Medical practice is practiced morality, and clinical research belongs to normative ethics. The present book elucidates and advances this thesis by: 1. analyzing the structure of medical language, knowledge, and theories; 2. inquiring into the foundations of the clinical encounter; 3. introducing the logic and methodology of clinical decision-making, including artificial intelligence in medicine; 4. suggesting comprehensive theories of organism, life, and psyche; of health, illness, and disease; of etiology, diagnosis, prognosis, prevention, and therapy; and 5. investigating the moral and (...) metaphysical issues central to medical practice and research. Many systems of (classical, modal, non-classical, probability, and fuzzy) logic are introduced and applied. Fuzzy medical deontics, fuzzy medical ontology, fuzzy medical concept formation, fuzzy medical decision-making and biomedicine and many other techniques of fuzzification in medicine are introduced for the first time. -/- . (shrink)

The notions of health, illness, and disease are fuzzy-theoretically analyzed. They present themselves as non-Aristotelian concepts violating basic principles of classical logic. A recursive scheme for defining the controversial notion of disease is proposed that also supports a concept of fuzzy disease. A sketch is given of the prototype resemblance theory of disease.

What follows is a brief comment on Ludwik Fleck's paper on the foundations of medical knowledge translated by Thaddeus J. Trenn in this issue. Since the original is much older than I am, I have some scruples in presenting the critical thoughts which occurred to me when I read it a few years ago. Despite the criticism, I am very sympathetic to most of what Fleck has told us in his tragically neglected work. Two facts make Fleck's tragedy even more (...) disturbing: (i) others have given rise to post-Fleck revolutions in epistemology by exploiting his ideas while omitting proper references to him, and (ii) sociology of science, precisely what Fleck wanted to promote, has emerged without his work being operative in any sense. In my commentary, I shall examine his concept of social conditioning of knowledge. CiteULike Connotea Del.icio.us What's this? (shrink)

On the basis of a ten-place comparative value relation, artificially reduced to a binary relation, some human value structures are studied and a concept of value kinematics is proposed. A miniature value logic is outlined, making it possible with precision to handle several explicated value notions and to analyze interrelations between them. Finally, the question is discussed whether health can be said to be an absolute and an intrinsic value.

At least as important as a particular item of medical knowledge itself is to know something about the relationships of that knowledge to the experiential world it is talking about. The reason is that the patients the physician is concerned with are parts of that experiential world. So, when using any knowledge in her practice, e.g., some knowledge on infectious diseases, a morally conscientious doctor will be interested in whether, and in what way, this knowledge relates to the ‘world out (...) there’. Does the medical knowledge she employs bear any relevance to the bodies and souls of her patients? Does it enable her to understand the patient’s suffering, illness experience, and illness narrative? Will it help her find useful diagnoses and treatments? Are there in fact any indicators of such qualities of medical knowledge? Why not use astrology, Ayurveda, or exorcism instead of the theory of infectious diseases? A prerequisite for dealing with such questions is the awareness of the relationships between medical knowledge and its referent, i.e., of the semantics of medical knowledge, on the one hand; and of the pragmatic factors beyond this semantics, which influence the role medical knowledge plays in health care, on the other, e.g., social and economic processes. In the present chapter, we shall look at these issues with an eye toward understanding why some particular information is allowed to enter the medical world as knowledge, whereas other information is considered unacceptable or quackery. Is there a clear line of demarcation between medical knowledge and self-deception? To begin with, we will discuss the issues of truth and justification because, as pointed out in Section 10.1 on page 402, knowledge is traditionally defined as justified true belief . These two defining features of knowledge, truth and justifiedness, are due to the classical conception of knowledge as the representation of some ‘reality’. This ancient, representational postulate brings with it that the predominant view on the semantics of medical knowledge is realism, i.e., the view that medical knowledge is concerned with and represents ‘the real world out there’. We shall therefore need to inquire into the philosophy and medical relevance of this doctrine before we proceed to alternative views. Our discussion thus divides into the following five parts: 12.1 Justified True Belief; 12.2 Realism; 12.3 Anti-Realism; 12.4 Beyond Realism and Anti-Realism in Medicine; 12.5 Social Epistemology. (shrink)

The question is raised whether it would be beneficial to establish a clinical praxiology for the sake of a multi-focused inquiry into the foundations of clinical pratice. Beginning with the concept of medical diagnosis, a framework is presented which makes it possible to view diagnosis as an element of a complex structure whose adequate analysis requires at least comparative diagnostic methodology and epistemology.

Patrick Suppes'' set-theoretical approach to the analysis of theories, and Joseph D. Sneed''s metatheory are briefly outlined. The notions of observation, illusion and hallucination are reconstructed according to these approaches. It is argued that the terms perception and truth are theoretical with respect to observation but nontheoretical with respect to illusion and hallucination. Hallucination is construed as a special kind of illusion.

Patrick Suppes' set-theoretical approach to the analysis of theories, and Joseph D. Sneed's metatheory are briefly outlined. The notions of observation, illusion and hallucination are reconstructed according to these approaches. It is argued that the terms ‘perception’ and ‘truth’ are theoretical with respect to observation but nontheoretical with respect to illusion and hallucination. Hallucination is construed as a special kind of illusion.

ZusammenfassungWas ist praktisches Wissen?Die Diskussion über diese Frage hat sich in den letzten Jahrzehnten darauf konzentriert, das praktische Wissen als ein Wissen- wie aufzufassen. Im Folgenden wird eine weitere Differenzierung dieser Ansicht vorgenommen, indem durch eine Analyse der Syntax des klinischpraktischen Wissens dafür geworben wird, dieses Wissen als eine Kategorie von bedingten Geboten für das ärztliche Handeln in der klinischen Entscheidungsfindung zu betrachten. Syntaktisch gesehen, sind diese Gebote deontische Normen („conditional obligations“). Da sie durch die diagnostisch-therapeutische Forschung (= klinische Forschung) (...) aufgestellt und erforscht werden, muss die klinische Forschung als eine deontische Disziplin angesehen werden. Sie ist deshalb dem Bereich der normativen Ethik zuzuordnen. Im direkten Zusammenhang damit ist die klinische Praxis – als eine überzeitliche Institution, nicht als das Handeln von Einzelpersonen – als praktizierte Moral im Dienste der Menschen („Karitas“) einzustufen, weil sie aus dem Versuch besteht, jene Gebote umzusetzen. (shrink)

Western (deductive) logic originated in Greek antiquity. It found its first expression in those works of the great philosopher Aristotle (384–322 BC) which have come to be known as the Organon, i.e., ‘instrument’. Aristotle’s logic, also known as syllogistics, was unsystematically concerned with patterns of reasoning and argumentation. It remained in this rudimentary state relatively unchanged and unchallenged until the second half of the nineteenth century. At that time, logic underwent a period of unprecedented reform and modernization, due in large (...) part to the German mathematician Gottlob Frege (1848– 1925) It thus became more and more a mathematical endeavor of studying the structure and peculiarities of artificial, formal languages. In this new form, logic gave rise in the twentieth century to disciplines such as theoretical informatics and programming languages, and transformed our lives through computation, information processing, and the Internet. A formal language consists, in effect, of a particular alphabet and some precise rules of forming, and transforming, strings over this alphabet. There exist several types of formal languages analyzed in logic. Depending on their structure, they are called first-order languages, second-order languages, and so on. Today a logic is considered a theory of such a language and is, correspondingly, referred to as a first-order logic, a second-order logic, and so on. In this chapter, we shall outline a first-order logic as a paragon of deductive logic. Its full name is: “Classical, first-order predicate logic with identity”. What all these expressions mean exactly, will become clear below. The logic we shall study first is termed classical logic because the idea to create such an instrument, or ‘organon’, is rooted in Greek antiquity. Owing to its origin, it is based on three time-honored Aristotelian doctrines. For these and several other reasons that we shall discuss later in this chapter, it is also called a logic of the Aristotelian style, or an Aristotelian logic for short. (shrink)

Clinical practice is where the clinical encounter and decision-making occur. Thus, it constitutes the focus of medicine. Since the time of Hippocrates, it has been composed of five activities that have come to be known as anamnesis, i.e., history taking or clinical interview, diagnosis, prognosis, therapy, and prevention. These five activities are fundamental features of the healing relationship. The present chapter is devoted to the analysis and discussion of their logical, methodological, and philosophical problems. Usually, the patient expects the physician (...) to be an expert of her specialty devoid of a bad reputation. This constitutes what may be called a good doctor, i.e., one whose clinical decisions are right and good in most cases, at least in as many cases as another expert in the same area also achieves. In what follows, we shall analyze the characteristics and presuppositions of such right and good clinical decisions. To this end, we shall undertake a conceptual analysis of the clinical encounter and its outcomes, in order to develop a theory of clinical practice. Our analysis consists of the following five parts: 9.1 The Clinical Encounter; 9.2 Anamnesis and Diagnosis; 9.3 Prognosis; 9.4 Therapy; 9.5 Prevention. (shrink)

Medical knowledge as well as clinical practice are characterized by inescapable uncertainty. There are many reasons this is the case, but foremost among them is that almost everything in medicine is inevitably vague, be it something linguistic such as the term “illness”, or something extra-linguistic such as the condition referred to as illness. If we ask ourselves, then, what the term “illness” means exactly, on the one hand; and how we may precisely delimit the condition illness, on the other; we (...) shall realize that to answer these and similar questions requires specific methods that enable us to adequately cope with vagueness. As we shall see below, fuzzy logic provides us with just such methods. (shrink)

The concepts of categorical diagnosis and conjectural diagnosis are introduced. It is argued that in diagnostic reasoning conjectural diagnosis plays a more important role than categorical diagnosis. Attention is called to the inevitable vagueness of clinical language and to the suitability of epistemic logic and fuzzy logic for diagnostic reasoning.

The language of medicine is an extension of everyday language by adding technical terms such as "appendicitis", "angina pectoris", "blood pressure" and the like. It is therefore characterized by semantic chaos. Most of its terms are either not defined or ill-defined. The chaos would not deserve any attention, however, if it were not practically detrimental in research and practice. The best way to prevent the damage it causes is to learn in medicine something about methods of scientific concept formation. The (...) present chapter provides a concise and unrivalled introduction to such a methodology. We shall discuss the main methods of scientific concept formation known today, that is, all methods of definition and explication. Our discussion divides into the following four sections and is based on, and extends, the most valuable pioneering studies by Carl Gustav Hempel and, especially, Patrick Suppes (Hempel, 1952; Suppes, 1957, 151–173, 246–260): 6.1 What a Definition is; 6.2 What Role a Definition Plays; 6.3 Methods of Definition; 6.4 What an Explication is. (shrink)

Clinical judgment, also called clinical reasoning, clinical decision-making, and diagnostic-therapeutic decision-making, lies at the heart of clinical practice and thus medicine. In thepast, clinical judgment was considered the expert task of the physician. But the advent of computers in the 1940s and their use in medicine as of the late 1950s gradually changed this situation. In the 1960s, a new discipline emerged that has come to be termed medical computer science or medical informatics, including clinical informatics. Clinical informatics is concerned (...) with all aspects of the application of computing machinery in clinical research and practice. As one of its accomplishments in clinical practice, the physician’s capacity for clinical judgment is in the process of being turned over to computers. We are told that computers will be responsible for making diagnoses and treatment decisions in a not-too-distant future. This prospect, its historical, methodological and philosophical background, and its impact on health care will be discussed in the present Part VI which divides into these three chapters: 19 Medical Decision-Making 20 Clinical Decision Support Systems 21 Artificial Intelligence in Medicine? (shrink)

Linguistics, in general, is the basic science of all language studies. It is concerned with the nature and structure of language and with the role it plays in human communication. Medical linguistics uses some methods of general linguistics and also creates additional ones. This is motivated by the following practical needs: Computer-aided data record, storage, and retrieval in medical practice and research require that medical data be stored in such a manner that enables their computational processing. However, databases written in (...) natural medical language cannot be easily processed. To enable efficient natural language processing, medical terms and sentences used in them must be made amenable to syntactic and semantic operations by computer programs. Medical linguistics is an ill-defined, interdisciplinary branch of medical informatics and medical information and library sciences concerned with methods and problems of natural language processing in medicine. (shrink)

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

Two common medical-ethical axions, the health-maximizing axiom and the personhood-respecting axiom, are discussed. On the basis of a philosophical analysis of personhood and freedom of the will it is shown that these two axioms are incompatible. The rejection of the first axiom is suggested.

Since the advent of the natural sciences, natural scientists have spread the idea that the pursuit of truth about the facts of the world is the main drive of scientific research. The aim, they say, is to acquire knowledge and to provide explanations and predictions of phenomena and events. Surprisingly, even in our contemporary world in which scientific research is strongly involved in seeking solutions to practical problems pertaining to the pursuit of food, water, energy, health, labor, peace, war, nuclear (...) weapons, money, and the like, the pursuit-of-truth postulate nevertheless enjoys vigorous advocacy, especially in philosophy. In this chapter, the role that truth actually plays in medicine will be examined. Our discussion of this issue divides into the following four sections: 24.1 Truth in Medical Sciences; 24.2 Truth in Clinical Practice; 24.3 Misdiagnoses; 24.4 Truth Made in Medicine. In summary, it is shown that medical knowledge does not contain much truth because it mainly consists of hypotheses, theories, and deontic rules. The truth values of the former are unknown, while theories and deontic rules do not assume truth values. Likewise, in clinical practice true diagnoses and prognoses are not always attainable because (i) medical knowledge is inevitably vague, uncertain, and unreliable and is therefore scarcely truth-conducive; (ii) this also applies to most parts of patient data; (iii) physicians are not trained in viable and efficient methodology of clinical reasoning; and (iv) neither clinical decision support systems nor the automation of clinical decision-making will be able to compensate for the first two shortcomings. So, misdiagnoses will remain inevitable forever, although their frequency may be reduced by improving the techniques of clinical judgment. Since medical theories are artifactual structures and medical languages are artifactual systems, the truth of diagnoses and prognoses, and of any other judgment based thereon is made in medicine. (shrink)