Abstract
In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of disease, I configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008, 783).
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Notes
Crepitations: this word is onomatopoeic for fine crackles heard with a stethoscope, usually low down at the back of one or two lungs. Their interpretation can be complex, two common causes being pneumonia and left ventricular failure.
“The sign no longer speaks the natural language of disease; it assumes shape and value only within the questions posed by medical investigation. There is nothing, therefore, to prevent it being solicited and almost fabricated by medical investigation. It is no longer that which is spontaneously stated by the disease itself; it is the meeting point of the gestures of research and the sick organism” (Foucault 1994, 162).
I am aware that my treatment of Foucault and reason is superficial. This can be seen in the following quote, taken from Rabinow (1991, 13): “But questions—both philosophical and political—remain about the exact status of reason in Foucault’s work. He seems to set himself close to, but apart from, a line of thinkers stretching from Max Weber to Martin Heidegger through Theodor Adorno and Max Horkheimer. Each of these men, in different ways, recognised both a centrality and a danger in the processes of increasing rationalisation and technological development of the world. Each also differentiated between types of reason of thinking—instrumental, substantive, formal, critical etc—and attempted to separate out those dimensions and consequences of rational activity which were pernicious and those which in some form or other could serve as instruments of resisting or overcoming the destructive functioning of reason in Western culture.”
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Walsh, B.H. The Spatialisation of Disease: Foucualt and Evidence-based Medicine (EBM). Bioethical Inquiry 7, 31–42 (2010). https://doi.org/10.1007/s11673-010-9216-8
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DOI: https://doi.org/10.1007/s11673-010-9216-8