arising from the social environment appear most important to Morselli because, as he argues, ‘the psychical life of the individual is but the reflex of the nature and characteristic of that social aggregate in the midst of which it thinks, wills, and acts’ (ibid.: 114). These include the state of religion, culture and instruction, public morality, general economic conditions, general political and psychological conditions, population density, and urbanization. For example, more Protestants kill themselves than Catholics, more Catholics than Jews, and more members of religious majorities than those of religious minorities. Periods of economic crisis, such as financial crisis or bad harvest, witness an increase in suicide rates, while periods of political upheaval, revolution, or war show lower rates of suicide. Both of the above arguments were later adopted by Durkheim himself. Perhaps taking a line from Comte, Morselli also argues that societies in a state of transition and compromise between the ‘metaphysical’ and the ‘positivist’ phases of civilization have higher rates of suicide. High culture, the state of public morality (measured in terms of crime rates), and the density of population in urban areas are also positively correlated with higher suicide rates (ibid.: 120–86). As Figure 3.3 demonstrates, the combined effects of these factors lead to higher rates of suicide in ‘civilized’ societies. The table arranges data in such a way as to display the negative effects of civilizing forces over a large historical timespan (sixty years) and across different nation-states. The realization that there is a link between civilization and suicide led Morselli to, yet again, question the existence of subjective meanings in suicide. Many presumed motives of suicide to which ‘we give the vainglorious names of “duties of one’s own position, exigencies of morals, education, judicial order”’ are nothing but the consequences of the limits of civilization and of social living, which ‘enclose and press

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Figure 3.3 Increase in Number of Suicides per Million Inhabitants (Morselli, 1881 [1879]: 22).

around us like a circle of iron’ – a phrase that echoes the notion of ‘iron cage’ used by Max Weber to point out the irreversible loss of meaning in Western civilization – (ibid.: 274). Similarly, ‘weariness of life and disgust of existence’ are nothing ‘but a form of hypochondria and sometimes of melancholia’ that result from civilizational pressures (ibid.: 273). In general, suicide is simply an effect of the struggle for existence and of human selection, which becomes ever more fierce in civilized societies because of competition among workers and the intensification of the struggle with other people and with nature. The combined effect of these conflicts allows nature to cut off the weak by extreme poverty, slow privation, illness, madness, and suicide (ibid.: 364–7). Seen through the lens of social Darwinism, suicide becomes an objective symptom of biosocial evolution rather than a subjective act or a symbolic protest against the unjust conditions of physical, emotional, and moral life in advanced (Western) societies. The existence of possible interrelations between civilization, biology, and suicide intrigued Emile Durkheim as well, who first became seri-

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ously interested in this question in 1888 while working on the problem of low birth rates. In France concerns about moral degeneration skewed the debate over suicide for much of the nineteenth century (see Nye, 1984; Pick, 1989). Suicide, low birth rates, decadence, and crime were more often attributed to national moral decline, especially as compared with Germany and with France’s own past, than to the general effects of civilization experienced across a variety of European nations. The chief worry was ‘the sluggishly growing population’ (Nye, 1984: 140). This led to the pervasiveness of a racialized medical model in political and moral debates at the cost of strictly sociological analysis. The degenerate individual is not an isolated case but ‘a painful reminder of the weakness of the ‘race’ and a living assurance of its continued decline’ (ibid.: 143). A viable and consistently argued sociological alternative to the medical debate finally emerged in the work of Durkheim who, following the example set by Comte, treats the social body as an organism that experiences periods of relative health, acute illness (anomie), or gradual decline. In a little-known essay entitled ‘Suicide and Fertility: A Study of Moral Statistics,’ written nine years before his famous monograph, Durkheim attributes suicide to a disruption of the equilibrium of the ‘vital force’ in the individual and the social organism (1992 [1888]: 193). Suicide numbers are not, he asserts, an indicator of individual happiness but of the comparative state of health or sickness of a society: they are a sign of the decline of the power of resistance of the social organism (ibid.: 177). Thus, Durkheim goes beyond Morselli’s Darwinism, to argue that suicide is a pathological, and not a normal, sign of sociobiological evolution. Rather than a mere consequence of, or a solution to, the growing struggle for survival, suicide should be seen as a symptom of strictly ‘social or, if you will, moral causes’ (ibid.: 196). This analysis illustrates the close association, or indeed, the identification, of social and moral forces that is characteristic of Durkheim’s entire sociology. Here enters the problem of low birth rates: comparing birth rates and mortality rates, Durkheim provides further evidence for what had already been feared in France for some time, namely, that in county towns in each département mortality exceeds the birth rate (ibid.: 189). Although this hardly counted as a new revelation, the originality of Durkheim’s argument lies in his effort to establish a systematic connection between high suicide rates and low birth rates, indicating that the two ‘abnormal’ trends derive from the same deep-seated moral causes (ibid.: 192). This comparison

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demonstrates that, because of the increasing weakness of collective ties, the declining social organism becomes unable to reproduce itself (thus low birth rates) and unable to preserve its existing members (thus increasing suicide rates). According to Durkheim, a strong ‘domestic spirit’ and communal life protect the individual against suicide and at the same time lead to higher birth rates. In comparison, a strong emphasis on material well-being and on individuality weakens family ties and leads to both higher suicide rates and lower birth rates (ibid.: 195). Table 3.2 illustrates this correlation, while revealing the persistence of Graunt’s double-entry model: the imbalance between suicide rates (debits) and birth rates (credits) serves as an alarming sign of a national crisis and the need for urgent social and political action. The brief excursion on this topic gave a boost to one of Durkheim’s longest-lasting endeavours, as it provided ‘yet more evidence of the truth that, in social questions, it is the social point of view that predominates’ (ibid.). The topic seemed so promising that Durkheim soon dropped his other projects to dedicate himself to another, more comprehensive study (Suicide, 1897), one that he subtitles ‘a study in sociology’ rather than ‘a study of moral statistics’ (as in the 1888 essay). It was not that Durkheim no longer considers suicide to be a moral issue, but that he regards morality (i.e., the strength of collective bonds and social solidarity) to be the essence of social life itself: the concept of morality is embedded in the very word ‘social.’ The originality of Durkheim’s Suicide is not in linking suicide rates to religious sentiments, urbanization, high culture, or individualism, for which he is often credited. As we have seen, Morselli had already established statistical associations to demonstrate the influence of these factors on suicide rates (cf. Turner, 1989; Porter, 1995).3 Durkheim’s most original contribution is his willingness to confront 3 From a strictly sociological point of view, Durkheim distinguishes himself from his predecessors by narrowing down and limiting rather than expanding what counts as a statistical fact. Instead of merely highlighting variations in suicide rates by age, sex, religion, climate, or race, as Quetelet, Morselli, and Guerry do, Durkheim searches for moral forces behind such statistical variables (Porter, 1995; Giddens, 1971: 38). Religion, for instance, is not by itself a sociological variable. Rather, it is sociological because of the moral force that it exerts on the community of believers, creating a more or less strong state of the collective conscience. The latter, in turn, bolsters social integration and provides a stronger state of cultural regulation, thereby leading to lower rates of suicide.

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Table 3.2

Suicide–Fertility Table for Europe (Durkheim, 1992 [1888]: 178).

Countries with the most suicides Suicides per 1,000,000 inhabitants

Births per 1,000 inhabitants (1865–76)

Denmark (1866–75) France (1871–75) Switzerland (1876) Prussia (1871–75) Austria (Cisleithan) (1873–77) Bavaria (1871–76) Sweden (1871–75) Norway (1866–73) England and Wales (1871–76)

267 150 196 133 122 90 81 74 70

30.9 25.7 30.4 38.5 38.7 39.2 30.4 30.3 35.5

Mean

131

33.3

Countries with the fewest suicides Hungary (1864–65) Belgium (1866–75) Netherlands (1869–72) Italy (1864–76) Finland (1869–76) Spain (1866–70) Romania (?) Scotland (?)

52 67 35 31 31 17 25 34

41.7 32.1 35.6 37.1 34.5 35.7 30.2 35.1

Mean

36

35.7

and address the moral implications of suicide directly. Pathologically high rates of egoistic and anomic suicide are not only an attack on the life of the individual, which is held sacred in modern societies (see Prologue above), but also a reflection of the shortcomings of our civilization. High suicide rates reveal a general spirit of egoism and society’s failure to integrate the individual through viable social bonds. This makes suicide a difficult moral subject to reckon with: Western societies cannot condemn suicide without condemning themselves be-cause ‘the state of mind from which it [suicide] springs is a general one’ (Suicide: 372). In the nineteenth century, sociologists and physicians interested in

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objectifying suicide intellectually often turned out to be against suicide personally. They objectified suicide exactly because they saw it as evil but did not want to use moral-metaphysical or philosophical arguments to back their point. Often a disguised subjective contempt for those who killed themselves underlies the objective ‘scientific’ accounts that came into vogue, especially early in the nineteenth century, when a host of medically or sociologically oriented writers portrayed suicides as degenerate, impotent, weak, and insane. They could not explicitly condemn suicide as a sin or an immoral act for which the individual is responsible because that would amount to admitting the existence of free will. Instead, the sociomedical language of madness, mental instability, and degeneration was used to cast a disguised moral judgment on suicide. Even social thinkers like Morselli, who emphasize the effects of civilization in explaining the rising rates of suicide, attribute this influence to the straining effect that civilization and social pressures have on the mental health of the population. Tellingly, the causes of insanity, as enumerated by the psychiatrist Esquirol, largely overlap with the causes of suicide as pointed out by the sociologist Morselli: both consider the role played by climate, seasons, age, sex, temperament, and profession, as well as the modes of living, laws, civilization, and the moral and political condition of a people. Durkheim stands out in this respect: for him, the social, the moral, and the private aspects of suicide, as an individual act, are interwoven (Suicide: 39, 325n2). Of significance is his emphasis on free will when he defines suicide as a voluntary act or rather as a ‘resolution [entailing] certain sacrifice of life’ (ibid.: 42). Individual motives are not a factor in defining an act as ‘suicide,’ but it remains important to ascertain that the individual knowingly gave up his or her will to live (ibid.: 44, cf. 325n2). Moreover, for Durkheim, although higher rates of suicide signify a collective moral crisis, individual cases of suicide are often influenced by personal motivations that may be morally admirable. What often makes us sympathetic to suicide is attention to the motives behind it – something Durkheim was intimately familiar with because of the suicide of his closest friend at the École Normale Supérieure, which happened in 1886, only two years before he wrote his first work on the subject (see Lukes, 1985: 49–51). From this point of view, suicides are neither degenerate nor insane: ‘suicide is a close kin to genuine virtue which it simply exaggerates’ and is connected via a chain of graduating acts to the whole range of moral conduct (ibid.:

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371). It is not difficult to think of shame, remorse, love, and despair (some of the usual motives for suicide) as related, in varying degrees, to noble human traits. In this sense, suicide still belongs to the category of moral acts. Yet despite, or perhaps because of its moral dimensions, suicide must be condemned and punished: suicide is a close kin to genuine virtue and at the same time a genuinely immoral act. Precisely because social determinism does not rule out individual determinism in each particular instance the suicide is morally responsible for her or his acts. Here, Durkheim walks a fine line to balance the ideological tension that characterizes much of Suicide. His work has a decidedly antiegoistic flavour, yet it embraces moral individualism (cf. Nemedi, 1997). What needs to be punished is not suicide, as such, but the egoistic spirit that lurks behind the increase in suicide rates and threatens the collective conscience in modern Western societies. Above all, with Durkheim, suicide becomes a symbolic act again, making it still more significant from a moral point of view: it harms the individual, which is the ultimate sacred object (or totem) of modern Western societies. Suicide thus regains its ancient status: an act of rebellion against god (albeit a secular and human one) that must be condemned but that is, nonetheless, worthy of our sympathy. Durkheim’s recommended punishments for suicide, such as deprivation from proper burial or certain civil rights, have a moral and symbolic character just as the act of suicide itself does (Suicide: 371). In contrast, since the nineteenth century, most other social-epidemiological studies of suicide recommend and help devise a less conspicuous system of social control, wherein statistical tabulation functions as a mechanism of surveillance all the while treating suicide as a statistical-moral rather than a symbolic-moral problem. Durkheim is among a host of nineteenth-century statistically minded social thinkers, including Buckle, Guerry, Masaryk, and Morselli, who are convinced that Western societies are undergoing a profound moral crisis resulting in higher suicide and crime rates and that this increase is regular and easy to explain as an effect of ‘civilization.’4 From the 4 Gates (1988: chapter 8) shows the same patterns in the works of fiction writers and essayists. She argues that these references to the role of culture and civilization functioned as a critique of modern civilization. My analysis, however, of the more strictly sociological literature on this subject (see below) shows that this criticism was eventually muted in the interest of upholding Western civilization as superior.

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earlier studies that look only for statistical correlations to the more sophisticated models, it is apparent that the rates of suicide warranted concern throughout the Western world. Morselli notes that even English periodicals, like the Times, the British Medical Journal, the Journal of Mental Science, the Pall Mall Gazette, and the Quarterly Review, which often showcased the superiority and benefits of English civilization, were nevertheless forced to ‘confess this painful truth [of increased suicide rates]’ (Suicide, 1881: 24). National rivalries had become irrelevant, and it was no longer important whether France or England had more suicides: the whole edifice of the West’s moral superiority was now crumbling under the crush of numbers. Suicide is a malaise of civilization, a ‘disease of civilized peoples’ as Morselli (ibid.: 13) puts it. It has gone beyond a mere national disgrace and threatens to taint the image of the whole civilized – that is, Western – world. To make matters worse many found out, to their surprise and contrary to popular belief, that within Western societies those of higher culture and education were more prone to suicide, indicating that the rates of suicide were only going to increase with the spread of public education. The ‘civilized race,’ however, found a way to explain this imagined scandal (high rates of suicide) without conceding any moral ground to the ‘savage’ or to the less civilized. A positive spin was put on the scandal: suicide is a human sacrifice to civilization, and suicide victims are the tribute of humanity to the growth of mental culture. The blame, therefore, has to be put on ‘modern civilization with its burning fever which, like Saturn in the fable, devours its own children’ (Morselli, ibid.: 301). As Durkheim (Suicide: 324) memorably puts it, through annual suicide rates society pays its bill in instalments. Suicide reappears as sacrifice: ‘the ransom money of civilization’ (ibid.: 367), albeit in a language (bill, instalments, rates) reflecting the economic and statistical sensibilities that had underlined the question of life and death since the mid-seventeenth century. In contrast, the absence or rarity of suicide among the ‘uncivilized’ was taken as a sign of their inferiority. At first, the uncivilized were found to have no suicide (Westermarck, 1917: 229–41), and when contradictory facts emerged out of ethnographic works showing that suicide had, in fact, existed outside of the ‘civilized’ world, it was attributed to unworthy causes or unsophisticated mentalities: the primitive sacrifice themselves for superstitious gods, while the civilized are human tributes to progress. The ‘savage’ only kill themselves because of hunger or out of spite, whereas the civilized are led to suicide by a

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multiplicity of motives caused by psychical needs arising from the mutual relations of highly organized societies (Morselli, Suicide: 118). Above all, although suicide was a vice and a crime, it was a nobler crime because its ratios fluctuated in direct proportion to the level of culture and in reverse proportion to the more ‘savage’ and violent forms of crime such as homicide. Ultimately, the very ability to study suicide in terms of rates and ratios proved the intellectual superiority of modern Western civilization not only over the savage but also over its own past. Moral statistics completed the shift from an individual-centred to a socially deterministic outlook on suicide. The laws of aggregate numbers made a mockery of old moralistic views of free will and individual determinism. ‘The old philosophy of individualism,’ as Morselli (ibid.: 3) argues, ‘had given to suicide the character of liberty and spontaneity,’ but it had now become ‘necessary to study it no longer as the expression of individual and independent faculties, but as a social phenomenon allied with all the other racial [here meaning demographic] forces.’ Not long after Enlightenment philosophy had established the centrality of free will and of critical reason as the defining characteristics of the dignity and individuality of a person, moral statisticians became fascinated with the possibility that the most private and the most individualistic demonstrations of personal agency through marriage, suicide, and homicide can, in fact, be explained by something other than free will. Even the existence of motives does not indicate the existence of free will, which is at best the equivalent of chance in nature (ibid.: 269). The objective causes of suicide exclude individual spontaneity and ‘the will to quantify’ questions the existence of free will. Conclusion: The Lingering Curse U.S. Army Specialist Joseph Suell wanted to be a career soldier. After serving in Korea for a year, he re-enlisted and last April was dispatched to Iraq. Two months later, he took his own life – or, in Pentagon parlance, suffered a ‘non-hostile, self-inflicted drug overdose.’ He was 24. Lynda Hurst, Toronto Star

In light of the above histories of suicide, what still needs to be explained are the forces that have for so long galvanized both public and expert opinion around suicide, at times resulting in severe pun-

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ishments and at others generating a drive towards medical and statistical objectification. Could it be that behind a facade of modern scientific rationality there lurk the primordial flames of an old socialpsychological anxiety about suicide? Could it be that the modern-day scientific methods of suicide prevention (from statistical objectification to psychiatric medication) have something in common with the macabre medieval rituals of desecration, designed not only to contain the diabolical powers of the suicide’s ghost but also to discourage others from taking their own lives? Does suicide still cast an unspeakable curse on the social psyche, one that our ancestors readily acknowledged and tried to deal with but that we do our best to hide in cost analysis calculations? Are we afraid of the one who says no to society and to life? In its most elementary form, suicide is a symbolic act of protest, a way of exacting revenge, a strategy to call attention to an urgent cause when all other avenues are closed. In Bronislaw Malinowskiy’s book entitled Crime and Custom in Savage Society (1976 [1926]: 77–8), a Trobriander boy accused of incest hangs himself to provoke retribution against his accusers. In China, nineteenth-century ethnographers reported that a man could kill himself to ensure punishment for his enemies or those responsible for his despair, a practice officially endorsed by the law (Westermarck, 1917: 242). In Western history and literature suicide has similar symbolic meanings: Lucretia’s name became immortal because she wished not to survive her ‘dishonour,’ as did Milesian and Corinthian women who are praised in Greek epigrams because they preferred death to falling into the hands of the enemy (ibid.: 247). Throughout the feudal period, those accused of treason would kill themselves to escape the brutal justice awaiting them. The gentleman’s sword was similarly his last avenue of escape from imminent financial disgrace. There are ‘philosophical suicides’ of the stoic or pessimistic kind, in which the value and meaning of life, collective or individualistic, is questioned. In our day, there are occasional but somewhat provocative news reports of bullied schoolchildren hanging themselves, political prisoners going on fatal hunger strikes, and demonstrators setting themselves on fire. Three cases of suicide recently took place at Guantanamo Bay prison, and these were promptly described by U.S. authorities as ‘an act of asymmetric warfare against us’ (Selsky and Loven, 2006). Weary soldiers choose dying over killing or being killed, and there are frequent suicide attempts by inmates on death row, so frequent that in some countries

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they are all automatically put on suicide watch. Most significantly, the symbolic power of suicide is displayed in the modern-day logic of suicide attacks, best captured in the title of Christoph Reuter’s 2004 book My Life Is a Weapon, or even in Jean Baudrillard’s (2001: 137) characterization of ‘the spirit of terrorism’ as a form of ‘symbolic and sacrificial death, i.e., the absolute event without possibility of appeal.’ What is common to all of these cases is the symbolic use of death as a means to make a social claim to something not attainable otherwise: suicide is a protest, a yearning for justice, meaning, or happiness in a world perceived to be without these. Suicide reminds society of its imperfections. This fundamental subjectivity of the act and its symbolically powerful subversive claim distinguishes suicide as the ultimate political act and as the ultimate avenue of exercising individuality and agency over one’s destiny in the absence (perceived or real) of all other alternatives. As Pliny argues in the first century AD, suicide is what distinguishes man from gods and redeems humanity’s imperfections. Man alone is capable of doing for himself what gods cannot do for themselves, a view that was not lost on early modern sympathizers such as David Hume and Mme de Staël. It is in this light that the un-human agony of immortals like Fosca, the Medieval king in Simone de Beauvoir’s All Men Are Mortal, becomes comprehensible: ‘Even if I want to die, I can’t’ (1995 [1946]: 28). Similarly, suicide gives the individual a sort of symbolic power that cannot be easily cancelled out: as a fait accompli, suicide helps the author of the act to establish a moral claim that neither the sovereign nor society can challenge. By killing themselves, the soldier, the prisoner, the housemaid, the teenager, and the philosopher pronounce moral judgments on life and on society that cannot be reversed posthumously. The greatest sin, as Saint Augustine calls it, is simultaneously the greatest act of social and political rebellion. Suicide is the greatest sin because it is a unilateral challenge: it is an act of rebellion against God, one that rejects His offer of benevolence by destroying any chance of repentance. Similarly, such an act rebels against society without giving it a chance to respond and redeem itself. From the collectivity’s point of view, there is something precarious about suicide: in the armies it demoralizes soldiers and in society at large it works as a sign of rampant moral decline, social disintegration, economic destitution, or political discontent. It is with regard to this symbolic challenge that we can perhaps best understand and explain the long-lived laws in Western European societies, among many

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others, that banned suicide as an act against the sovereign, against God, and against society, as reflected in Imanuel Kant’s assertion that suicide is an insult to humanity and a sign of contempt for society (1949 [1785]: 38–9; Westermarck, 1917: 260). This same symbolic challenge might shed light on why in France, once in the late eighteenth century during the ancien régime and then again during the Napoleonic era, newspapers were prohibited from reporting suicides for fear of imitation, public demoralization, or loss of faith in the government administration (Minois, 1999: 293; Fedden, 1938: 286) – explanations that also seem to be relevant to the silencing of the news of suicide among soldiers in modern-day militaries and to the prevalence of euphemisms such as ‘non-hostile, self-inflicted drug overdose’ used by the Pentagon. Similarly, the dominance of medical and social-deterministic discourses on suicide can be explained in terms of the socially necessary attempt to silence the symbolic challenge of suicide: these discourses transplant an event that belongs to the social and symbolic realm of gestures and of ambivalent exchange between the living and the dead (the left-hand column of Table 1 in the Introduction) into the political-economic realm of facts and of exact and equivalent values (the right-hand side of Table 1 in the Introduction). The symbolic protest or the sacrificial gift implied in suicide is, therefore, repressed by and contained within the logic of statistical objectification. In anticipation of the following chapter, therefore, we need to consider whether the same logic would apply equally to euthanasia and physician-assisted suicide, now used in a highly technical and medicalized sense to refer to the voluntary death of a severely ill person. Euthanasia and physician-assisted suicide are essentially acts of voluntary self-killing, and they have become increasingly popular in response to a societal need for a private space within which individuals can exercise autonomy over their own dying process. Yet, as the following chapter demonstrates, this space is highly medicalized and it often works to neutralize the meaning and symbolic significance of the decision to choose death over life.

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4 Thou Shalt Not Die an Undignified Death: The Discursive Constitution of Death with Dignity

Prologue: From the Sanctity of Life to the Dignity of Death A prominent motif in the modern Western iconography of death is the romantic portrayal of serenity: in the works of nineteenth-century painters and the novels of the Victorian period, the premodern macabre image of death is abandoned in favour of the pictorial infusion of death with eroticism and beauty or the verbal imagery of peacefully giving up the soul (see Binion, 1993; cf. Aries; 1974: 58). Thomas Chatterton died one of the typical deaths of his period: violent, lonely, ‘premature,’ and in desperate poverty. But Henry Wallis, nonetheless, famously depicted Chatterton’s death as serene and beautiful: there is no vomit to be found on the sheets, no sign of convulsion or struggle, and the window is half-open to let his soul fly gently away (Figure 3.1). The violent reality of Chatterton’s death is masked by the beauty and peace of his afterdeath. Beautiful corpses lie at the centre of other mid-nineteenth-century paintings, such as Gabriel von Max’s The Anatomist (1869) and John Everett Millais’ Ophelia (1851–2). In fiction, Charles Dickens captured the mood of the time in his portrayal of the easy and gentle ‘departure’ of Lucie Darnay’s son in A Tale of Two Cities (1859). Yet, outside of the margins of a book or the frames of a canvas, death was becoming more laborious than ever, as humans’ bodily capacities were being stretched to the limits. From John Graunt, Sir William Petty, and Johann Peter Frank to modern-day social and medical epidemiologists, technologies of power and knowledge have led an unyielding crusade against accidental and premature death. These developments, however, combined with technological advances in medicine and

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public health, have resulted not only in the prolongation of life but also in the prolongation of the dying process and the intensification of the suffering that accompanies it. The blessing of a long, accident-free life, romanticized since Graunt, has turned into the curse of a prolonged, painful death: we can now avoid dying precipitously from strokes, falls, drowning, fire, and military combat, only to die from cancer and other agonizing forms of slow death (see van der Maas and Emanuel, 1998: 174). On 6 August 1900 Ivan Pavlov, the celebrated Russian physiologist best known for his reflex conditioning experiments with dogs, read a paper entitled ‘Experimental Therapeutics as a New Exceedingly Fruitful Method of Physiological Investigation’ to the Thirteenth International Congress of Medicine in Paris, elaborating on his experiments on the edges of vitality. He described to the audience, in detail and without flinching, how he tried to keep dogs alive after cutting the vagus or pneumogastric nerves located in their necks. The vagus is a rather fine pair of fibres which, in Pavlov’s own words (1974 [1900]: 1019–20) invest ‘nearly all the principal parts of the body in their cobweb-like ramifications.’ This implies that vagotomized dogs are deprived of all their vital functions: circulation, respiration, digestion, and the control of their body temperature. Early in the experiments, the dogs died from hunger due to vomiting or to the decomposition of food in their stomach because of their inability to pass it through the digestive system. Eventually, Pavlov devised a completely artificial series of interventions to replace the natural process of digestion, which involved feeding the animals artificially, preventing vomiting, and then having their intestines washed with strong chemicals. He was glad to report to the assembly of physicians that he and his colleagues were the first to be able to keep vagotomized dogs alive, ‘happy and strong,’ with normal weight, and in a ‘satisfactory physiological condition,’ although, as he admits later in the paper, ‘this was only on condition of a life artificially simplified, with a bland and tranquil regime’ without even the possibility of taking a walk (ibid.: 1023–4). In short, these experiments were undertaken to unveil the ‘mystery of the death of the animal organism’ by distinguishing the many different causes of death in vagotomized animals (ibid.: 1025). It was these experiments, and not his more commonly known experiments on the ‘drooling dogs’ that ultimately brought Pavlov the Nobel Prize in medicine in 1904. After a lengthy discussion of his experiments, Pavlov asked his audience to excuse him, and I may need to do so as well, ‘for devoting

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so much time to this secondary question of physiology,’ noting that ‘there seemed to be concentrated in the question the fundamental idea of my discourse’ regarding the contributions of physiology to lifesaving and life-prolonging medicine. Likewise, Pavlov’s experiment contains an idea fundamental to my own argument regarding the consequences of the drive in Western societies to prolong life as much as possible. It illustrates the continuity between the statistical objectification of mortality explored in Chapters 2 and 3 and the biomedical methods of objectifying death as primarily explored in the present chapter. Moreover, Pavlov’s approach to the body and to life more generally is eerily similar to Hobbes’ mechanistic view of natural and political bodies. Like Hobbes’, Pavlov’s approach entails a redefinition of life and death in terms of mechanical metaphors, that is, as highly malleable mechanical processes. His experiments and those of the physiologist who preceded him, showed that the organism, taken as ‘an assemblage of organs,’ is primarily a ‘physical-chemical and mechanical entity,’ and that the animal organism is ‘a machine – extremely complicated, undoubtedly, but all the same manageable and obedient as any other machine’ (Pavlov, ibid.: 1025–6). If we ceased looking at the organism in an analytical fashion corresponding to the ‘entire plentitude of living phenomena,’ and instead regarded the body, synthetically, ‘as a machine whose parts could be repaired after their ruin,’ we could then also look at physiologists and physicians as mechanics of the body machine. For ‘the aim of synthesis is to establish the significance of each organ from its actual and vital side, to indicate its place as well as its corresponding nature’ (ibid.: 1027). The machine metaphor, so consistently used since the seventeenth century by Hobbes, la Mettrie, Pavlov, and others in reference to the human organism, has not been without moral consequences for the actual human beings that embody it. These consequences are illustrated by the story of the short life of Dylan DeCosta, a premature baby born at only twenty-four weeks’ gestation and featured in a New York Times article by Darcy Frey (1995). In the neo-natal intensive care unit, Dylan was hooked up to a web of hardware: a respirator breathed for him; a catcher pumped fluids into his body; various monitors ran through his arm to control his heart rate, oxygen level, and temperature; a monitor placed on his chest controlled the heat lamp that kept him warm; and a plastic wrap functioned in place of his underdeveloped skin to prevent his body fluid from evaporating. At the dawn of the twentieth century, Pavlov suggested that physicians could learn

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from his experiments in physiology, take on the role of mechanics, and attempt to repair human body parts as if they were machines. Dylan’s doctor might as well have been reading from Pavlov’s paper when he told Frey that it takes a while to get attached to babies like Dylan: ‘Sometimes they seem almost like physiologic machines that we can keep going’ (ibid.: 22). Dylan was nothing but a ‘Body-with-Organs,’ as Fox (1998: 30) has put it. The meaning of his existence is redefined in terms of the state of functioning of each of his organs as sustained and measured by technological processes. From Frey’s description it is not hard to tell that Dylan was in pain: he would spring up his arm to remove the tube from his throat, try to kick away the plastic wrap, and struggle to kick free every time the nurse pricked his heel to draw three drops of blood for tests. The latter procedure would take place several times a day and took more than one try and as long as twenty minutes each time, since Dylan had little blood to give. Just over a day after his birth Dylan’s agony was over. In the end, his kidneys were determined to have failed him: there was nothing that medical technology or the good will of his parents and doctors could do to keep them functioning. The contradiction between the actual ‘labour of dying’ (Davidoff, 2002: 989) as suffered by Dylan and the Victorian image of a serene death, as captured by Henry Wallis’ depiction of Chatterton’s corpse, is not surprising. After all, for a culture obsessed with the virtues of hard, productive labour, death is nothing but an aberration in the officially sanctioned image of a well-earned rest at the end of a productive life. Not surprisingly, perhaps, this culture has witnessed the development of an unprecedented ethical orthodoxy in which life as such, defined merely as a biological and quasi-technological process, has become sacred. In the past few centuries, much of the Western world has gradually given up the religious reverence for life understood as a divine destiny that should not be artificially prolonged, along with the belief in an other-worldly life that would redeem the suffering of the dying. But it has continued to uphold the religious prohibition on choosing death over life, even when the dying process becomes unbearable. Surprisingly, the progressive decline of religious sentiments has coincided with, or indeed brought about, the hardening of the human resolve to protect ‘the sanctity of life’ against profanation by death. Death has perhaps never been as profane as it has become at present. When people believe that the soul is eternal, death is still a mixed blessing: it ends earthly life only to bring about an eternal one.

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In the absence of such beliefs, life finds the seat of its unequivocal sanctity solely within the individual body and death becomes the ultimate profanation of life. Any sign of life, however trivial, must now be protected and its continuation must be ensured almost at any cost and by any means. Consequently, the bare means of life (breathing, digestion, urinating) have become sacred ends in themselves (see Keyserlingk, 1979: 66). As early as 1913, Maurice Maeterlinck observed that doctors behave ‘as if they believed that any, however terrible, suffering is better than those which await us in the great Unknown’ (quoted in Bauman, 1998: 221). In reaction to this new reality, the death with dignity movement, which emerged in the early twentieth century and gained ground after the 1960s, demands that ‘dignified death’ be legally granted to the dying and to those who no longer wish to live an artificially prolonged life (see the next section below). It advocates the legalization of euthanasia, assisted suicide, and other forms of medically negotiated death as ways to restore dignity to death. As such, the demand for dignified death can be seen as a symbolic challenge to a sociomedical and cultural order that holds life itself to be an ultimate value. It passes a verdict on society and calls attention to the indignity of the dying process in modern Western societies. In addition, oftentimes patients demand a ‘quick release’ not only to escape the burden of a painful death but also out of a wish to release their relatives, caregivers, or even society as a whole from the burden of care. As was the case for suicide in the nineteenth century, however, the liberalization of laws around dignified death (e.g., euthanasia and physician-assisted suicide) is achieved largely at the expense of suppressing the possible social and symbolic meanings inherent in the decision to choose death over life. Rather than treating it as a cultural and moral challenge to the prevailing views on the meaning of life and death, contemporary debates often portray euthanasia as a medical and/or legal question. This transmutation is most evident in the debates in the Netherlands, the first country to legalize euthanasia, in 2002. The success of the euthanasia movement in that country is in large part because the debates on this issue have primarily addressed either medico-legal technicalities or procedural questions, thereby avoiding more profound sociological and moral questions that tend to stall the debate in other countries, especially Canada and the United States.

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Demystifying the Sanctity of Life The time is approaching when we shall consider it abhorrent to our civilization to allow a human being to lie in prolonged agony which we should mercifully end in any other creature. When all usefulness is over, when one is assured of unavoidable and imminent death, it is the simplest of human rights to choose a quick and easy death in place of a slow and horrible one. Believing this open choice to be of social service in promoting wiser views on this question, I have preferred chloroform to cancer. Charlotte Perkins Gilman

The last words of Charlotte Perkins Gilman, the prolific fiction writer, feminist, and independent sociologist, embody the frame of reference of the euthanasia debate in the twentieth century: it begins where the nineteenth-century debate on suicide left off. In the twentieth century, as in the nineteenth, the right of the individual to take her or his own life is deduced from Western society’s image of its own civilization and of what constitutes an orderly and acceptable death. The second half of the twentieth century witnessed the emergence of a sustained intellectual interest in questioning the unconditional reverence for life predominant in the medical culture, as well as an interest in understanding and redefining the concept of the sanctity of life that underlies such an attitude of reverence. Glanville Williams’ 1957 work The Sanctity of Life and the Criminal Law is among the earliest texts explicitly discussing the sanctity of life, but even there the author does not elaborate on the concept. This silence suggests that the sanctity of life has been more often than not merely assumed by law, religion, and custom, rather than deliberately articulated as it has been in recent times. It was more comfortable, and safer too, simply to assume the sanctity of life and not to inquire into it. But by the 1970s the advancement of Western medicine had already made problematic the rigid adherence to the value of the sanctity of life. Moreover, Western societies had recovered enough from the inhumanity of the eugenics movement and the horror of the wars that characterized the first half of the twentieth century to be able to reflect again on what it means to be human, ‘to have a life,’ to live, and to die. It was now possible for Western bioethicists (among them philosophers, sociologists, and physicians) to ask, What is sacred about life? There was the hope that such debates would lead to the weakening of the medical hold on the dying process in favour of an

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approach that takes into account not merely the absolute sanctity of life as an inviolable principle but also the place and meaning of death as an integral part of life. What differentiates this debate from those raised in the context of the eugenics movement and Nazi ‘euthanasia’ (see, e.g., Binding and Hoche 1975 [1920]) is that it is no longer anchored around the right of the state over the life and death of its citizens, nor does it entail any interest in defining the life that can be disqualified and killed in the name of the interest of the majority. Rather, it seeks to create a space outside of the medical field wherein the meaning and value of life can be debated from the point of view of the living individual both as a unique person and as a social being defined by culture and bound by interpersonal relations. Jan H. van der Berg’s book Medical Power and Medical Limits (1978 [1969]) played a pioneering role in this debate. It greatly influenced Dutch discourse of euthanasia by critically addressing the medical power over death, or more precisely, the power to postpone death. Ivan Illich published the influential book, Medical Nemesis: The Expropriation of Health, in 1975, criticizing the excessive medicalization of life and death. Earlier, two prominent American sociologists, Talcott Parsons and Edward Shils, had published several essays addressing the sanctity of life as a socially and historically specific ethical subject, and examining the medical, cultural, and ideological apparatuses behind medicine’s power over life and death. Before it had become fashionable to write about life and death in the wake of the ‘postmodern’ obsession with the body, before Foucault’s path-breaking work on biopolitics had been claimed and incorporated by sociology, and before Deleuze and Guattari had made the body a primary subject of cultural inquiry, Talcott Parsons and his colleagues, Renée Fox and Victor Lidz, had carried out a series of empirical investigations on the subject of death and dying that culminated in the publication of ‘Death in American Society’ (1967) and ‘The “Gift of Life” and Its Reciprocation’ (1999 [1972]). Around the same time, sociologist Edward Shils published his reflections on ‘The Sanctity of Life’ in a journal article in 1967, later republished as a book chapter in 1975. The common thread in these works is the realization that our modes of regulation and ritualization of life and death are in need of major reconfiguration, which itself entails a revision of our outlook on the sanctity of life. From a structural-functionalist point of view, which informed the works of Shils and Parsons, it was necessary to theoretically rethink the place of death in American society after it had undergone profound medical

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and cultural changes. Shils approaches the question of death within the context of his broader question of the possibility and viability of civic morality in secular societies: in a sense, the ultimate test of secular morality is its ability to give meaning to death and continue protecting the value of life without resorting to religious faith. Parsons, Fox, and Lidz were interested in the symbolic integration of the genetic reality of death as part of the larger functional need for adaptation with the natural environment: death is a biological inevitability designed to enhance the ‘adaptive flexibility of the species through the sacrifice of individuals,’ that is, by ensuring the succession of the bearers of older genetic patterns with the bearers of the emergent patterns (‘The “Gift of Life”’: 124). Culture plays a role in giving meaning to this natural necessity by means, for instance, of the belief in resurrection or the symbolism of Christ’s sacrifice on the Cross. However, according to Parsons et al., this adaptive flexibility is jeopardized by the contemporary drive to postpone death for no other reason than that it is possible to do so. The attempt to reconceptualize the value of life had a Durkheimian flavour. It was Durkheim who had discovered the individual as the ultimate totemic principle and perhaps the only sacred object of modern societies. According to Durkheim, the life of the individual has sanctity because it is the common denominator and the irreducible object of the collective conscience. But, as the new generation of sociologists pointed out, in practice, this sanctity has for too long been commonly expressed in terms of the sanctity of the sheer force of life. To illustrate this point, Shils and Parsons go beyond the notion of the individual as sacred and invoke the Kantian interpretation of individuality which underlay Durkheim’s 1914 essay entitled ‘The Dualism of Human Nature.’ This essay explains the sanctity of individuality in terms of the dual life of the individual: the biological and the psychological. Durkheim’s distinction between the sheer biological force of life signs and the social-psychological life of the mind functioned to qualify the principle of the sanctity of life: biological life alone, deprived of its psychological aspects, is no longer automatically sacred; it is neither the foundation nor a sufficient ground for the sacredness of life. For Shils, the belief in the sacredness of life stems from a ‘proto-religious natural metaphysics’ that runs deeper in the human psyche than religion itself (1975: 222). It is ‘generated by the primordial experience of being alive, of experiencing the elemental sensation of vitality and

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of fearing its extinction’ (ibid.: 226). The experience of vitality includes not only the life of the organism but also the physiological and mental processes of perception, imagination, self-consciousness, memory, and reason (ibid.: 223 and 231). The sacredness of individuality implies that any form of contrived and deliberate action beyond a ‘normal’ range that can alter the natural patterns of individuality will and should be deemed undesirable (ibid.: 232). The sanctity of life, whether articulated from a religious or secular perspective, has to incorporate a sense of respect not merely for the physiological manifestations of life, but more importantly for what makes each of us a distinctive person whose individuality has meaning and significance (ibid.: 235). As we shall see shortly, such concerns inform the biographical (as opposed to the biological) interpretations of the sanctity of life within the context of death with dignity debates. Taking these biographical meanings into account, Parsons et al. argue that the absolute ethics of respect for life has to be replaced with a relativized ethics or an ‘ethics of responsibility’ that would take into account the meaning of death and the costs of treatment in decisionmaking in hard cases (‘The ‘Gift of Life’’: 143). This would imply that there will not be a fixed set of moral absolutes for physicians to fall back on. Instead, physicians will have to take more responsibility for the possible consequences that their actions might have for the patient and for the welfare of society as a whole (ibid.: 144). The sanctity of life has to be redefined in terms not of the sanctity of life signs but of social and psychological determinants of the place and functions of a good death in life (ibid.: 147). This would mean that doctors will have to let go of certain patients without using all that is in their power to keep them alive. They will have to take into account the personal and social dimensions of death, rather than treating it as a scientific and technological issue. This approach will enable the dying – and the living – to reincorporate the psychological and moral aspects of death and to approach death as something more than a mere physiological process (ibid.: 144). On closer examination, such a redefinition will also reintroduce the proto-religious meaning of death as a ‘consumatory’ act: the dying person can become a giver in the religious sense of Christ’s sacrifice on the Cross, but also in the social evolutionary sense of giving one’s place to new generations after a ‘job well done’ (ibid.: 145). Death is to be approached neither as the failure of treatment nor as a physiological process but as a social and psychological process through which a person can maintain a sense of dignity and the ability

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to ‘put his affairs in order’ (ibid.: 144). In essence, Parsons et al. use Christian religious symbols to rewrite the place of death in social and individual life. Their secular rereading of the Christian iconology of sacrifice implicitly disputes the Freudian view of life and death as antithetical aspects of the biological existence of the organism. Instead, it highlights the social significance of life and death cycles as providing a context for gift giving, redemption, and collective survival (O’Neill, 2002: 27–9). Parsons’ notion of the sanctity of life calls for the restoration of death as an occasion for symbolic exchange between the living and the dying, an occasion of reversibility between the gifts of life and death, in which collective immortality is gained in return for the mortality of the individual. At the present time a major locus for the reinvention of the concept of the sanctity of life, in terms envisioned by Parsons and Shils, is the death with dignity debate, wherein the pain, suffering, dependence, and hopelessness that accompany the dying process are problematized as being ‘undignified’ and preventable. These debates primarily focus on the overmedicalization of the end of life, arguing that Western medicine has too rigidly adhered to an ethics of ultimate ends or absolute conviction with respect to life: medicine upholds the sanctity of the sheer fact of life regardless of the price in human suffering or indignity that has to be paid for it. Advocates of dignified death highlight the injustice done to patients who are ‘victims’ of an impersonal medical system that subjects the dying person to ‘a form of medically sanctified torture’ (McInerney, 2000: 142). They call on the medical profession to recognize and follow the wishes of the person who wants to die when life ‘has become unbearable, meaningless and disgracing, when prolonged and hopeless suffering overcomes the positive meaning of life,’ because to do so is to express ‘respect for human life and human dignity’ (ibid.). Currently, in many countries, medical guidelines allow doctors to withhold or withdraw treatment when the patient does not wish to prolong his or her life or when treatment is deemed hopeless. The most significant and radical developments, however, have taken place in the Netherlands, where euthanasia and physician-assisted suicide have been gradually endorsed by the medical establishment and the law. In 1959 Medical Ethics, a publication of the Royal Dutch Medical Association (RDMA), brought up the issue of euthanasia for the first time in its history. It dwelled on a doctor’s duties at the deathbed at great length but rejected euthanasia and assisted suicide, emphasizing

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‘the doctor’s duty to preserve life and to do this as long as possible’ (van Berkestijn, 1990: 1). Doctors were advised of their duty to protect suicidal patients against themselves and to do everything to preserve life even in the face of great suffering, because ‘it is not up to the doctor ... to wonder whether suffering is meaningful or not’ (ibid.). In 1973, after much debate over the subject within the medical profession and in the larger public, the study group set up by the RDMA made a cautious move towards change when it concluded in its report that ‘it is the duty of every doctor to reflect on this subject and, in doing so, that he should consult other disciplines’ (ibid.: 3). Since then the RDMA has assumed the leading role in setting guidelines regarding when and how a request for euthanasia can be honoured. Such debates within and outside the medical profession are premised on a novel form of medical ethics: no longer universal rules, expressed in terms of the sanctity of life, but the particularities of each person’s case should govern end-of-life decision-making. They assert the necessity of a more pragmatic interpretation of the sanctity of life based on an ethics of responsibility towards the gift of life and the person holding that gift. This new moral approach regards the quality of life, assessed from the subjective point of view of the living – and dying – person, as a value higher than the sanctity of life signs. It acknowledges that physicians should not invoke or prioritize life as such (the biological) above and over personhood (the biographical). Accordingly, there may be a point where biological life can continue but it is no longer worth living for the person involved (RDMA, 2000a: 4). In this new interpretation of life ‘human personhood as a unique manifestation of biological life, has a strong moral relevance:’ ‘Someone’s life history, his biography, encoded in his body and his brain, resulting in his wishes and preferences, are unique manifestations of human life. If someone has a well-considered wish for euthanasia or assisted suicide, then this might overrule the principle of respect for biological life. In essence the more complex form of life (personhood) can overrule the lesser complex form of life (the presence of the force of life as such)’ (ibid.: 4). Yet, despite this call to consider the limits of life and the meaning of death, in practice the medical establishment, as well as the majority of the proponents and opponents of death with dignity, tend strongly to avoid such subjective questions when dealing with the issue of euthanasia. Instead, they emphasize more ‘objective’ concerns with rights, autonomy, and the medico-legal definition of dignity. This

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transmutation has taken place on two fronts: ethics and public policy. The ethical side of the debate is dominated by the medico-legal language of ‘professional autonomy,’ ‘informed consent,’ and ‘force majeure,’ while the public policy side of the debate is saturated with statistical figures and statistically based arguments regarding the potential benefits or harms of legalizing euthanasia. As we shall see in the following two sections, the recasting of the debate in terms of the universalistic norms of law, medicine, and public policy has allowed the debate to proliferate and move with ease between various institutional settings (medicine, law, government, media). Yet, it has also led to the overmedicalization, legalization, and objectification of the language of death and dying at the expense of the suppression of the personal, relational, symbolic, and – in the words of Parsons and Shils – biographical meanings that often underlie the decision to ask for and grant euthanasia. In particular, this recasting of the debate leads to the silencing of the symbolic gift economy of euthanasia as an act of exchange between parties that often intimately know and care for one another. Dying M/Others: The Ethics of Euthanasia 1973: Criminal Court Ruling, Leeuwarden: ‘The Postma Case.’ In 1971, Geertruida Postma (GP) injected a patient, her mother, with a lethal dose of morphine. The patient had suffered brain haemorrhage, was deaf, had difficulties speaking and had to be tied to her chair to avoid [keep] her from falling. On many occasions she asked her daughter to end her life. Dr Postma was charged under Article 293 of the Penal Code.1 In 1973 the criminal court found Dr Postma guilty of voluntary euthanasia and ordered a one-week suspended sentence and one year’s probation. At the court-session, an Inspector of Health – seen as an expert – declared that the average physician in the Netherlands left [abandoned] the idea that life always should be prolonged until the bitter end. However, there are certain conditions he said: The patient is incurably ill; the patient finds his suffering (mentally or physically) unbearable; the patient requested [sic] to terminate his life; a physician acts; the 1 Article 293 of the Dutch Penal Code states: ‘He who robs another of life at his express and serious wish is punished with a prison sentence of at most 12 years or a fine of the fifth category’ (Gomez, 1991: 19).

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patient must be in a terminal stage of his illness. The court agreed with these conditions, apart from the last one. Right to Die Society, the Netherlands

So read the more-or-less standard lines, retelling the story of the woman who stands as an icon of the euthanasia movement in the Netherlands. I find this story intriguing because it recounts a pathbreaking event that led to the eventual legalization of euthanasia in the Netherlands and functioned as a paradigm for future court cases and legislative acts on the issue. The above excerpt is quoted from online publications of the Right to Die Society of the Netherlands (NVVE), for whom Dr Postma is an inspiring hero. I shall cite and discuss three more accounts of this same event as narrated by both proponents and opponents of euthanasia, focusing on what they choose to highlight and what they leave in the margins when retelling the story of the original event. The analytical significance of such details is rooted in the fact that the ‘speech-act’ of recounting the story of origin not only narrates the events that happened in the past but also shapes the language and parameters of present and future debates. The analysis of this particular speech-act will help us understand some of the underlying dynamics of the legalization of euthanasia in the Netherlands that have not been studied elsewhere so far. Dr Derek Humphry (1993), the vocal supporter of the right to die in the United States and internationally, describes the story as follows: In 1973 the Dutch in combination with the medical profession were the first people in the world to start down the road to lawful voluntary euthanasia for the terminally ill. That year Dr Geertruida Postma, a general practitioner, was accused of murdering her mother by the injection of morphine. The old lady was in a nursing home, had suffered a cerebral hemorrhage, was partly paralyzed, was being treated for pneumonia, was deaf and spoke only with difficulty. She had failed in a suicide attempt and told her daughter, ‘I want to leave this life. Please help.’ At her trial Dr Postma said her chief regret was not to have done it earlier. Found guilty, her penalty was a one-week suspended sentence and one year of probation. (online essay)

There are also accounts of the trial by the opponents of physicianassisted death, who see it as the starting point of a ‘slippery slope’ leading to the erosion of respect for the ‘absolute principle of the sanc-

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tity of life’ in the medical context. For example, Dr Ezekiel Emanuel wrote in 1997: Contemporary Dutch policy regarding voluntary euthanasia had its origins in 1973, with the case of a physician, Geertruida Postma, who injected a deaf, partially paralyzed, seventy-eight-year-old woman with morphine, ending her life. The patient happened to be Postma’s mother. Postma was convicted of murder but given a suspended sentence of one week in jail and one year on probation, a sentence that effectively exonerated her. (online essay)

Finally, the following account of the event was written by Dr H.J.J. Leenen and published by the Royal Dutch Medical Association: The first case of euthanasia was brought before the Court of Leeuwarden. A 78 year [old] nursing home patient, who was severely ill, had requested her daughter, a doctor, several times and urgently to terminate her life. The daughter and her husband, also a doctor, refused to do so, arguing that it was against the law. The mother could not accept this refusal and turned away from her daughter and her husband. Finally, the daughter decided to concede to her mother’s request. The court ruled that euthanasia would be acceptable if: the patient is incurably ill; the patient suffers unbearably; the patient has requested the termination of his life and the termination of the patient’s life is performed by the attending doctor or in consultation with this doctor. The court explicitly rejected the criterion that the phases of dying must have been entered. The doctor was convicted [sentenced] to one week conditional confinement with one year probation. This landmark decision not only [was] widely discussed in the professional and lay press but also induced the establishment of pro-euthanasia organizations. The Leeuwarden decision more or less started the public debate on euthanasia. (1991: 6–7)

All three accounts mention, with varying degrees of emphasis, that the ‘patient’ in question had been Dr Postma’s mother, that she had been severely ill for some time, and that she had voluntarily requested her daughter’s assistance to die. All three agree that this event set the stage for subsequent developments that eventually led to the legalization of euthanasia in the Netherlands. Yet, none of these sources, or others that I have seen, takes into account the significance of the fact that the person euthanized was Dr Postma’s mother. During the trial

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itself, the district attorney of Leeuwarden reportedly did make a reference to the familial relationship, but only to highlight that it prevented Dr Postma from acting objectively (Het Vrije Volk, 16 January 1973). The role of Dr Postma’s husband, who is himself a doctor and who also initially refused to euthanize his mother-in-law, is left unclear, as well. Was he consulted? What was his role in the case? Did his involvement (or lack thereof) in euthanizing ‘the patient’ make the whole process more ‘objective,’ or the reverse? The neglect of the familial relationship is all the more surprising considering that all existing accounts that I have seen refer to the ‘patient’ only as ‘Dr Postma’s mother’ without using her own name, Margina Grevelink.2 While marginalizing the personal relations between the ‘patient’ and the ‘physician,’ all four of the above accounts highlight the medical details of the case. Ms Grevelink’s condition as a severely ill person is played up in all of the existing accounts of the trial, including those produced by advocacy groups on both sides of the debate, albeit for very different purposes. In Dr Humphry’s account, and in that of Dr Leenen for the RDMA, the medical history of Ms Grevelink is laid out in detail to emphasize her status as a suffering patient worthy of sympathy. In Dr Emanuel’s account, written from the point of view of a physician critical of euthanasia, the details of the medical history, including that the woman in question was deaf, partially paralyzed, and quite old, are laid out in a way that stresses her vulnerability. Here again, she is first and foremost a patient who only ‘happened to be Dr Postma’s mother.’ The intertwinement of the biological and the biographical relationship between the two women – the one who asked for help to die and the one who provided that help – would appear to have played a major role in shaping the event. It is significant that, as reported by Leenen (1991: 6), Margina Grevelink asked for her daughter’s help after her own doctor had refused to help her die, and that she turned away from her daughter and son-in-law after they, too, initially refused to grant her wish. Another important detail is that Dr Postma testified that later she regretted not having helped her mother die sooner. These aspects of the event point to the personal and affectual 2 I would like to thank Kim J.A. Goossens for kindly finding Ms Grevelink’s name from the original court transcripts. According to him, it is hard to find Ms Grevelink’s name even in Dutch language material dating back to the time of the trial. Mr Goossens also found and translated the district attorney’s statement cited above.

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character of what transpired between these two women. Dr Postma broke the law and violated medical ethics, but in doing so she was motivated by a sense of morality that was beyond the comprehension of what either the law or medical ethics could codify or capture. It was the gift of death – one of the rare moments when death can become a gift – that the daughter ultimately gave to the mother in return for the gift of life she had received from her. This ultimate gift could be explained neither in terms of spoken objective laws nor comprehended by anyone not privy to that situation (see Derrida, 1995: 61). In Baudrillard’s (1981) words, an exchange such as this follows not the rule of exact equivalence inherent in market transactions, or foreseen in legal contracts, but an ambivalent logic of its own. The mother gives a double gift of life, once by giving birth to and raising her daughter and once by wanting to die in part so that her daughter can live without the burden of a very sick mother. The daughter, in turn, takes legal and professional risks and exposes herself to potential moral and emotional backlash by agreeing to give her mother a peaceful death. The daughter’s initial hesitation and refusal indicate that the decision to help her mother die was not an easy one for the daughter and that she had to overcome her own fears, feelings, and sense of morality to take part in this exchange. This case of euthanasia entails sacrifices – past and present – from both sides. The court transcript and the existing accounts of the trial largely suppress or sever this symbolic gift economy. Geertruida Postma could have given her mother additional doses of painkillers, as the court later suggested she might have; she could have sedated her into a peaceful sleep; or brought in psychologists, counsellors, and priests to change her mother’s mind; she could have walked away, citing legal restrictions, as Ms Grevelink’s own doctor had done. But the person requesting death was not simply ‘a deaf, partially paralyzed, seventy-eight-year-old woman,’ as Dr Emanuel puts it. She was not just the private citizen conceived by modern Western political and legal thought, nor simply Levinas’ ‘Other as Stranger’ – to whom one owes responsibility, respect, and deference because of her ‘otherness’ (1991: 118–21; 1985: 86; see Fox, 1998: 35). The private citizen and the Other as Stranger are persons to whom one can relate externally. Ms Grevelink was kin, mother: at once self and other. The affective relationship between mother and daughter is typical and at the same time unique and singular, mediated by a web of familial interactions that cannot be described using the vocabulary of social

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contract theory which underlies both the logic of the law and the position of the proponents and opponents of euthanasia. The symbolic gift economy of a ‘good death’ (the literal meaning of euthanasia in Greek) transcends the limits of the values on which the present-day practice of medicalized euthanasia as a medical service is based. Seen from the perspective of the symbolic gift economy of good death, Dr Postma’s act of helping her mother die is a demonstration of caring for her mother, as she later confirmed when she said that she regretted that she had not helped her mother die sooner. The medical ethics of curing revolves around the paternalistic commandment to keep alive and to let go of a patient only when medical intervention is seen to be hopeless; the ethics of caring, however, transcends this commandment to embrace both life and death as gifts that can be wished for, offered, accepted, returned, or rejected. As Selma Sevenhuijsen (1998: 63) has put it, the ethics of caring bravely embraces vulnerability, rather than shies away from it, and recognizes ‘connection and dependence’ not as things to overcome but as integral parts of human life and moral subjectivity. The ethics of caring underlies much of the unofficial, un-institutionalized history of dignified death. This ethics is often associated with the feminine relational notions of empathy and interdependence, as opposed to the masculinized ethics of social contract expressed in the concepts of autonomy, universality, and objectivity (Warren, 1992: 33; Sherwin, 1992: 26). Some of the most influential icons of the movement, besides Geertruida Postma, are women who have had to grapple with the issue personally. This includes Sue Rodriguez and Nancy B. in Canada, each of whom went to the courts to assert her right to a dignified death within a medical setting. In both the Netherlands and the United States, studies show that of all medical staff those with closer personal contact with patients (nurses in the United States and family doctors in the Netherlands) are more likely to be in favour of euthanasia (van der Maas and Emanuel, 1998: 168). Statistical surveys in the United States also indicate that patients and their families are more likely to be in favour of euthanasia than are physicians themselves (ibid.). Dr Derek Humphry, whose statement is cited above, became involved in euthanasia advocacy after he helped his own wife die. In short, individuals suffering an incurable illness and those closely involved with caring for them are more likely to be in favour of euthanasia than people who talk about it in the abstract or strictly as a matter of professional (legal and medical) practice.

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Nonetheless, in the Netherlands as in the United States and Canada, the debate for or against euthanasia has been mostly articulated in terms of medical, legal, and ethical concepts. The discursive suppression of the familial and reciprocal caring between Geertruida Postma and her mother is not an accidental oversight but symptomatic of the general direction of the debate, which has been governed by abstract values and universal rules that largely disregard the details of the personal context and its effects on particular persons. According to Susan Sherwin (1992: 26), this impersonality is the predominant mode of operation and policy development in medicine and public health. The main questions are asked in an ‘androcentric frame of reference,’ involving competition and power between patient and physician, such as autonomy versus paternalism, wellinformed consent, and patient independence (Warren, 1992: 33). A leading liberal legal ethicist and a supporter of euthanasia, R.M. Dworkin (1993: 216–17), reduces the problem of euthanasia and assisted suicide to the question of a contract governed by the principles of self-interest and the value of individual life. With regard to self-interest, Dworkin argues that in certain circumstances, living longer is not necessarily in the best interests of a patient, especially when it involves unbearable pain or living in a vegetative state. As for the value and sanctity of life, Dworkin’s position is that nothing sanctifies forcing people to live against their wishes (ibid.). The ‘patient’ that Dworkin is defending is an abstract person whose problem is best addressed in terms of self-interest and the exact value of life, as determined by the extent of illness and general quality of living. A similar vocabulary and frame of reference is utilized by those who oppose euthanasia. For instance, Carlos Gomez, a pro-life American physician, uses the logic of commodity exchange and market value, if unconsciously, to articulate his arguments against euthanasia. The crux of the moral problem, for Gomez, lies in the fact that ‘the claim to a right to death at the hands of a physician is essentially a private claim on a public good’ and it would, therefore, call for a degree of public scrutiny (1991: 134); however, regulations governing euthanasia often employ ambiguous criteria, such as ‘unbearable pain’ or ‘voluntary decision,’ none of which can come under objective and transparent definitions (ibid.: 122). Essentially, Gomez’s objection centres on his concern that a public good (a physician’s services) is being distributed without sufficient accountability and transparency (see also Callahan, 1992: 52).

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Others have likewise articulated their concerns about euthanasia in the language of social contract theory, with an emphasis on patient autonomy, voluntary decision-making, and power relations in the medical context. Beverley McNamara (1998) questions whether and to what extent patient autonomy is meaningful in the cultural and medical context within which it is supposed to apply. For her, factors such as the terminally ill person’s altered conceptions of self, as well as social location and structural constraints, can prevent autonomous decision-making. These arguments represent legitimate concerns regarding the construction of autonomy within the medical setting. The opponents of euthanasia, however, use these arguments to deny the possibility that a person could really and voluntarily choose to die. Frank Leavitt, for instance, criticizes the ‘blind trust’ in the rationality of end-of-life decision-making, arguing that ‘there can be no informed decision to die’ because ‘not knowing what it is like to be dead, no consent to die can be “informed consent”’ (1996: 62, quoted in Sleeboom, 2003: 24). Henry Wijsbek disputes whether a death wish can ever be voluntary and well considered. Even if it could under ideal circumstances, it is doubtful that it could under circumstances of unbearable and hopeless suffering; rather, for Wijsbek, all requests made under such circumstances are compelled and, hence, involuntary (cited in Sleeboom, 2003: 22). These arguments invoke the nineteenthcentury belief that those who choose to die are not in full possession of their mental faculties (see Chapter 3). In light of the increasing subjection of the language of the death with dignity debate to medico-legal abstraction, it is important to examine the way in which the Dutch medical establishment itself has participated in this process, especially since the Royal Dutch Medical Association played the most prominent role in the years (1973 to 2001) leading to the legalization of euthanasia in the Netherlands. In the Postma case (1973), the court’s pronouncement leaned heavily on what it called the ‘existing medical norms,’ as sanctioned by the medical establishment, with regard to the limits of medical behaviour that potentially shortens life. The main expert medical witness testified that, in accordance with the existing medical norms accepted by the RDMA, when it is medically established that a dying patient is incurably ill or suffers from an unbearable physical or spiritual pain, and that person has indicated in writing a desire to terminate his or her life, the attending physician or medical specialist can administer increasingly larger doses of medication that would alleviate suffering while

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knowing that it would also shorten the patient’s life (Gomez, 1991: 31). According to the medical expert, the existing norms required that the prescription be administered by a physician and in consultation with a colleague (ibid.). Although the court concluded that Dr Postma’s case did not fall under this category, the medicalized criteria set forth by the expert medical witness functioned as a working agreement between the courts and the medical profession in subsequent cases. In several other trials since then, the courts have asked for and heard the testimony of the RDMA on whether – from an objective medical perspective – a particular case would be justified as legitimate euthanasia. Since 1973 the RDMA gradually developed guidelines for its membership, outlining what is perceived at any given point in time to be the ‘acceptable medical practice.’ According to these guidelines, the patient’s decision has to be voluntary, the request to die must be well considered, the desire to die must be persistent, and the suffering unacceptable. It is emphasized that only a physician in consultation with other physicians can carry out euthanasia. The guidelines set by the RDMA, and occasionally amended by the courts, define ‘a situation of necessity’ or force majeure under which medicalized euthanasia or assistance in suicide could be acceptable. In a case brought before the Netherlands Supreme Court in 1984 the RDMA successfully argued, in defence of a physician, that sometimes the great suffering of a patient puts the physician in a situation of necessity where euthanasia seems to be the ‘least unacceptable’ alternative both to the doctor and to the patient (reported in Gomez, 1991: 38). The ‘situation of necessity’ arises out of a conflict of duties for the doctor: the duty to save life and the duty to find an answer to the explicit wish of a patient to be relieved of pain. Similar to the way the suicide debate developed in the nineteenth century, the euthanasia debate of the late twentieth century took a turn towards the nonmoral, non-intentional terrain of necessity. For force majeure implies the presence of a factor that necessitates an act, much as a cause necessitates a more-or-less involuntary and automatic effect. This is different from a situation when a motive or intention inspires a more-or-less voluntary and, therefore, im/moral act. These developments in the areas of ethics, law, and medicine constitute a near-complete medicalization of death. The person wanting to die has to take on the identity of a terminally ill patient and conform to the codes and norms of the doctor-patient relationship, where legally conceived conditions of autonomy, consent, and well-

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considered request are met in the context of a medically hopeless prognosis and a ‘situation of necessity,’ as discussed above. In a curious sentence in a case in Rotterdam, a court judged that force majeure was reserved for physicians to the exclusion of others, including even nursing assistants (Leenen, 1991: 8). The definition of unbearable suffering is also the prerogative of physicians (van Berkestijn, 1990: 5–6), who are seen to be the only competent persons in such situations (RDMA, 2000a: 7). The medicalization of death has, in turn, led to a further medicalization of life. In a controversial case, eighty-six-year-old Edward Brongersma, a retired Dutch senator, asked for and received assistance in suicide from his physician, Philip Sutorius. Brongersma did not have symptoms of any particular medical condition beyond what old age entails: he was lonely and physically deteriorating. He told his doctor that he felt death had forgotten him and that he was dead tired; life, as such, had become unbearable for him (see Griffiths, 1995: 367). Yet, when prosecuted, Dr Sutorius was forced to narrate the situation in terms of a medical condition to justify his actions before the court. He had to argue that a situation of force majeure existed, that Brongersma was a legitimate medical case – a patient – and that, as a physician and from an objective medical standpoint, he had acted properly in granting his patient’s wish (Sutorius, interview in Relevant, 2003). It was not enough to say that he had known Senator Brongersma for years (as he had), that he empathized with his pain, and that he had felt there was no other moral choice. Instead, the physician had to expose and reinterpret many details of the late senator’s everyday life to prove ‘objectively’ that he really was suffering from an illness and was, therefore, entitled to assisted suicide. Sutorius told the court that his patient ‘had lost 95 per cent of his life’s values: his mobility, his contacts, his will to live, control over his bladder and bowel movements’ and that he had increasingly become ‘dependent on others, which he hated’ (ibid.). Whereas Edward Brongersma said he suffered from life itself (Griffiths, ibid.), his doctor was forced to recast the story in terms of a situation of medical futility and immense physical suffering. This renarration erases the senator’s explicit subjective judgment on the value of life. Edward Brongersma did not suffer from life itself: such an argument would have been unacceptable to the court. He suffered, rather, from something more precise, an illness or a set of symptoms that can be objectively pinpointed. Lost in the medicalized and legalized language of the debate is the fact that, in the past and the present, euthanasia has often been justi-

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fied and practised with an implicit reference to the altruistic ethics of duty and responsibility towards others, and an ultimate understanding of the meaning and limits of life, as opposed to formal and institutionalized entitlements to rights (see Gilman, 1935). The Inuit elderly practised euthanasia in the interests of the young, and the Dinka in the Sudan chose euthanasia when they perceived that they had lost the capacity for responsible citizenship (van der Mass and Emanuel, 1998: 162). These and similar stories from Siberia, Melanesia, Fiji Islands, Ancient Greece, and Hindu societies indicate that, historically, euthanasia has been practised out of a sense of personal and collective responsibility. In their co-authored essay on the subject, Paul van der Maas and Linda Emanuel, leading figures from opposite sides of the euthanasia debate, point these cases out but quickly dismiss them as irrelevant to the contemporary question of euthanasia (ibid.). That van der Maas, a proponent, and Emanuel, an opponent of euthanasia, would agree on this point is interesting. For both of them, modern Western euthanasia is a question of law medical ethics and not a subject of the ambiguous and altruistic ethics of responsibility and duty as present in the premodern, non-medical, and often nonWestern history of euthanasia. Yet, despite such denials from both sides, evidence suggests that there is historical continuity in the demand for euthanasia that transcends some cultural boundaries and makes the traditional, tribal practice of euthanasia relevant to the present context. This continuity consists, partly, in the persistence of altruistic motives as a main factor in the decision to demand euthanasia. Today, the common perception, partially created by the pro-euthanasia literature, is that patients request death because they are suffering unbearable pain. In reality, the main reasons that people cite when requesting physician-assisted death are the loss or fear of the loss of dignity and the interrelated feelings of loss of control, being a burden on others, and being completely dependent on others (van der Maas and Emanuel, 1998: 155). Yet patients wanting to die cannot officially state that they fear they are or might become a burden as the reason for this request (RDMA, 2000a: 40). They cannot express a wish to die out of an altruistic sense of duty and responsibility towards other family members who are caring for them. In most existing medical guidelines for the practice of assisted death, especially in the guidelines set by the medical association in the Netherlands, patients can request euthanasia only if they are suffering unbearably or hopelessly from a physical or mental condition or if

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their condition subjects them to living with indignity (ibid.: 40–2). In theory, and as a matter of formal procedure, death can be requested and granted in the interests of a patient only, that is, at most as a form of what Durkheim would characterize as egoistic suicide. Death cannot be requested and granted out of a person’s choice formulated in terms of a duty to others or a preference for oneself; rather, death has to have become a necessity for a patient because of the hopelessness and unbearable pain that an illness imposes on that patient. Likewise, a physician can grant a request for euthanasia only out of a situation of necessity (force majeure) when circumstances make it impossible not to comply with the request of the patient. Dying Dutch: On the Cutting Edges of Regulation The suppression of the sociosymbolic logic of caring, responsibility, and duty works hand in hand with a second discursive trend that seeks to rewrite the moral logic of dignified death in terms of public policy priorities. If the first trend portrays dignified death as a medical necessity, the second portrays it as a necessity of governing a complex society. It is argued that legalizing euthanasia and assisted suicide is, ultimately, in the interests of law and order, as it would lead to transparency and accountability. As we shall see below, from a public policy perspective, the ability to regulate trumps most other moral, ethical, legal, and sociological factors. What we know of the Netherlands is often consistent with that country’s image as a liberal, progressive, secular, and tolerant society unafraid of controversy, as exemplified in the areas of the sex trade and drug use. Yet, as my own experience and that of other researchers who have travelled to the Netherlands to study euthanasia (e.g., Gomez, 1991) show, it is typical to hear Dutch experts in this area explain their attitude towards euthanasia in terms that highlight not tolerance or progressive views on moral issues but the long-standing influence of Calvinism in the Netherlands. Sociolegal scholar Rob Schwitters points out that attitudes towards euthanasia in the Netherlands are shaped by a history of Calvinist emphasis not only on individualism but also on bringing law and practice together, on dialogue, and on giving names and words to controversial problems rather than to shove them under the carpet (personal communication, 2003). Schwitters sees the secular spirit of Calvinism as the source of the heterogeneity that characterizes the Dutch legal system, and of the instrumental approach that the Dutch

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take towards the law. In supporting his view, he noted that the first physician and academic to write positively on the subject of euthanasia was Jan H. van der Berg (1978 [1969]), an affiliate of the Protestant Free University in Amsterdam. The decriminalization and eventual legalization of euthanasia is thus to be judged as an extension of Dutch cultural Calvinism, rather than as an expression of that society’s radical liberalism. This context of concern with order, openness, communication, and transparency differentiates the Dutch history of policy-making concerning the end of life from that of countries such as the United States and Canada. In North America the main concern in public and political debates has always been the right of the individual patient to life or death (as exemplified by Sue Rodriguez’s high-profile case in Canada), whereas in the Netherlands the debate has been formulated mainly in terms of the need for transparency, order, public scrutiny, and bringing law and practice in line with one another (see Griffiths, 2000: 174–5). This debate dates back, at least, to the 1970s when euthanasia was not legalized in the Netherlands but its practice was permitted under strict guidelines set by the courts, the RDMA, and the government. During this period, much of the debate was formulated in terms of the potential costs and benefits of legalizing euthanasia. The possibility of nonvoluntary euthanasia was a great concern and some feared that allowing voluntary euthanasia would open the door for the non-voluntary termination of life. Others argued that, legal or not, euthanasia does take place and that greater openness would encourage doctors to report euthanasia without fear of being prosecuted, making it easier for the state to regulate euthanasia and prevent abuse. This debate has its own history, with both sides arguing that only quantitative data can illuminate the answer (see, e.g., van der Maas and Emanuel, 1998). As with the case of suicide in the nineteenth century, statistics is invoked when all abstract moral arguments have been exhausted – which often happens very early in the debate because of the impossibility of convincingly proving one side or the other of the issue. In the years leading to the legalization of euthanasia in the Netherlands, three physician surveys were undertaken by the Dutch government, in 1990 and 1995, and 2001 (best known as The Remmelink Report); these surveys are often placed at the centre of the debates and cited by both sides in support of their points. For the opponents of euthanasia, the statistical problem hinges on what they call ‘the slippery slope argument.’ They cite the government-

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sponsored surveys to justify the assertion that the legalization of voluntary euthanasia opens the door for involuntary euthanasia, the term used in reference to euthanasia of patients who have not explicitly asked to die or who are incapable of expressing themselves (Keown, 1995: 262–3; O’Steen, 2001). Table 4.1 shows that in 1,000 cases or about 0.8 per cent of all deaths in the Netherlands in 1990 and in 900 cases or about 0.7 per cent of all deaths in 1995 a medical decision was made to end the patient’s life, but the patient was not consulted immediately before euthanasia was performed (although the patient might have expressed such a wish at an earlier time). There are also grey areas in which life was terminated without the patient’s explicit request but it is difficult to clearly categorize the death as non-voluntary euthanasia. For instance, sometimes doctors decide not to initiate or not to continue treatment in cases of medical futility or when the patient is very close to death, a practice that is common in most countries. As Table 4.1 shows, in the Netherlands 17.5 per cent of all deaths in 1990 and 20 per cent of all deaths in 1995 were hastened by a ‘non-treatment decision.’ Griffiths, Bood, and Weyers (1998: 218) show that even when patients are competent or partly competent they are often not consulted about the non-treatment decision, raising concerns about lack of adherence to medical safeguards. Opponents of euthanasia cite this lack of a concurrent request as proof that, in the Netherlands, abuse has been both prevalent and inherent in the practice of euthanasia. Supporters of euthanasia cite the very same statistics but as evidence that there is no slippery slope and that the rates of involuntary euthanasia in the Netherlands are not on the rise (see Table 4.1).3 Indeed, they see legalization as the best way of preventing involuntary euthanasia, the abuse of power, underreporting, lack of control over the administration of euthanasia, and lack of transparent and democratic decision-making (Leenen, 1991: 6). They argue that transparency of practice and open3 What explains the disparity between such conclusions is that often there is little agreement on what constitutes a statistically significant change, let alone what constitutes ‘involuntary euthanasia.’ In addition, the data are often compounded or interpreted so as to support the researcher’s own views. For example, Gomez believes that non-voluntary euthanasia often goes unreported in the Netherlands and that its real numbers might be as high as 18,000 to 20,000, which represent about 14 to 16 per cent of all deaths in that country (1991: 53). On the other side of the debate, researchers have cautioned against such exaggerations and suggested that even when a patient’s death is hastened without his or her explicit concurrent request, it does not necessary mean that he or she is a victim of non-voluntary

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Table 4.1 Estimates of Frequencies of Medical Behaviour That Shortens Life (MBSL), as percentages of all deaths 1990

Euthanasia Death on request Assistance with suicide Ending of life without patient’s explicit request Death due to pain relief Accepting riska Subsidiary purposeb Death due to non-treatment decisionc Accepting risk Express purposed Total MBSL Total deaths in the Netherlands

1995

%

N

%

N

1.8 0.3 0.8 17.5 14.0 3.5 17.5 9 8.5 38

2,300 400 1,000 22,500 18,000 4,500 22,500 11,500 11,000 48,700 128,800

2.4 0.3 0.7 18.5 15.5 3 20 7 13 42

3,200 400 900 25,100 21,000 4,100 27,100 9,500 17,600 56,700 135,500

Source: Based on Griffiths, Bood, and Weyers, 1998: 208 and 210. a The physician did not intend to shorten life but took into account the probability that the administration of the heavy doses of medication for the purpose of pain relief may shorten life. b The primary intent of the physician was to relieve pain but might have acted partly with the purpose of shortening life. c Withholding or withdrawing life support, life-saving medication, or other life-saving interventions. d The physician withheld or withdrew life saving measures with the express purpose of shortening life.

ness of law will ultimately work to protect patients from abuse and involuntary euthanasia. Here, the sociolegal benefits of legalizing euthanasia are pitted against the potential harms that it might entail (the possibility that a person about to be euthanized might die without euthanasia. David Orentlicher and Lois Snyder, for instance, point out that often the doctor’s actions violate the letter of the law but not the spirit of the law (2002: 59–60). In these cases, the termination of life is probably consistent with the patient’s wishes but these wishes have not been expressed in accordance with the formal procedural requirements of the law; that is, they are not expressed in writing or are not repeated persistently over a period of time. In some cases, the patient is only hours away from death, is in great agony, and has expressed a wish to die in the past, but has since become incapable of confirming his or her wish (ibid.: 60). For more on these statistical disputes see Griffiths (2003) and van der Maas and Emanuel (1998).

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a concurrently expressed request to do so). It is also pointed out that ending life without the patient’s concurrent request occurred in the case of 3.5 per cent of all deaths in Australia, where euthanasia is not allowed, compared with 0.8 per cent in the Netherlands, suggesting that Dutch openness towards euthanasia has actually led to lower risks of abuse (‘The Ethics of Euthanasia,’ RDMA, 2000b: 5; van der Maas and Emanuel, 1998: 161). This ‘instrumental policy approach’ (Schwitters, 2001: 102–4) to euthanasia, premised on the assumption that legalizing euthanasia will statistically minimize the potential harms, has become dominant in almost all of the pro-euthanasia literature, including the studies sponsored by the Dutch government (RDMA, 2000a; Griffiths et al., 1998). Writing on the controversial issue of euthanasia and psychiatric patients, John Griffiths, Alex Bood, and Heleen Weyers best exemplify this point of view when they argue that the real potential harms lie not in the legalization of controversial practices but, rather, in not knowing what precisely is happening when practices are hidden from the eyes of the law and regulatory agencies: Is a tiny number of highly-regulated cases of legal assistance with suicide really a serious social threat, or does the real threat lie in an unknown but probably larger number of totally unregulated cases? Anecdotal evidence suggest that psychiatrists have long engaged in practices that amount to assistance with suicide and there is no apparent reason to suppose they do so more often in the Netherlands than in the United States. There are psychiatrists who turn a blind eye to the fact their patients are storing up medicines for a suicide attempt; who allow the release of suicidal patients from institutions to enable them to commit suicide; who inform patients about the existence of organizations such as the Hemlock Society or call their attention to do-it-yourself books on suicide. How much of this goes on, we cannot say. The only thing we can safely say is that so long as it is underground, it is quite beyond any form of legal or other control. (Griffiths et al., 1998: 303)

Griffiths and his colleagues go as far as to argue that the Dutch experience could be relevant to the situation in the United States (and probably to other countries by extension) because, among other reasons, ‘if one seriously wants to keep such practices under control, there does not seem to be a real alternative to getting them out of the closet and into the light of the day, even (or particularly) if one does not like what

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one is going to see; for this, some degree of legalization is probably a first prerequisite’ (ibid.: 305). From their study, hinging mostly on statistics, Griffiths, Bood, and Weyers draw a familiar conclusion that is echoed everywhere in the pro-euthanasia camp: the only difference between the situation in the Netherlands and elsewhere ‘lies in the fact that Dutch doctors have been willing to take public responsibility for what they are doing, to submit it to public scrutiny and debate and, ultimately, control’ (ibid.: 260). Consequently, although euthanasia is inevitably a matter of law and politics, these scholars hold that ‘it does not follow that the most effective form of legal control takes the form of criminal prohibitions and prosecutions’ (ibid.). Rather, professional control by the medical establishment itself, especially if it is accompanied by general social norms and social control, is sufficient ‘to ensure that the behavior of most doctors is socially acceptable most of the time.’ Accordingly, legal control ‘can best confine itself, within wide margins, to supporting, strengthening and structuring professional control’ (ibid.). This argument implies that as long as the current practice is transparent, and as long as it lends itself to surveillance, there is no reason to be concerned about euthanasia. Thus, statistics here serve to reveal a truth particularly valuable from the perspective of legislation, governing, and law enforcement. The Dutch government decided to reduce the influence of the criminal law in cases of euthanasia after the Remmelink Report suggested that matters were not getting out of hand, that more openness resulted in the exercise of more care, and that physicians preferred and would comply more with a less threatening review mechanism outside of the criminal law context. For this purpose, the government introduced a multidisciplinary review committee made up of a lawyer, a physician, and an ethicist to advise the public prosecutor on the question of whether or not to dismiss any given case. The assumption was that ‘the introduction of such a committee will increase the willingness of physicians to report cases’ (Legemaate, 2000: 57) and help keep the situation under professional self-control. These measures were adopted in the legislation that officially decriminalized euthanasia in the Netherlands in the spring of 2002. All in all, the prevailing attitude in the Netherlands implies that professional regulation, statistical record-keeping, and a minimum of legal control make the practice of euthanasia more transparent and manageable and, therefore, morally superior. The risk of abuse in the medical setting, thus, becomes only one among many forms of risk that the neoliberal state embraces. This form of ‘embracing risk’ (Baker

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and Simon, 2002) and, in fact, governing through risk (see Giddens, 1991; Ericson, Doyle, and Barry, 2003), reduces justice and morality to the utilitarian question of choosing the least risky option, thereby sidestepping the task to address the meaning and conditions of medicalized living and dying. Conclusion: Living a Modern Death Medically sterilized death provided by euthanasia and physicianassisted suicide serves as an alternative to the disorderly, painful, and often laborious reality of the modern dying process. It is meant to make the dying process dignified, which has a range of meanings from neat and clean, to sanitized, orderly, aesthetically not unpleasant, and quick. Euthanasia and assisted suicide also provide an opportunity to remake death into an event that can be experienced by dying individuals before they have lost the mental or physical capacity to live their own deaths. The opposing ritualistic and discursive orderings of death coexist, albeit in tension with one another, within the context of legalized medical euthanasia in the Netherlands. Most documented accounts of assisted death indicate a tendency on the side of patients and their families towards reritualizing death through euthanasia. Existing accounts typically give the impression that often the administration of euthanasia takes place in the form of a highly ritualized ‘appointment with death’ (Zaritsky, 1994, video documentary). There is an emphasis on a timely and planned death, as implied by the word ‘appointment,’ as well as a tendency to incorporate symbolically and ceremonially meaningful elements. Often family and friends are present, and the family priest is called in for the last rites (see Gomez, 1991; for similar rituals in non-medicalized euthanasia in U.S.A. and Canada see Magnusson, 2002; Ogden, 1994). The timing and circumstances of death are sometimes carefully chosen so that they reflect something meaningful in the life of the dying person. A last cigarette marked the final hour of one elderly woman with cancer before her doctor euthanized her, while a young painter with AIDS chose the anniversary of a significant personal achievement as the time of his dying (Zaritsky, 1994). The desire to share the moment of death, to release others from the burden of caring, and to be there for a dying friend is accommodated by the medico-legal framework. Medical ethics and law cannot and often do not formally acknowledge the presence of such desires (as happened in the Postma case), but they nevertheless provide a space within which they can be fulfilled.

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But beyond the rhetoric and reality of caring, ritualization, and reclaiming one’s own death, beyond the notion of the right to one’s own death, what seems to have shaped official public policy most decisively in the Netherlands is the extent to which the burden of governing the dying process and the responsibility of the ‘custodianship of the collective sanctity,’ to paraphrase Shils (1975: 225), could reliably be distributed among practitioners in the medical field and among the dying themselves. From this perspective, the legalization of euthanasia is an attempt to bring effective and consistent regulation to physician-patient relations, making patients responsible for their own choices and also bringing a degree of medicalized (self)-government to the last stage of life. In any case, there is no official reference to the ulterior moral, symbolic, or affectual motives of the euthanizer and the euthanized, of the living and the dying. Hence, requested death, as a mode of resistance against the excessive medicalization of life, has itself become a variant of the existing modes of governing death: it might have succeeded in challenging some aspects of the medicalization of life, but it has also produced and legitimized other forms of medicalization of both life and death (as best evidenced by the case of Edward Brongersma). It is perhaps little wonder that euthanasia was first decriminalized in the Netherlands where, from the point of view of law and jurisprudence, the question was never formulated in terms of a patient’s right to her own death but rather in terms of a doctor’s right to assist or deliver such death when deemed medically appropriate. In contrast, progress towards a legally codified ‘right to death’ has been slow or absent in places like Canada and the United States, where from the beginning the question has been formulated in terms of a patient’s right to request assistance in death. The iconic figure of euthanasia in the Netherlands is Dr Geertruida Postma, who helped her ailing mother die in 1971 and whose later trial opened the way for the eventual legal acknowledgment of the rightfulness of similar actions. In Canada, on the contrary, Sue Rodriguez, an incurably ill woman, stands as the icon of a movement that has pressed, so far unsuccessfully, for obtaining a patient’s right to request death. Similarly, in the United States, the request of Karen Ann Quinlan’s parents to grant their comatose daughter a ‘dignified’ death was stalled by years of legal wrangling. The decision of the New Jersey Supreme Court, in 1976, ultimately hinged on the argument that ‘pulling the plug’ is what Karen Ann Quinlan would have wanted if she could have had a say in the matter (see Battin, 1994: 4). In the Postma case the entire affair

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boiled down to medical ethics, while in the Quinlan case it was reduced to what the person herself would have wanted. As another unintended consequence, the death with dignity movement has contributed to the rearticulation and reassertion of the modern modes of regulating death in terms of the objective criteria of a liberal social contract. The language of social contract theory treats medicalized death as a contract between a physician and a patient, each of whom is regarded to be equally rational, autonomous, and capable of protecting his or her own interests. This insertion of the social contract into the medical field suppresses the intergenerational, interpersonal, gendered, and familial gift of death. It denies the mutual gift exchange between the dying person, society, and the family. By framing the practice of euthanasia in medico-legal discourse, by imposing the terms of a liberal social contract (such as autonomy and mutual consent) and of medicine (cure, hopeless suffering, and professional consultation), it denies in the last instance, that death can be requested and given out of a sense of caring on the side of the one who gives death and a sense of altruistic responsibility on the side of the one who requests and receives it in order to release others from the burden of perpetual dependence and futile care. As Moi (1985: 110) and Fox (1993: 91–4) have argued, gift relationships entail generosity, trust, confidence, love, benevolence, commitment, involvement, delight, allegiance, esteem, accord, admiration, and curiosity. What a medical contract can offer, in contrast, is patronage, for it portrays euthanasia as a physician’s favour and expertise as opposed to a gift offered out of love and generosity. It furthers the dependency of a dying person on the judgment and capabilities of a physician rather than on that person’s trust in the concern and caring of the one who gives death. The law and the norms of professional practice demand detachment and objectivity as opposed to involvement and empathy. Finally, the liberal medical contract governing euthanasia presumes the institutionalized gaze of a medico-legal surveillance mechanism, rather than the curiosity of exploring what the gift of death can entail. All of these aspects of the modern ordering of death stem from the fact that, as Fox (1993: 92–3) argues, in the context of healing and health care, the notion of gift, which entails trust, empathy, curiosity, generosity, and involvement, is considered unprofessional, subjective, and therefore, suspect. The latest form of death is, thus, subject to the modern institutional and disciplinary mechanisms of regulation, often resulting in the suppression of the potentially symbolic gift economy of death and dying.

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Conclusion: Thou Shalt Die an Orderly Death

The Orderly, the Disorderly, and the Un-orderable Reality of Death death of the poor Death can console, and Death can re-create; Life’s hope and goal, which, as strong liquers might, Arouse our courage and intoxicate, And give us heart to walk until the night. Baudelaire, Flowers of Evil

In a 1904 publication entitled, The Nature of Man: Studies in Optimistic Philosophy, celebrated zoologist and professor at the prestigious Pasteur Institute in Paris, Elie Metchnikoff, suggests that among higher organisms violent death caused by ‘maladies or the voracity of enemies’ is the rule, and natural death, if found at all, is the exception. From as early as the eighteenth century the question of natural death preoccupied a number of natural scientists; the existence of such a phenomenon was seriously questioned and even denied by distinguished biologists and botanists like Jacque Leob (ibid.: 265–6). Relying on an impressive body of knowledge, Metchnikoff concludes that ‘natural death in man is probably a possibility rather than an actual occurrence’ (ibid.: 277). Even death from old age is not to be considered natural but, rather, a premature and pathological result of serious lesions of the internal organs or of infections and germs. Likewise, senile debility is attributed largely to various infectious diseases such as pneumonia and nephritis (ibid.). In the early twentieth century, as in the late seventeenth, mortality, morality, and social

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order were seen to be intertwined: Metchnikoff speculates that much of the unhappiness, moral dilemmas, and metaphysical anguish afflicting humanity is the direct result of a profound disharmony in the human constitution: the morbid nature of old age makes it impossible to live long enough to reach and experience the instinct of natural death (ibid.: 285). Humans, he concludes, die far too early to reach a state of development where they might naturally develop an instinct and a desire for death and welcome their own end without anguish. For Metchnikoff, this disharmony results in anxiety in the face of death, passive fatalism, or the creation of ‘childish and erroneous conceptions of the immortality of the soul’: ‘Death brings absolute extinction, and it seems unbearable because of the condition in which it surprises us. It comes before man has finished his physiological development, and when the instinct of life is still strong’ (ibid.: 287). Metchnikoff finds both contradiction and confirmation of his views in none other than Baudelaire, the poet of the modern life. He agrees with Baudelaire (see poem cited above) that death is the goal of life but adds that we are not likely to aspire to it unless a full ‘normal life’ has been lived and the moment of a ‘normal death’ has arrived (ibid.: 288). The solution to this moral and existential dilemma lies not in religion or philosophy but in exact science, which could eventually replace disharmony with harmony by helping humans achieve the ultimate goal of their existence: ‘a normal end, coming after the appearance of the instinct of death’ (ibid., see also 280 and 289–90). Achieving this state would entail continual improvement in the conditions of old age and the development of the necessary means for postponing death until its natural time has arrived, that is, until the individual has developed a death instinct. This was a life mission for Metchnikoff himself, who discovered, among other things, the functions of the white corpuscles in human blood. The endless fight of the little blood cells against intruding germs mirrors the larger scale struggle in which humanity has to participate if it is to attain happiness. For ‘physiological happiness’ it is necessary to make sacrifices of civilization: we would have to lose much of our liberty and subordinate our private lives and public policy to the guidance of science and the rules of hygiene. We would have to get accustomed to less luxury and readjust the human constitution just as we do to animals and plants (ibid.: 301–2). Modernity’s poetic dream of resignation to the beauty of death as it is, which found expression in Baudelaire, at once clashes

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with and finds fulfilment in its rationalist dream of a final mastery over nature. Thomas Hobbes’ concern with violent death at the beginning of the modern era is echoed in Metchnikoff’s ‘optimistic philosophy’ at the dawn of the twentieth century: the mastery of violent death – whether inflicted by fellow citizens or by tiny germs – is the precondition of lasting social harmony and peaceful coexistence. Metchnikoff’s brief foray into the socio-moral implications of how and when we die is yet another reminder of the enduring significance of the interconnections between death and social order pointed out by Hobbes. Indeed, the moment of the problematization of violent death by Hobbes is also the moment when the modern question of order is first formulated. Although Hobbes’ approach to this question is far from the only one, he can be credited with introducing a debate and setting its framework for later generations of social and political thinkers from Rousseau (1754: Book I) to Durkheim (1984: 220), Parsons (1937: 89–94), and Foucault (1990: 147; 2003: chapter 5), all of whom draw from or respond to his work (see O’Neil, 1972; van Krieken, 2002). Robert van Krieken argues that the salience of the ‘Hobbesian problem of order’ in sociology results from the fact that it points towards the more profound question of ‘how is society possible’: ‘The “Hobbesian problem of order” is seen as central to sociology because the question of “how is social order possible” slides over to the quite different one of “how is society possible.” Alexander puts it in precisely this way: “What Parsons called the Hobbesian problem can be understood in the following way: What holds society together?”’ (2002: 259; see Alexander, 1998). Hobbes’ own response to the question of how social order is possible seems to stand on two pillars: a political convention and a moral principle. Social order requires a mutually agreed on contract (covenant) between the ruler(s) and the ruled as a basis for peaceful coexistence, together with a fundamental moral commitment by all to the inviolable sanctity of life as the greatest good. In Hobbes’ view, a sense of moral respect for material, earthly life, along with a political contract that prohibits either side from unlawfully or arbitrarily harming others, are the preconditions for humanity’s emergence from savagery and the beginning of a civilized and collective life of peaceful production and consumption. What Hobbes has in mind is not merely a one-time passage from the natural state of war of all against all into civilization but, rather, a continued dedication to the value of

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life as a precondition for long-term political stability and economic prosperity. For, the war of all against all is not confined to the state of nature, but is an always-present potentiality at the heart of civilization (Chapter 1). Hobbes’ idea that social order rests, in large part, on maximizing the pleasures of life and minimizing the risk of violent death implies a preference for the value of longevity. It, therefore, paved the way for the formulation of other types of death – such as premature death and suicide – in terms of personal and public risks. The link between social order and how, why, and when people die thus became a persistent theme in much of the early social statistical writings on death. For John Graunt (1662), premature death is not merely a personal ‘trouble,’ but, more significantly, a social ‘issue’ that can be analysed, addressed, and managed in the aggregate and in terms of various risk factors, including economic class and lifestyle. Sir William Petty (1687, 1690, 1691, 1699) and Johann Peter Frank (1786), along with various other eighteenth-century political economists, statisticians, and public health (medical police) experts, extend these risk factors to include sex, age group, occupation, living conditions, and other social categories. All the while it was understood and explicitly expressed that the problem of premature death challenges good governance in commerce, as well as in politics (Chapter 2). Suicide came to the fore as a problematic form of death in the nineteenth century because it was seen to be a threat to the moral integrity of the society or a sign of larger, more fundamental social problems. For statisticians such as Guerry (1833) and Morselli (1879) preventing suicide by uncovering its external, objective causes is a political, if not a moral, duty. Sociostructural factors including education, religion, means of communication, and general political and economic conditions, among others, are considered to have a determining influence on the rates of suicide. The problematization of suicide as a social issue is a significant contribution to the sociopolitical techniques of regulating life and death: it demonstrated that it is possible to explain and predict the patterns of the most private actions of the individual in terms of social factors outside of his or her volition, and to, therefore, find a way to control the incidence of such actions in the aggregate (Chapter 3). Finally, in the twentieth and twenty-first centuries, the euthanasia debate has hinged on finding a proper institutional place for death in societies that are, arguably, one-sidedly preoccupied with life and its prolongation. As people increasingly avoid premature

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death only to die from painful and chronic conditions associated with old age, the challenge has become to find a legitimate outlet for physicians to assist patients in dying without at the same time weakening society’s moral integration which centres around the principle of the sanctity of life. The crux of this problem lies in authorizing some people to take the lives of others without falling back on the social chaos that Hobbes associated with the arbitrary power of people over the life and death of one another (Chapter 4). Ordering Death: From the Symbolic to the Discursive I should now be in a position to return to the question that originally inspired this research: how should we interpret the incorporation of euthanasia into a sociomedical culture that seems to be primarily oriented towards postponing and preventing death? If modern Western culture is obsessed with prolonging life, as is often charged, why does it allow and even institutionalize certain forms of voluntary death? One possible answer might be sought in the proposition that such seemingly contradictory trends as those oriented towards postponing death at any cost and those aimed at regulating and liberalizing euthanasia are all instances of a more general sociopolitical strategy of ordering death, that is, managing and containing the threat to social order imposed by the unpredictable nature of human mortality. Such ordering consists of all efforts to tame, discipline, postpone, prohibit, incorporate, allow, or deny death within socially sanctioned institutional frameworks. The driving force behind the social need to order death is not the fear of death, as such, but a fear of its unruly and disorderly manifestations. Violent death threatens political stability; high rates of premature death deplete a country’s labour force and cause economic uncertainty; suicide puts in question a society’s ability to keep its members content; and undignified death betrays the pain and sense of abandonment that awaits many at the end of life. To better understand the various ways in which societies deal with and manage death, we need to abandon the conceptual distinction between practices that seek to hasten death (such as euthanasia or selfsacrifice) and practices that seek to postpone death (such as public health and suicide prevention), because this schema only pertains to the temporal aspect of death and reinforces the belief that death can be either ‘timely,’ and therefore acceptable, or ‘premature,’ and therefore unacceptable. A more useful theoretical distinction might be made

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between orderly death and disorderly death: the former includes all institutionally regulated death such as medicalized euthanasia, the death penalty after all legal procedures are completed, ‘natural’ death in hospitals and nursing homes, and even to some extent death in battle, while the latter includes teenage suicide, underground euthanasia, murder, premature death, traffic fatalities, and what I would call death-in-defiance, such as death during violent demonstrations and martyrdom. Death is not in itself an object of control or prohibition; only in its unruly, disorderly, and for the lack of a better word, messy aspects does death have to be prohibited or discouraged. Death can be given the appearance of an orderly, tame, and disciplined event within the context of various traditional and modern institutions. Religion gives an appearance of meaning and purpose to death in a highly ritualized setting. Law can play a role in bringing order to death by sanctioning or prohibiting certain forms of dying including euthanasia and the death penalty. Medicine functions as an institutional setting within which decisions about whether to save a life are made on the basis of approved medical norms of conduct. Finally, risk management – within the institutional frameworks of public health, epidemiology, public awareness campaigns, and suicide prevention programs – functions as a mechanism of regulating and managing death. Each of these discourses and practices issues a death sentence or an ordering of death in that each tells us, with varying degrees of authority and efficacy, how, when, where, and even why to die. They also issue a life sentence insofar as they tell us how and how long to live. Orderly death can be public, bearable, acceptable, even morally and legally approved. As a mode of ordering death, legalized and medicalized euthanasia has a logical continuity with other modes of ordering death including those oriented towards the prevention of violent, premature, and self-inflicted death. All of these represent cultural strategies to manage death as an orderly, predictable, tame, and riskfree event. By contrast, the shock and horror induced by murder, suicide, underground euthanasia, and suicide bombings derive, in part, from the unexpected confrontation with a death that is out of control, unpredictable, and disorderly. An advantage of the concept of ordering is that it connects a whole host of practices concerning the regulation of death and dying across time and place. The effort to order death does not appear to be limited to any particular human society or any particular time span. Ordering

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is neither modern nor premodern; it is neither Western, nor Oriental. Ordering appears to be a common, although not necessarily universal, human practice. Rita Caccamo (1988) has argued that death violates the dynamic equilibrium of not only personal life but social life as well, and is therefore associated with disorder and inadequacy because it undermines the continuity and stability of society. But Caccamo’s argument could be modified to state that while death disrupts social order, it also carries the potential to create and sustain order. Each society has to devise its mode(s) of ordering death to deal with death as a change in its overall continuity and to incorporate this change in a positive and productive way into its overall order. Ethnographic studies suggest that rituals and practices surrounding death in many societies function to tame the danger imposed by death and to carve a sense of continuity and order out of the disruption created by it (see Bauman, 1992). For many cultures death, the dying, and the dead can represent a danger that has to be ritually managed or avoided. Clifford Geertz (1973: 158), for instance, observes that in Bali the corpse has to be buried as soon as possible ‘because it is dangerous to have the spirit of the deceased hovering around the house.’ The ignominious treatment of the suicide’s corpse or of suicidal individuals in some societies can reveal cultural apprehensions towards those who kill themselves, possibly because by deliberately choosing death they challenge society’s respect for the value of life. This sense of apprehension is expressed in cultural and legal strategies devised for the handling of such situations and for the prevention of their spread (see Chapter 3). In general, the rituals of death consist of necessary steps to be taken before political, familial, economic, and social life can return to normal (Hertz, 1960). Otherwise the dead can subject life to chaos, famine, and disease. The proper handling of death can create or help maintain not only social stability and continuity but also a sense of unity. Robert Bellah (1967: 11) notes that national cemeteries such as Arlington and Gettysburg in the United States are sites of physical and symbolic statements about the great number of war deaths. The belief in self-sacrifice – itself an aspect of the American ‘civil religion’ – and the rituals surrounding this theme, Bellah submits, serve to unify the nation and give a sense of meaning and purpose during difficult times of war and grave loss of human life. All this occurs within a well-managed political culture, one might add, that sets a limit on the extent to which religious symbolism or the rhetoric of self-sacrifice can play a role in political life.

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The insights of some of sociology’s greatest thinkers might help us interpret the social significance of these death rituals. In The Elementary Forms of Religious Life (1965 [1912]), Durkheim argues that the most fundamental religious distinction, meaning the most fundamental social distinction, is between the sacred and the profane. The entire edifice of social order rests on the distinction between that which inspires awe and respect and that which is mundane and, therefore, profane (ibid.: 361). From this fundamental distinction stem all other social, moral, and logical classifications (ibid.: 365). This distinction is maintained and recreated through ‘rites of institution,’ to paraphrase Pierre Bourdieu (1991b: 120), that is, social rituals designed to establish and reinforce cultural differences between arbitrarily separated classes of people and things and to keep them all in their proper place (see also Douglas, 1966). The division between the dead and the living is among these arbitrarily established distinctions, and even the progress of science has not brought ultimate certainty to it (Agamben, 1998: 60–5). This arbitrary distinction is maintained through funary rituals of burials, mourning, and gift exchange. In some societies the ritual of mourning and conferring the status of dead on a person starts long before his or her biological death, while in others people might continue to live with the dead and even feed them for years (Durkheim, 1965: 436). In today’s Western and Westernized societies, where death and dying are to a large extent medicalized, rituals continue to govern and organize the experience of death (Prior, 1989: 27). Executions in the United States are embroiled in rituals designed to impose a strict separation between the executioner (a physician, who often only pushes a button or flips a switch from a separate room) and the executed and, by extension, between the world of the living governed by the principle of the sanctity of life and an exceptional world governed by the menace of death. Ritual distinctions between ‘dead’ and ‘alive’ serve to confer a status, to keep the sacred (i.e., the living) apart from the profane (i.e., the dead). Society imposes the implementation of utmost ritual care in safeguarding these divisions and the hierarchies and inequalities that derive from them – between those who have ‘committed suicide’ and those who have died of other causes, between ‘premature’ and ‘natural’ death, or between ‘violent’ and ‘peaceful’ death. Secular rituals and ceremonies are similar to religious ones in that both are social devices for upholding and affirming the collective sentiments and ideas that constitute society’s unity and personality

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(Durkheim, 1965: 474–5). To make a distinction between a death that is orderly and, therefore, socially and morally sanctioned and a death that is disorderly and, therefore, prohibited is to institute a line between the fundamental categories of life and death. Orderly death has a defined place within the social structure, a structure created by and for the living: it helps maintain and reinforce stability, peace, and continuity by reinforcing the value of life. Within this larger trajectory of ordering death in human societies, the Western history of death has offered at least two distinctive, but not mutually exclusive, models: the symbolic and the discursive. The symbolic ordering of death consists in the cultural and religious beliefs that give meaning and purpose to death, often by providing ritual avenues for symbolic exchange between the living and the dead and dying. The belief that the timing and manner of one’s death is governed by divine providence, for example, gives an appearance of meaning and purpose to the otherwise arbitrary and nihilistic reality of death. The Christian belief in life after death, accompanied by incentives to encourage good this-worldly conduct in exchange for other-worldly rewards is the prime example of an ordering of death that not only gives meaning and purpose to death but also allows for a channel of symbolic exchange between life and death (good deeds in exchange for other-worldly rewards). Yet, as Hobbes discovered, symbolic systems, such as religion, leave institutional gaps in the social ordering of death, making it possible for individuals or groups to take control of giving meaning and purpose to mortality in ways that do not necessarily serve the social interests of peace, security, and prosperity. For Hobbes, the violence of the English Civil War was underpinned not merely by the chaotic presence of death but, more importantly, by religious or otherwise ideological beliefs that were exploited to justify and encourage killing and dying for a cause. Thus, the real threat was not in the act of killing itself but in what inspired such killing: the invocation of the religious desire for other-worldly salvation and glory. The modern discursive ordering of death goes a long way in filling this institutional gap by excluding or marginalizing these symbolic meanings. It is characterized by a systematic attempt to draw an objective and more-or-less decisive line between the world of the living and that of the dead, which forecloses the possibility of recognizing any avenues of exchange between the two. Rather than being a symboli-

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cally meaningful event, death becomes a risk that can be managed, prevented, or regulated within the institutional confines of medicine, statistics, social sciences, epidemiology, law, and medical ethics. Together, these institutions create a network of power and knowledge that aims to transform death into an object of curiosity and control. Death becomes a moment beyond which nothing exists: no meaning, no other-worldly powers, and no purpose. As in the technological metaphor of a final beep and a flat line in the intensive care unit, death itself gradually becomes a dot at the end of a life lived and conceived as a linear process. The previous four chapters document a gradual, but never definite, process of transition from the symbolic to the discursive orderings of mortality that started in the mid-seventeenth century. Hobbes posits a secular political order in which peace, prosperity, and the comforts of this life take precedence over other-worldly rewards. The value of life is promoted as the greatest personal and moral good, while death is portrayed as nothing but the greatest of all evils (Chapter 1). Graunt’s work on premature death challenges, albeit inadvertently, ‘fatalistic’ beliefs in the omnipotence of divine providence and in the superiority of other-worldly life over this-worldly existence. Life here and now has to be prolonged and lived as if it were the sole form of existence: the individual’s one and only chance (Chapter 2). The nineteenth-century shift in the methods of suicide prevention, characterized by the abandonment of ritual desecration of the body in favour of the statistical and medical objectification of suicide, also speaks to the desire to sidestep the issue of meaning and symbolism in the act of self-killing (Chapter 3). Finally, the medicolegal discourse of euthanasia carefully leaves out any reference to the subjective and symbolic nature of the decision and determination to die on the part of those who request death (Chapter 4). With the reduction of the role of death in the political realm, the emphasis on the virtues of living long, the attribution of suicide to deterministic causes outside of the individual will and subjectivity, and the formulation of the question of euthanasia in strictly objective and medicolegal terms, death becomes a zero point, a negation, a loss that must be prevented – or at best sometimes tolerated – but that cannot be redeemed through any act of exchange between the living and the dying or the dead. The discursive problematization of violent, premature, self-inflicted, and undignified death has been intertwined over time with evolving

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conceptions of what it is to have order, to live in an orderly society, and to die in an orderly manner. A Globalizing Order? The drive to protect life against the threat of anarchic and disorderly death has significance not only within national borders but also internationally. The United Nations measures ‘human development,’ in part, in terms of longevity, health, and infant mortality, and, as a consequence, international aid is often targeted to address high mortality rates in poor countries. Moreover, provisions are made within international laws and conventions to protect all citizens of the world against genocide, war crimes, and arbitrary killings. In practice, however, the principle of the sanctity of life has been upheld in a morally inconsistent manner. Beginning with Hobbes, the moral commitment to the value of life has always been qualified and conditional: it has meant respect for the life of some but not all people. Hobbes himself argues that the prohibition against war only applies to civil wars – wars of ‘us’ against ‘us’ – and not wars aimed at the domination of ‘other’ peoples by ‘us’ (Leviathan, xx). By waging wars and colonial campaigns or by presiding over a system of distribution of wealth in the world that leaves many to die from hunger, the ‘civilized,’ life-respecting countries of the West have, arguably, imposed more death on one another or on the rest of the world than any of the vilest empires that history can remember. The case of Terri Schiavo, which I first discussed in the introductory chapter of this book, is instructive. In the spring of 2005, when this conclusion was originally being drawn up, a genocidal campaign was being waged in Sudan, many civilians were struggling with the ‘collateral damage’ of the war on terror in Afghanistan and Iraq, and thousands of people in the world’s poorest countries were dying prematurely from easily preventable causes. As all this was unfolding, the United States came to grips with a moral crisis over the question whether it was right or wrong to let one person, Terri Schiavo, die after being in a persistent vegetative state for years. The pilot who drops bombs from a safe distance is a national hero, the terrorist who blows himself up is a coward, the child dying from hunger is a non-person, and Terri Schiavo is a cause célèbre for a morally confused culture of respect for life. The writings of Foucault (1990, 2003), Agamben (1998, 2005), and Bauman (1992, 1998), as well as those of postcolonial writers such as

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Balibar (2001), suggest that this moral inconsistency is integral to the dynamics of the Western culture of life and death. Foucault has argued that racism and violence on a mass scale is inscribed in Western political order: ‘For millennia man remained what he was for Aristotle: a living being with the additional capacity for political existence; modern man is an animal whose politics calls his existence as a living being into question’ (1990: 143). According to this view, the Holocaust, as well as the looming possibility of a nuclear war during the Cold War, both stemmed, ironically, from the modern Western political imperative to take charge of life and how it is lived. Wars are no longer waged to defend the sovereign, but rather, they are undertaken ‘on behalf of the existence of everyone; entire populations are mobilized for the purpose of wholesale slaughter in the name of life necessity: massacres have become vital’ (ibid.: 137). Similarly, today the ‘naked question of survival’ (ibid.) is reinvoked to justify the actions of those who endanger the lives of thousands of civilians around the world in the name of a pre-emptive ‘war on terror,’ undertaken to protect their own citizens and civilization from the mere potential of terrorist, nuclear, and biological attacks at some uncertain point in the future. In all of these cases, ‘the power to expose a whole population to death is the underside of the power to guarantee an individual’s continued existence’ (ibid.). Giorgio Agamben and Etienne Balibar explain this ironic contradiction in terms of the creation of categories of living non-citizens (within national borders as well as on a global scale) and their subsequent exclusion from participation in the politicolegal realm. Invoking the ancient figure of homo sacer – the person who falls outside of legal and political protections and thus can be killed with impunity but not sacrificed – Agamben argues that sovereignty, ancient or modern, is characterized by the exceptional right to define and exclude homo sacer or bare life from the politicolegal realm: ‘What is at stake is, once again, the definition of a life that may be killed without the commission of homicide’ (1998: 165). Agamben describes the Nazi concentration camps, as well as contemporary refugee camps in the heart of Europe and elsewhere, as zones of exception, which function to exclude certain categories of people from the legal protections afforded ordinary citizens who are integrated in the political community (ibid.: 147). Balibar has argued that under modern capitalist political-economic conditions, the whole world is divided into life zones and death zones, the former occupied by the citizens of affluent, stable, and mostly

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Western countries, while the latter host millions of the world’s inhabitants who are subjected to various forms of extreme violence, including primarily, the lack of access to political participation, as well as being subject to hunger, war, and genocide. For Balibar (2001: 10), although it is not always clear whether the life zones are responsible for the creation of the death zones, what is less in doubt is that the existence of such zones is beneficial for the workings of Western capitalism, as they leave millions of people too concerned with the naked question of survival to democratically participate in securing their political and economic rights against global powers. The Return of the Repressed? The modern discursive ordering of death, which aspires to uphold life as the highest value while at the same time denying any meaning or purpose in death or the possibility of any symbolic reciprocity between life and death, has been challenged, internally and externally, by the persistent symbolisms of death on several fronts. Internally, the modern Western discursive ordering of death is confronted by the survival and rebirth of the symbolic forms of death: suicides in the armed forces, underground euthanasia, the refusal of some death row inmates to appeal their sentences, and acts of defiance by peace activists travelling from the comforts of the West to war zones in the rest of the world in order to act as human shields. Within the medical setting, many aspects of euthanasia are governed by highly ritualistic and symbolic underpinnings. Some euthanasia cases, for example, are planned in a way that facilitates certain forms of symbolic exchange between the dying person and the people who witness the death, or between the dying person and the person who administers euthanasia. In the political realm, there are moments when the symbolics of death is invoked rather than concealed for political purposes, as in the U.S. where the rhetoric of the sacrifices of ‘our men and women in uniform’ is frequently invoked as a unifying moral force (even while the images of military casualties are carefully concealed from the public). In social, political, and moral theory, death has returned as a repository of moral strength. Prominent moral philosophers and sociologists have invoked the symbolism of death and its extraordinary potential as a source of morality (Kierkegaard, 1939), as the ultimate symbolic gift (Levinas, 2000; Derrida, 1995), and as a path towards the discovery of one’s identity and uniqueness (Heidegger, 1962; Freud,

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1922; Simmel, 1906). Jacques Derrida argues that the finitude of death can be the source of a moral sense of infinite responsibility towards oneself and the other, a sense of guilt and sin, a yearning for salvation – in this finitude originates an economy of gift exchange in which one sacrifices oneself for the other; in which one becomes oneself, a singularity, by becoming responsible to the other, a different singularity (1995: chapter 2). As discussed in Chapter 2, Parsons, Fox, and Lidz (1999) also invite us to allow death to be an occasion that binds people together and provides a ritualistic context for the symbolic exchange of the gifts of life, death, and caring, as was the case between Dr Postma and her mother. Death, in this sense, becomes a condition for and a motivator of interpersonal responsibility. This approach encourages the exercise of responsibility towards the gift of life and allows death to take on a positive meaning and function in human interrelations. John Seery (1996: 162–7) has shown that from Hobbes to Rawls, life operates as the organizing ideological principle of liberalism, metaphorically conveyed in the concept of the original position, the position of the living person, from which the individualistic morallegal framework of Western liberal democracies is envisioned (cf. Rhodes, 2002). In contrast, we can interpret the works of Derrida, Parsons, and Levinas as a call for a return to death, that is, to a countermetaphor of the final position from which life can be retrospectively evaluated, lived, and put in perspective. This counter-logic can potentially function to redefine society’s moral-legal system and its corresponding political and economic systems not in terms of the liberal rights to life and its pleasures, but in terms of a moral duty towards both living and dying persons. In addition to these internal challenges, the modern ordering of mortality has also been externally confronted by terrorist groups that seek to invoke the symbolisms of death and sacrifice by using life itself as a weapon (see Reuter, 2004; Rose, 2004). The events of 11 September 2001 in the United States, the widespread sense of panic – signified by the belief perpetuated almost by anyone talking on television that this event has changed history – and, more importantly, the economic downturn that followed this event (partly stemming form the fear of air travel), all highlight that what is under attack is not merely a people or a country but, rather, a whole social order that is founded on the inviolable sanctity of life as an absolute value. This radical will to die brings Western societies face to face with a form of death that, since Hobbes, has been made a taboo. It belongs to an economy of gift-

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giving between a person and a higher being (the nation, God, religious beliefs, justice), wherein life is exchanged for a greater, yet uncertain and often intangible, good. The ‘spirit of terrorism,’ as Baudrillard (2003: 57) puts it, consists in offering the symbolic gift of death as an absolute impossible gift: a gift that cannot be reciprocated unless by the death of the system itself (ibid.: 17 and 43). Terrorism poses an almost impossible challenge to a society that is socially, politically, and economically integrated around the ‘moral imperative of unconditional respect for human life’ because it calls for the recognition that ‘one might respect, both in the other and in oneself, something other than, and more than, life (existence isn’t everything, it is even the least of things): a destiny, a cause, a form of pride or of sacrifice. There are symbolic stakes which far exceed existence and freedom – which we find it unbearable to lose, because we have made them the fetishistic values of a universal humanistic order’ (ibid.: 68). The potency and power of this symbolic – and real – confrontation can best be appreciated within the context of a comparison between the demand for euthanasia, as the ideal type of a discursively and medically regulated death in modern Western societies, and a wouldbe suicide bomber’s yearning for martyrdom, as the iconoclastic mode of symbolic, but also, unpredictable, ‘irrational,’ and highly subjective dying. The underlying logic of each of these voluntary forms of death places it on a historically specific social ordering of death. What distinguishes suicide bombing from euthanasia would appear to be symptomatic of a larger social-psychological divide between ‘us’ and our ways of dying and ‘them’ and their ways of dying. In reality, however, these two forms of voluntary death speak to a social evolution in the history of the West itself that has made particular forms of death unbearable on the personal, political, and economic levels. Rather than a cultural divide between ‘them,’ the people of some countries and followers of some cultures, who would use death as a weapon, and ‘us,’ the people of the ‘civilized’ world, of the West, or of America, who are the primary targets, the events of 9/11 highlight a historical divide between the modern West and its own past. As we saw in Chapters 1 and 3, within the context of the early Christian culture of martyrdom, as well as during the English Civil War, the use of one’s own death as a weapon and even the aspiration to martyrdom as a short cut to salvation was not uncommon. But starting in the midseventeenth century we witness the emergence of a political-economic culture wherein this approach to death has no place. Hobbes’ elabora-

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tion of a theory of political order and economic prosperity premised on the exclusion of the possibility of using one’s own death as a weapon or, in other words, the exclusion of the possibility of a death that is subjectively purposeful and politically potent, heralds the beginning of this era. The most significant problem of our day, therefore, whether real or imaginary, is defined almost exactly as it was for Hobbes some 350 years ago: how can we save civilization and its comforts from the danger imposed by the arbitrary threat of chaotic death? Moreover, how do we protect ourselves from a death whose menace, symbolic and real, originates in the unpredictable subjectivity of an Other?

Recto Running Head

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Name Index

Affray, Janet 15 Agamben, Giorgio 14, 27, 43, 44, 45f, 162, 165, 166f Ahrensdorf, P. 40, 42f Alexander, Jeffrey 157f Anderson, K. 15 Arbuthnot, John 69 Arendt, Hannah 26f, 27, 29f, 38, 39 Aries, Philippe 4f, 124, 171 Aristotle 26, 30, 37, 38f, 43, 46, 53, 166 Arnason, Amar 51f B., Nancy 140 Bacon, Francis 53 Baker, Tom 14, 151 Balibar, Etienne 14, 165, 166f, 167 Barry, Dean 152 Battin, Margaret 153 Baudelaire, Charles 155, 156f Baudrillard, Jean 7, 15, 16–17, 43, 48, 51, 122, 139, 169 Bauman, Zygmunt 4f, 9, 14, 20, 45, 51, 55, 87, 128, 161, 165 Beccaria, Cezare 96 Beck, Ulrich 100 Becker, Ernest 4, 51, 55, 87

Bellah, Robert 161f Benjamin, Walter 27 Binding, Karl 130 Binion, Rudolph 124 Bodin, Jean 38f Bood, Alex 148, 149, 150, 151 Bourdieu, Pierre 98, 162 Brongersma, Edward 144f, 153 Brown, Thomas Sir 98 Buck, Peter 49, 56, 66, 67f, 70 Buckle, Henry 118 Buffon, Georges-Louis 70 Burgess-Jackson, Keith 96 Burrows, George 103f Bush, George W. 3 Byron, Lord 91 Caccamo, Rita 161 Callahan, Daniel 141 Carruthers, B.G. 59 Cavendish, Margaret 31f Chadwick, Edwin 21, 73, 75–6, 78–9, 80, 84, 85 Charleton, Walter 98 Chatterton, Thomas 89–91, 124f, 127 Chevalier, Louis 101 Clark, Geoffrey 8, 61, 77, 79, 82, 83

190

Name Index

Clifton, Francis 69 Comte, Auguste 21, 112, 114 Condorcet, Marquis de 52, 70 Crocker, Lester 94 Cullen, Michael J. 76 Daston, Lorraine 56f, 78 Daube, David 98f Davidoff, Frank 127 Davis, Malvin E. 79, 82, 83, 84 De Beauvoir, Simone 122 De Moivre, Abraham 56, 78 Dean, Mitchell 54f Derrida, Jacques 27, 47, 139, 167–8 Dickens, Charles 85, 124 Doran, ‘Nob’ 8, 83 Doré, Gustave 34, 35 Douglas, Mary 162 Doyle, Aaron 61, 84, 152 Durkheim, Émile 4, 19f, 20, 21, 25, 44, 47, 91–2, 99, 102, 107, 111f, 112, 113, 114–15, 116, 117–18, 119, 131f, 146, 157, 162f Dworkin, R.M. 9, 141f, 175 Elias, Norbert 4, 14, 25, 44, 45, 51 Emanuel, Ezekiel 137, 138, 139 Emanuel, Linda 125, 140, 145f, 147, 149, 150 Ericson, Richard ix, x, 2, 61, 84, 152 Espeland, W.N. 59 Esquirol, Etienne 99, 102, 103f, 117 Falret, Jean-Pierre 102, 103 Farneti, Roberto 35 Farr, William 73 Farren, E.J. 56, 61, 67, 77, 78 Fedden, Henry R. 94f, 97, 123 Fielding, J.E. 86 Flathman, Richard E. 44

Forde, Olav H. 86, 87 Foucault, Michel 6, 10, 12–13, 14, 15f, 16, 17f, 27f, 32, 35f, 43, 44f, 56f, 59, 73, 76, 86, 92, 104f, 130, 157, 165f Fox, Nicholas J. 14, 127, 139, 154f Fox, R. 9, 55, 130, 131, 168 Frank, Johann Peter 54, 55, 72–5, 86, 92, 124, 158 Freud, Sigmund 4f, 45, 47, 51, 133, 167 Frey, Darcy 126, 127f Friendly, Michael 110 Gaius Petronius 98 Gates, Barbara T. 89, 94, 104f, 106, 118 Geertz, Clifford 161 George, Dorothy 52, 76 Giddens, Anthony 9, 103, 115, 152 Gilman, Charlotte Perkins 9, 129f, 145 Glass, D.V. 58, 71, 77 Godwin, William 52, 71 Gomez, Carlos F. 135, 141f, 143f, 146, 148, 152 Goossens, Kim x, 138f Graunt, John 7–8, 20, 21f, 49f, 52–4, 56f, 58–9, 60, 61–7, 68, 71, 72, 73f, 74, 75, 77, 78f, 84, 85f, 86, 87f, 109, 115, 124, 125, 158, 164 Green, Judith 54, 86, 87 Grevelink, Margina 138–9 Griffiths, John x, 144f, 147, 148, 149–50, 151 Grotius 46 Guerry, André-Michel 21, 99, 100f, 101, 102, 107–10, 111, 115, 118, 158 Hacking, Ian x, 9, 56f, 64, 72, 78, 93, 101, 102, 103

Name Index Hafsteinsson, S.B. 51f Halley, Edmond 56, 78f, 85f Harmsen, Alexander x, 50 Hayes, Peter 29f Haygarth, John 69, 71, 72f Hegel, G.W.F. 48, 73f Heidegger, Martin 40, 47, 51, 167 Henry VIII 56 Herbert, Gary 29 Hertz, Robert 4, 26, 161 Hobbes, Thomas 6–7, 8, 10, 20, 21, 25, 26–9, 30, 31–2, 33, 34, 35f, 37–8, 39, 40–9, 50, 52f, 62, 66–7, 70, 86, 109, 126f, 157f, 158, 159, 163f, 164, 165f, 168f, 169, 170 Hoche, Alfred 130 Hooke, Robert 69 Hudde, Johan 56 Huebner, Solomon 83f, 84 Hume, David 96, 97, 122 Humphry, Derek 136, 138, 140 Hurst, Lynda 98, 120 Huygens, Christiaan 56 Illich, Ivan 9, 130 Johansson, Sheila 14, 56 Jurin, James 69 Kant, Imanuel 123, 131 Keats, John 91 Kemple, Thomas ix, 40, 48 Keyserlingk, Edward 128 Kierkegaard, Søren 47, 167 King David 53f Koselleck, Reinhart 42 Kreager, Philip 59 Kübler-Ross, Elisabeth 51 La Mettrie, Julien 31, 126

191

Latour, Bruno 30 Le Bras, H. 53, 70 Le Play, Frédéric 101 Leavitt, Frank 142 Leenen, H.J.J. 138f, 144, 148 Legemaate, Johan 151 Levinas, Emanuel 47, 139, 167, 168 Leviton, Daniel 51 Lidz, Victor 4, 9, 51, 55, 130, 131, 168 Lining, John 69f Lloyd, S.A. 27 Lobo, Francis 71 Locke, John 28 Loven, J. 121 Lukes, Steven 117 Lupton, Deborah 54f, 86 MacDonald, M. 94, 95, 96f, 105f Macpherson, C.B. 28, 29, 44, 47 Maeterlinck, Maurice 128 Magnusson, Roger 152 Malinowski, Bronislaw 121 Malthus, Thomas R. 70–1 Marra, Realino 92 Martineau, Harriet 99 Marx, Karl 15, 16, 19f, 20, 21, 47, 48, 101 Masaryk, Thomas 99, 118 Maudsley, Henry 104 Maugham, W. Somerset 55 Mauss, Marcel 47 Mbembe, Achille 14 McInerney, Fran 133 McNamara, Beverley 142 Mercier, Louis-Sébastien 79f Metchnikoff, Elie 52, 155–7 Millais, John Everett 124 Mills, C. Wright 55, 87 Minois, Georges 105, 123

192

Name Index

Moi, Toril 154 Montesquieu 96, 97 Morselli, Henry 21, 99, 101, 102f, 107, 111–12, 113, 114, 115, 117f, 118, 119–20, 158 Murphy, T. 94, 95, 96f, 105f Murray, Alexander 94f, 95 Nef, J.U. 25, 26 Nemedi, Denes 118 Neustatter, Lindsey 106 Newton 70f Nightingale, Florence 73 Nye, Robert 93, 101, 114f O’Hara, John 55 O’Malley, Pat 14 O’Neill, John 20, 133 O’Steen, David N. 148 Oberschall, Anthony 93, 100, 101, 109 Ogden, Russel 152 Orentlicher, David 149 Orru, M. 92 Parsons, Talcott 4, 9, 20, 44, 51, 55, 130–1, 132, 133f, 135, 157f, 168f Pavlov, Ivan P. 125–6, 127 Pericles 39f, 40, 47 Petty, William Sir 8f, 21f, 34, 40, 49, 52, 54, 67–9, 70, 71, 72, 74, 85, 109, 124, 158 Pick, Daniel 93, 114 Pickering, Roger 69 Plato 36, 46 Pliny 92, 122 Poitras, Geoffrey 69 Poovey, Mary 56, 59, 66, 77, 85 Porter, Theodore 56, 70, 72, 76, 100, 101, 115f

Postma, Geertruida 135–40, 141, 142, 143, 152, 153f, 168 Price, Richard 71f, 72, 78 Prichard, James C. 103, 104f Prior, Lindsay 162 Prometheus 29f Quetelet, Adolph 99, 102, 109f, 111, 115 Quinlan, Karen Ann 153f, 154 Rabinow, Paul 14 Rawls, John 28f, 168 Reuter, Christoph 122, 168 Rhodes, Rosamond 28, 168 Riley, James 69f Rodriguez, Sue 140, 147, 153 Rogers, John 30f, 31 Rose, Jacqueline 168 Rose, Nikolas 13, 14f, 56, 76 Rosen, George 72 Rousseau, Jean-Jacques 29, 31, 157 Rusnock, Andrea 56 Saint Augustine 95, 96, 97, 122 Salumets, Thomas x Schabas, Margaret x Schiavo, Terri 3, 165f Schlatter, Richard 39 Schmitt, Carl 27, 28 Schrijvers, Winnie x, 50 Schwitters, Rob x, 146f, 150 Seery, John 26f, 27, 28, 168 Selsky, A. 121 Seneca 37, 47 Sevenhuijsen, Selma 140 Shapin, Steven 30 Sherwin, Susan 140, 141 Shils, Edward 9, 47, 130–1, 133, 135, 153

Name Index Short, Thomas 69 Simmel, Georg 19f, 47, 51, 167 Simon, Jonathan 14, 152 Skinner, Quentin 49, 52 Skolbekken, John 86 Sleeboom, Margaret 142f Smith, Dorothy 98, 99f Snyder, Louis 149 Sobel, Jordan H. 51 Socrates 42, 47 Spencer, Herbert 25 Strauss, Leo 28, 29f, 30, 38, 43, 46 Sutorius, Philip 144f Tarde, Gabriel 102 Thucydides 38–40 Torpey, John x Turner, Stephen 115 Valverde, Mariana 93 Van Berkestijn, T.M.G 134, 144 Van der Berg, Jan H. 9, 130, 147 Van der Maas, Paul 125, 140, 145f, 147, 149, 150

193

Van Gennep, Arnold 26 Van Hooff, Anton 92 Van Krieken, Robert 20, 27, 44, 157f Von Max, Gabriel 124 Wallis, Henry 90, 91, 124, 127 Walter, Tony 51 Warren, Virginia 140, 141 Weber, Max ix, 17, 19f, 20, 21, 22, 27, 44, 55, 59, 63, 113 Wescott, William 104 Westermarck, Edward 92, 119, 121, 123 Weyers, Heleen x, 148, 149, 150, 151 Wijsbek, Henry 142f Williams, Glanville 98, 106f, 129 Witt, Johan de 56 Wolin, Sheldon 26 Wordsworth, William 91 Young, Arthur 72 Zaritsky, John 152f Zelizer, Viviana 8, 61, 83f

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195

Subject Index

actuarial 6, 56, 61f, 71, 73, 75f, 77f, 78, 79, 82f, 84, 86f. See also life insurance actuary/actuaries 73, 58, 71f, 75, 83f. See also life insurance Afghanistan 3, 165 Africa 4 American 83, 130f, 141, 161. See also United States anthropology 4, 26 assisted suicide. See euthanasia Athens 39, 94 battle 23, 39f, 160. See also war Behemoth 29 Bible 41, 61, 95; biblical ix, 10, 35f, 53; Isaiah 35 and 36; Job 35f, 41; Psalm 53; Samuel 53 biopolitics 12–18, 35, 130; biopolitical 10, 14–15, 18, 21, 35, 62, 92 birth 13, 26f, 38, 40, 58f, 59f, 75, 116, 127; childbirth 74; giving 139; rates 13, 61, 63, 75f, 114–15; registration and reporting of 58, 71; stillbirth 58; trends of 49 body politic 31f, 35f, 48, 72f, 85, 86f, 102

burial 58f, 63, 98; at crossroads 89, 94; clubs 83; figures of 68; of those who had killed themselves 89, 94, 103, 118; records of 8, 58; rituals of 162; tables of 58–9, 60; trends of 58 capital punishment 3–4. See also execution; death (penalty, sentence) capitalism 12, 16, 47, 100, 167 Christian 29, 103, 133f, 163, 169 civil war 7, 31f, 34, 165. See also English Civil War civilian death 3. See also collateral damage class 31, 59, 66, 75–9, 85, 158, 162; higher 71, 79; lower 52; middle 105; warrior 44; working 21, 79, 83–4 collateral damage 165. See also civilian death De Cive 29, 30, 37f dead, the 17f, 39, 162f; as a danger 161f, 162; dance of 6, 17; exchange/reciprocity with the

196

Subject Index

living 17–18, 95–6, 123, 163–4; offerings to 18; point of view of 28; separation from the living 16, 27, 163 death: and dignity 6, 9f, 10f, 26, 48, 124f, 128f, 132, 133f, 134, 140f, 142, 146f, 152, 153, 154, 159, 164; and im/morality 47, 74, 76f, 92, 154, 167; and political economy 16, 17f, 18, 26, 27, 29, 40, 43, 50, 67, 77, 100, 169; and political morality 27, 28, 30, 32, 37f, 40; and politics 5f, 6f, 7–18, 20, 23, 25, 26–8, 31, 32, 33, 37, 38, 40, 42, 43, 44, 45, 46, 47, 54f, 55, 56, 62, 66, 72, 73, 159, 164, 166, 167f, 169f; and risk ix, 6f, 7, 54f, 63, 68, 71f, 76f, 77f, 78f, 79f, 82f, 83f, 86f, 87, 92, 158f, 160, 163; and security 17, 33, 42, 43, 48f, 62, 87, 163; and sociology 19f, 21, 55, 87, 130; and statistics 5, 6, 7, 8f, 10, 13, 51f, 52, 53f, 55f, 58f, 61f, 63, 63f, 64–5, 69, 72, 78f, 87, 126, 158f, 163, as a risk ix, 5–8, 12, 54f, 55, 69, 71, 72, 76, 83f, 84, 158f, 164; as a source of meaning 15, 48; as a symbolic gift 7, 47, 133, 139, 140f, 154f, 167, 168f, 169f; as an instrument of power 15, 17, 27, 37, 48; as a threat against society 5, 6, 27, 87, 159f, 170; as debit 59f, 62, 115; as supra-individual event 47; as the ultimate evil 9, 28, 29, 30, 47, 164; chaotic or anarchic 6, 11, 12, 19, 27, 28, 33, 37, 87, 163, 165, 170; conditions or circumstances of 19f, 20, 33, 44, 45, 142, 146, 152f, 156; cultural attitudes towards 5, 38, 83, 89; denial of 4f, 5f, 51; dis-

cursive ordering of 5, 6, 7, 10, 11f, 12f, 17, 18, 26, 28, 152, 159, 163, 164f, 167f; discursive problematization of 6f, 7, 8, 9, 10, 14, 21, 28, 48f, 52, 54, 56, 63, 157, 164; discursive reconceptualization or transformation of 6, 7, 9, 52, 53, 54f, 55f, 76, 85, 87, 164; disorderly or unruly 10, 11, 152, 155, 159, 160f, 163, 165; exoticization of 44; fear of 7, 28, 29, 30f, 32, 33, 40, 42–3, 46, 64, 159f, governing of 10, 11, 12, 47, 85f, 153f, 162; honourable 39, 44, 47; management of ix, 5f, 12, 17f, 18, 54, 72f; meaning of 7, 10, 11f, 12f, 16, 17, 18, 19, 20f, 26, 29, 38, 40f, 44, 47, 55, 59, 128, 130, 131f, 132f, 134, 152, 160, 163f, 164, 167, 168; objectification of 5, 8f, 12, 63, 87, 126 (see also suicide; euthanasia); ordering of 5, 6, 8, 10, 11f, 159, 165 (see also discursive ordering of, symbolic ordering of); orderly 10f, 11, 44, 129, 152, 155, 160f, 163f, 164; penalty 15, 45, 160f (see also capital punishment; death sentence; execution); power over/power of 7f, 12, 14f, 17, 18, 27f, 45, 46, 130f; premature 5, 6, 7f, 9, 11, 41, 50, 52f, 53, 55, 56, 61, 63f, 70, 71, 74, 76f, 77f, 82, 83f, 92, 124f, 126, 155, 158–60, 162, 164f, 165; preventable 3, 4, 5f, 7, 8f, 9f, 11, 52f, 53, 54f, 56f, 74, 75, 165; quantification of 8, 20, 50, 51, 61, 62, 69f, 84, 86, 100, 147; regulation of 51, 130, 160, 163; ritual ordering of (see symbolic ordering of); rituals 6, 15, 16, 17, 19, 44, 58, 152f, 160,

Subject Index 161f, 162f, 163, 164, 168; selfinflicted (see suicide); sentence(s) 10f, 54, 106, 160; separation from life (see life); speech 19, 86; symbolic gift economy of 7, 135, 139, 140f, 154 (see also death as a symbolic gift); symbolic ordering of 11, 12f, 17f, 18f, 152, 163; timely or punctual 17, 52, 55, 56, 152, 159; violent 6f, 7f, 9, 10, 20, 27, 28, 33, 41, 43, 44, 45f, 48, 51, 52, 92, 124, 155, 157f, 158, 159, 160, 162, 164. See also mortality demography 10, 13, 71 discursive ordering. See death disease 13, 64, 73, 76, 87, 104, 155, 161; fatal 68, 69, 72; indexing and description 64; notorious 58, 64–5; preventable 3–4 double-entry bookkeeping 8, 56, 59f Dutch x, 50, 130, 135, 136, 137, 138, 142f, 144, 146–7, 150–1. See also the Netherlands dying, the 9, 44, 45, 84, 125, 127, 128, 132–3, 152, 153, 154, 161, 164, 167f dying process 10, 21, 125, 127, 128, 129, 133, 152, 153 eighteenth century 12, 13f, 31, 52f, 55, 56, 69, 70f, 71, 72f, 76, 82, 83, 89, 89, 92, 97f, 105, 123, 155, 158 England 26, 51, 56, 58, 67, 68, 71, 72, 73, 75, 76–7, 82, 93, 100–1, 102–3, 105–6, 116, 119. See also English; English Civil War English: civilization 119; coroners 105; language 33, 38, 50, 111; medical care 68; periodicals 119; statistician(s) 75; writers 75

197

English Civil War 7, 23, 25f, 28–9, 37, 40–1, 47, 49, 51, 66, 70, 163, 169 epidemics 12f, 13, 52f, 56, 63, 70 epidemiology 8, 11, 13, 14, 20, 51, 63, 69f, 86, 87, 103, 118, 124, 160, 163 euthanasia 3, 4, 5, 6, 9, 123, 136, 137f, 147, 152f, 160f; and altruism 145f; and Calvinism 146, 147; and ethics 134, 135f, 139, 140, 145f, 150, 154; and policy 137, 147–8, 150–1; and sacrifice 139; and statistics 135, 140, 147f, 148f, 150, 151f; and the medical establishment 133–4, 143; and law 129f, 133, 135f, 137, 139f, 140, 143, 146, 147f, 149f, 150, 151f, 152, 153, 154; and the Remmelink Report 147, 151; as a medico-legal question 128, 134, 135, 141–2, 143, 145, 146, 151, 152, 153, 154f, 164f; as a right 3, 48, 129, 140, 141, 147, 153f; as dignified death 128, 152; as institutionally regulated death 160; as medicalized death 10, 123f, 140, 143f, 144, 152, 153, 154, 160f; as medically sterilized death 152; as part of the modern ordering of death 158, 159; debate over 129, 141, 145, 147, 158; Dutch attitudes towards 146; Dutch discourse of 130; gift economy of 135, 139f; legalization of 3f, 9, 10, 128f, 135, 136f, 137, 142, 146, 147f, 148, 149f, 150f, 153; meaning of 140; medical regulation of 151; movement 128, 136; Nazi practice of 130; non-voluntary or involuntary 142, 147–8, 149; objectifica-

198

Subject Index

tion of 126, 134–5; opponents of 136, 137, 140, 145, 148f; popularity of and demand for 4, 9, 140, 169; reasons for requesting 145f; regulation of 141, 146, 147, 151, 153, 154, 159; ritualistic and symbolic aspects of 152f, 153, 160, 167; underground 11, 160f, 167. See also death (and dignity) execution 162. See also capital punishment; death (penalty; sentence) executioner 46, 162 fate 6, 8, 42, 53–4, 55, 73, 87, 94 France 38, 51, 68f, 69, 70, 72, 75, 76, 93, 94, 100f, 101, 102, 103f, 107f, 108, 109, 110, 114f, 116, 119, 123. See also French French 49, 68, 70, 98, 100, 101, 103, 107, 108. See also France gender 31, 154 genocide 165, 161; genocidal 14, 165 German 51, 72f, 78, 98, 101, 102 governance 62, 67, 100, 158 governing 146, 151; art of 34, 40, 49, 62f, 67; life and death 47; regimes of 47; the dying process 153; through risk 152 Greece 145. See also Greek Greek 38f, 39f, 40, 121, 140. See also Greece Hobbesian problem of order 44, 48, 157f human sciences 13, 69 immortality 40, 41f, 43, 52, 133, 156 insurance. See life insurance

Iran xi, 15 Iraq 3, 14, 120, 165 Ireland 67 Islam 44 Israel 4, 53 killing 3f, 4f, 13, 25, 26, 27, 37, 43f, 45, 46f, 48f, 64, 89, 93, 94, 96, 97, 98f, 102, 103, 105f, 106f, 112, 117, 119, 121f, 122, 130, 161, 163f, 164, 165, 166. See also self-killing knowledge and power 5, 13, 37, 40, 48, 62f, 67f, 72, 99, 124, 164. See also death law 4, 11, 27, 37, 43, 46, 58, 60, 163, 165; and suicide (see suicide); and euthanasia (see euthanasia) Lebanon 4 Leviathan 27f, 31f, 34, 35f, 37, 43, 47, 67, 86f, 165 Leviathan, the 28, 29, 30, 31, 32f, 33, 35, 36, 37f, 38, 41, 42, 43, 46, 47 life: after death/eternal 7f, 16, 18, 28f, 37, 41, 43, 84, 127, 163; application of commercial models to the study of 59; as a form of capital or commodity 8, 83; as a political or economic question 13, 35, 48; as a right 46f, 47f, 48f, 168; as a starting point for morality/ethics 37–8, 46; as an absolute or ultimate value or good 12, 26, 27, 28f, 37, 46f, 48, 128, 167; as an obligation 47; as an ultimate end 28, 37; as biological signs 128, 131, 132, 134f; as the foundation of social order 6; continuity with death 20; earthly/ here and now 7f, 11, 18, 40, 41, 43,

Subject Index 84, 127, 157, 164; expectancy 61, 63, 76, 78; governed by divine providence 62, 87, 127; instrumental approach to 14, 29, 48; length or duration of 70–1, 77; limits of 9, 53f, 134, 145; management of 6, 13, 14, 15, 18, 37, 84; meaning of 4, 18, 20f, 25, 40, 84, 85, 121, 128, 130, 133, 145; mechanistic theory of 30–2, 126f; medicalization of 130, 144, 153f; political economy of 26; power over 7, 12, 13, 14f, 41, 43, 46, 130; preservation of 9, 28, 32f, 47, 48, 134f; prolongation of 47, 49, 55, 125, 126, 128, 133, 135, 158, 159; protection of 14f, 18, 37, 45, 46, 128, 165; quantification of 53, 58, 62; reciprocity with death (see reciprocity or exchange between life and death); sanctity/sacredness of 45, 46, 47, 48f, 116, 124, 127f, 128, 129–34, 136, 141, 157, 159, 162f, 165, 168; sentence 10f, 47, 48, 160; sentences 3, 10f; separation from death 19, 43, 84; value of 4, 7, 9f, 11, 19, 20, 25, 28, 48, 61, 62, 83, 84, 121, 130, 131f, 132, 141, 144, 157, 163, 164, 165 life insurance: 5–6, 8, 20, 54f, 61f, 62, 71, 75, 77f, 78, 79f, 82f, 83–4, 85. See also actuarial; actuary life sciences 13, 14 life tables 61, 78f, 85 lifespan 21, 70, 75, 79f longevity 5, 18, 19, 21f, 35, 43, 49, 52, 53, 66, 70, 74, 75, 77, 84f, 85, 87, 158, 165 martyrdom 11f, 15, 160, 169f. See also self-sacrifice

199

mathematics 67, 69 mechanism (philosophy) 30; mechanistic 30f, 32, 70, 126 medicine 4f, 5f, 10, 11, 13f, 14, 20, 21, 52: medical 5, 6, 9f, 18, 21f, 47, 51f, 52, 54, 55, 63, 69, 70, 72f, 73, 87, 99, 100f, 102, 103f, 104, 105, 106f, 107, 124, 125f, 126, 129, 130, 133f, 135f, 141, 143, 150, 154, 160, 163 medieval 44 mortality: rates 5, 6, 8, 19, 53, 61, 62, 64, 66, 69, 71f, 72, 75f, 77, 78f, 85, 86f, 100, 114, 165; statistics 8, 20, 66, 72, 83, 86; tables 59, 61, 62, 65, 66f, 67, 78, 80, 86; bills 7, 52, 56f, 57, 58f, 64, 67, 69, 78f. See also death necropolitics 14f Netherlands x, 3, 10f, 50, 116, 128, 130, 133, 135, 136f, 137, 140, 141, 142, 143, 145, 146–51, 152, 153f. See also Dutch nineteenth century 8, 9, 12, 20, 52, 70, 71, 72, 73, 75, 76, 82, 83, 87, 91–3, 97f, 99, 100, 101, 102f, 104f, 105, 106, 107, 111, 114, 116, 117, 188f, 121, 124f, 128, 129f, 142, 143, 147, 158, 164 non-Western societies 44, 145 order 7f, 20, 23, 26, 29, 30f, 32, 33, 37, 40f, 42, 43f, 48f, 62, 67, 70, 73, 128, 146, 147f, 160, 161f, 165, 169; social 6, 7, 11, 12, 18, 20f, 44, 97, 155, 157–8, 159, 161, 162, 168; sociopolitical 26, 35, 47; political 6, 7f, 18, 27f, 28, 29, 37, 87, 164, 166, 170

200

Subject Index

ordering of death. See death ordering of mortality. See death

quantitative 8, 20f, 53, 61, 63, 68, 69f, 71, 86, 100, 147

Peloponnesian War 38–9 philosopher(s) 20, 27f, 28, 29f, 42, 46, 53, 59f, 72, 96, 102, 122, 129, 167 philosophical 43, 48, 49, 102, 107, 109, 112, 117, 121 philosophy 40, 41, 42, 97, 111, 120, 155, 156, 157; Enlightenment 120; Greek 38; mechanistic 70; moral 37, 40, 96, 99, 100f; political 26, 29, 40. See also philosophers; philosophical political: ethic 25; morality 27, 32, 46; stability 6, 20, 33, 56, 158, 159; thought 27, 28f, 35, 38; world 18, 26f. See also order; philosophy; political arithmetic; political economy; politics political arithmetic 8, 40, 49, 52, 67f, 68, 76. See also political economy political economy 8, 16–17, 18, 26, 27, 29, 40, 43, 49, 67, 77, 100. See also death politics 7f, 13, 14f, 18, 23, 25, 26–8, 33, 35, 37, 38f, 40, 44, 58, 100, 151, 166; of blood 14, 44. See also biopolitics; death; necropolitics premodern 11, 44f, 124, 145, 161 problematization. See death prudence 29, 37, 43, 82 Prussia 72 public health 8, 10, 11, 13, 49, 52, 54f, 55f, 70, 72–3, 84, 86, 87, 125, 141, 158, 159, 160

reciprocity or exchange between life and death 17, 163, 167. See also the dead religion 11, 16, 18, 28, 41, 62, 74, 91, 95, 99, 100f, 112, 115f, 129, 131, 156, 158, 160, 161, 163 religious 8f, 25, 38, 48f, 59f, 74, 89, 91, 95, 96, 97, 98, 103, 112f, 115, 127f, 131f, 132f, 133, 161, 162–3, 168 right to die. See death right to life. See life risk. See death (as a risk) ritual ordering. See death (symbolic ordering) Royal Dutch Medical Association (RDMA) 133, 134, 137, 138, 142, 143f, 145, 147, 150f

quantification. See death; see also life

savage, the 44, 94, 119–20, 121, 157 science ix, 4, 13, 20, 21, 22, 30, 42, 52, 74, 85, 156, 162 scientific 5–6, 12, 13, 15, 18, 19, 20, 21, 28, 30, 38, 53, 54, 70, 83f, 85f, 86, 93f, 102, 109f, 112, 117, 121f, 132 security 4, 17, 33, 34, 35, 37, 42f, 43, 48f, 62, 64, 65, 66, 73, 82f, 87, 88, 163 self-inflicted death 6, 8, 96, 160 self-killer 8, 9, 93, 97, 103 self-killing 74, 93, 96, 98, 99, 123, 164. See also suicide self-sacrifice 17, 18, 38f, 161f. See also martyrdom September eleventh 3, 168–9 seventeenth century 5–6, 9, 13, 20,

Subject Index 21, 49, 51f, 53, 54, 67, 69, 83, 85, 92, 97, 103, 105, 119, 126, 155, 164, 169 social sciences 87, 111, 163 social theorists 20 social thought 21, 44 sociological ix, 5, 6, 21f, 19f, 20, 21f, 26, 44, 87, 88, 93, 95, 99, 102, 103, 107, 111f, 114–15, 117, 118, 128, 146 sociologist 4, 19, 20, 21, 27, 55, 97, 99, 102, 107, 109, 116, 117, 129, 130f, 131, 146, 167 sociology ix, 9, 19–21, 44, 53, 55, 87f, 100, 103, 107f, 114, 115, 130, 157f, 162; as a biopolitical discipline 21; history of 21; positivist 21. See also social sciences sovereign 7, 12, 33f, 35, 37f, 40, 41f, 42, 43, 45, 46f, 67, 86, 122, 123, 166 sovereignty 13, 15f, 16, 17f, 18, 27f, 31, 40, 45, 67, 86, 166 state x, 3f, 4, 17f, 38, 42f, 43f, 45f, 49, 55, 58, 62f, 63, 66f, 69, 72, 73, 87, 91f, 99, 101f, 104, 103, 147, 151 state of nature 31, 33, 43f, 158 statistics: and life insurance 75; and population 66; as a discursive framework 107; bio- 49; moral 107, 109, 111, 114, 115, 120f. See also death; suicide; mortality; euthanasia sociostatistical 21f, 78, 107 Stoic 42, 74, 97, 121 suicide 28, 64, 74, 89, 158; and civilization 91, 94, 101, 102, 107, 112, 113, 118–19, 120; and degradation of the body 8, 9, 53, 89, 92, 93, 94–5, 121, 161, 164; and free will 93, 111, 120; and law 91f, 93, 94f,

201

95f, 97, 103, 105, 106f, 117, 121, 122; and madness 93f, 99, 102, 103–4, 106; and medicine 92, 93, 100f, 102f, 123; and morality 9f, 91f, 93, 97f, 99–100, 112, 115, 116, 118f; and positivism 97; and punishment 95f, 106f, 118; and sociology 93, 97, 100, 103, 107–20; and statistics 8, 9f, 14, 56, 92, 93f, 97f, 99–103, 107–9, 111f, 114, 115f, 118f, 119, 120, 121, 123, 158, 164; and symbolic exchange 95; and the uncivilized 119; as a criminal act 89f, 93, 103; as a disease 103, 104, 119; as a medical problem 93, 102–7; as a moral act 99, 117f; as a plague 102; as a social problem 93, 102, 107f, 114, 116, 158, 159; as a symbolic act 95, 97, 118, 121, 122, 167; as a symbolic threat or challenge 9, 95, 97, 118, 122, 123, 158; as an objective fact 112, 113; as an official category 98–9; as anarchic or disorderly death 11, 12, 160f; as criminal 92; as enigmatic 93; as offensive 91, 96, 123; as sinful or immoral 95f, 98, 102, 117, 122; attitudes towards 89, 91; causes of 97, 99, 104, 111, 112, 117, 120, 164; decriminalization of 91, 92; demoralization of 99, 100f; discursive relocation of 94; discursive transformation of 93; etymology of 98f; meaning and subjectivity of 93f, 94, 96, 97f, 112, 121, 123, 164; moralization of 100; motives for 99, 104, 105, 112f, 118, 120; objectification of 93, 103, 106, 117, 164; prevention of 8, 10, 92, 121, 158, 159, 160, 164; psychia-

202

Subject Index

trization of 104, 105; quantification of 100; rates 20, 93, 97, 100, 101f, 102, 103, 107, 108f, 109, 111f, 112f, 115f, 116, 117, 118f, 119f, 120, 158; regulation of 92; right to 3, 97, 102; suppression of subjective meanings of 93, 94. See also selfkilling; self-inflicted death symbolic exchange 7, 16–17, 18, 43, 95, 133, 163f, 167, 168 symbolic ordering. See death symbolics of blood 13, 14, 15 terror/ism 3, 4f, 14, 122, 156, 165, 166f, 168, 169f third world 12 thou shalt die an orderly death 10, 155 thou shalt not die an undignified death 10, 124 thou shalt not die prematurely 10, 50 thou shalt not die violently 10, 23 thou shalt not kill thyself 10, 48, 89 twentieth century 9, 21, 48, 83, 95,

106f, 126, 128, 129f, 143, 155, 157, 158 United States 3f, 4, 75, 83, 128, 136, 140f, 141, 147, 150f, 153f, 161, 162, 164, 168, 169. See also American violence 7f, 14, 17, 18, 25, 27f, 32f, 35, 37f, 41, 43f, 44, 45f, 67f, 163, 166, 167 violent. See death vital statistics 107 vitalism (philosophy) 30f war 3, 4, 13, 14f, 23f, 24, 25f, 26, 30–3, 37, 39, 40, 41f, 42f, 44, 46, 112, 129, 157, 161f, 165f, 166f, 167f; of all against all 28, 31, 33, 43, 157, 158; on terror 14, 165, 166. See also civil war; battle West 4f, 11, 12, 14f, 19, 21, 51, 63, 95, 165, 167, 169f Western: culture 5, 159, 165; Europe x, 55, 59, 91, 94, 105, 122; societies 4, 5f, 11, 12f, 14, 16, 44, 45, 51, 56, 106f, 113, 116, 118f, 119, 126, 128, 129f, 167, 168, 169