Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain (...) philosophical approaches, on the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (shrink)
The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness (...) -- Questioning the methodological superiority of "placebo" over "active" controlled trials -- Examining the paradox that traditional roles for mechanistic reasoning and expert -- Judgment have been up-ended by EBM -- A qualified defence of the EBM stance on mechanistic reasoning -- Knowledge that versus knowledge how : situating the EBM position on expert clinical judgment -- Moving EBM forward. (shrink)
This work brings together Philip van der Eijk's previously-published essays on the close connections that existed between medicine and philosophy throughout antiquity. Medical authors such as the Hippocratic writers, Diocles, Galen, Soranus and Caelius Aurelianus elaborated on philosophical methods such as causal explanation, definition and division and applied key concepts such as the notion of nature to their understanding of the human body. Similarly, philosophers such as Plato and Aristotle were highly valued for their contributions to medicine. (...) This interaction was particularly striking in the study of the human soul in its relation to the body, as illustrated by approaches to specific topics such as intellect, sleep and dreams, and diet and drugs. With a detailed introduction surveying the subject as a whole and a new essay on Aristotle's treatment of sleep, this wide-ranging and accessible collection is essential reading for the student of ancient philosophy and science. (shrink)
Most available resources for teachers and students in biomedical ethics are based on a notion of medicine and of how to understand and illuminate its ethical problems that is at least two decades old. Meaning and Medicine dramatically expands the repertoire of resources for teachers and students of bioethics. In addition to providing fresh perspectives on both traditional and emerging questions in bioethics, this Reader focuses on questions in social philosophy, epistemology, and metaphysics as they are raised (...) by developments in contemporary health care. A chief aim of this resource is to rekindle interest in seeing health care not solely as a set of practices so problematic as to require ethical analysis by philosophers and other scholars, but as a field whose scrutiny is richly rewarding for the traditional concerns of philosophy. (shrink)
What the philosophy of medicine is -- Philosophy of medicine: should it be teleologically or socially construed? -- The internal morality of clinical medicine: a paradigm for the ethics of the helping and healing professions -- Humanistic basis of professional ethics -- The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic -- Medicine today: its identity, its role, and the role of physicians (...) -- From medical ethics to a moral philosophy of the professions -- Moral choice, the good of the patient, and the patient's good -- The four principles and the doctor-patient relationship: the need for a better linkage -- Patient and physician autonomy: conflicting rights and obligations in the physician-patient relationship -- Character, virtue, and self-interest in the ethics of the professions -- Toward a virtue-based normative ethics for the health professions -- The physician's conscience, conscience clauses, and religious belief: a Catholic perspective -- The most humane of the sciences, the most scientific of the humanities -- The humanities in medical education: entering the post-evangelical era -- Agape and ethics: some reflections on medical morals from a catholic christian perspective -- Bioethics at century's turn: can normative ethics be retrieved? -- Hippocratic tradition -- Toward an expanded medical ethics: the Hippocratic ethic revisited -- Medical ethics: entering the post-Hippocratic era. (shrink)
Pellegrino's philosophy of medicine is explored in categories such as the motivation in constructing a philosophy of medicine, the method, the starting point of the doctor-patient relationship, negotiation about values in this relationship, the goal of the relationship, the moral basis of medicine, and additional concerns in the relationship (concerns such as gatekeeping, philosophical anthropology, axiology, philosophy of the body, and the general disjunction between science and morals). A critique of this philosophy is (...) presented in the following areas: methodology, relation to ontology and sociology, the dynamic of individual and social concerns, and the new social condition of medicine. Finally, some suggestions for the future revitalization of philosophy of medicine are made based on Pellegrino's ideas. The focus throughout is on the moral basis and moral consequences of the philosophy of medicine, and not on other important themes. Keywords: doctor-patient relationship, goal of medicine, medical ethics, philosophical method, philosophy of medicine, philosophy of the body, values in medicine CiteULike Connotea Del.icio.us What's this? (shrink)
the structure of medical science with a special focus on the role of generalizations and universals in medicine, and (2) philosophy of medicine's relation with the philosophy of science. I argue that a usually overlooked aspect of Kuhnian paradigms, namely, their characteristic of being "exemplars", is of considerable significance in the biomedical sciences. This significance rests on certain important differences from the physical sciences in the nature of theories in the basic and the clinical medical sciences. (...) I describe those differences and maintain that they are these differentiating features that require the use of more comparative and analogical reasoning in medicine. I suggest that Kitcher's recent introduction of the notion of a ‘practice’ may have similar implications if it is construed to contain more analogical elements than he appears to recognize in his initial formulation. Finally I argue that though Gorovitz and MacIntyre's characterization of medicine as a "science of particulars" bears some similarities with my thesis, I maintain that such a position without careful qualification can lead to ignoring both the nature of generalizations in these sciences and their role as positive analogies tying together a family of overlapping models. Keywords: medical reasoning, biomedical theories/paradigms, science of particulars, philosophy of medicine CiteULike Connotea Del.icio.us What's this? (shrink)
Basing ourselves on the writings of Hans Jonas, we offer to psychosomatic medicine a philosophy of life that surmounts the mind-body dualism which has plagued Western thought since the origins of modern science in seventeenth century Europe. Any present-day account of reality must draw upon everything we know about the living and the non-living. Since we are living beings ourselves, we know what it means to be alive from our own first-hand experience. Therefore, our philosophy of life, (...) in addition to starting with what empirical science tells us about inorganic and organic reality, must also begin from our own direct experience of life in ourselves and in others; it can then show how the two meet in the living being. Since life is ultimately one reality, our theory must reintegrate psyche with soma such that no component of the whole is short-changed, neither the objective nor the subjective. In this essay, we lay out the foundational components of such a theory by clarifying the defining features of living beings as polarities . We describe three such polarities: 1) Being vs. non-being: Always threatened by non-being, the organism must constantly re-assert its being through its own activity. 2) World-relatedness vs. self-enclosure: Living beings are both enclosed with themselves, defined by the boundaries that separate them from their environment, while they are also ceaselessly reaching out to their environment and engaging in transactions with it. 3) Dependence vs. independence: Living beings are both dependent on the material components that constitute them at any given moment and independent of any particular groupings of these components over time. We then discuss important features of the polarities of life: Metabolism; organic structure; enclosure by a semi-permeable membrane; distinction between "self" and "other"; autonomy; neediness; teleology; sensitivity; values. Moral needs and values already arise at the most basic levels of life, even if only human beings can recognize such values as moral requirements and develop responses to them. (shrink)
The celebration of thirty years of publication of The Journal of Medicine and Philosophy provides an opportunity to reflect on how medical ethics has evolved over that period. The reshaping of the field has occurred in no small part because of the impact of branches of philosophy other than ethics. These have included influences from Kantian theory of respect for persons, personal identity theory, philosophy of biology, linguistic analysis of the concepts of health and disease, personhood (...) theory, epistemology, and political philosophy. More critically, medicine itself has begun to be reshaped. The most fundamental restructuring of medicine is currently occurring - stemming, in part, from the application of contemporary philosophy of science to the medical field. There is no journal more central to these critical events of the past three decades than The Journal of Medicine and Philosophy. (shrink)
This article provides an introduction to the articles in this theme issue. This collection examines epistemological, ontological, moral and political questions in medicine in light of the philosophical ideas of Charles Taylor. A synthesis of Taylor's relevant work is presented. Taylor has argued for a conception of the human sciences that regards human life as meaningful–deriving meaning from surrounding horizons of significance. An overview of the interdisciplinary articles in this issue is presented. This collection advances our thinking in the (...)philosophy of medicine as well as the philosophy of Charles Taylor. (shrink)
Two crucial topics in the philosophy of medicine are the philosophy of nature and philosophical anthropology. In this essay I engage the philosophy of nature by exploring Anne Fagot-Largeault's study of norms in nature as a way of articulating a Confucian philosophy of medicine. I defend the Confucian position as a moderate naturalism.
Darwin's Hypothesis Nonviolence Samsara The Noble Road to the Eight Virtues Respect for Life The Infinite, the Absolute, the Eternal The Will The Narrow Door The Author 127 127 128 130 131 131 132 132 135 ...
: During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions (...) facing contemporary medicine and health care. (shrink)
In this introductory paper, I try to give an overview of the concept of normativity in its philosophical history and its contemporary interpretations and uses in different fields. From philosophy of logic and mathematics to philosophy of language and mind, and to philosophy of medicine and care, normativity is found as a key concept pointing at the possibility of scientific and technical progress and improvement of human life in the interaction between the individual and his environment.
The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism ﬂourished (circa 1920–1950). At the same time, the term ‘‘evidence-based medicine’’ has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can (...) and should be challenged on the grounds of how ‘evidence’ has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientiﬁc should give pause. (shrink)
In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, (...) moreover, in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient. (shrink)
Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the science of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I (...) shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice. (shrink)
There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough (...) to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field. (shrink)
Kenneth F. Schaffner compares the practice of biological and medical research and shows how traditional topics in philosophy of science--such as the nature of theories and of explanation--can illuminate the life sciences. While Schaffner pays some attention to the conceptual questions of evolutionary biology, his chief focus is on the examples that immunology, human genetics, neuroscience, and internal medicine provide for examinations of the way scientists develop, examine, test, and apply theories. Although traditional philosophy of science has (...) regarded scientific discovery--the questions of creativity in science--as a subject for psychological rather than philosophical study, Schaffner argues that recent work in cognitive science and artificial intelligence enables researchers to rationally analyze the nature of discovery. As a philosopher of science who holds an M.D., he has examined biomedical work from the inside and uses detailed examples from the entire range of the life sciences to support the semantic approach to scientific theories, addressing whether there are "laws" in the life sciences as there are in the physical sciences. Schaffner's novel use of philosophical tools to deal with scientific research in all of its complexity provides a distinctive angle on basic questions of scientific evaluation and explanation. (shrink)
In this commentary on the article by Arthur L. Caplan  the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine (...) may not deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline. (shrink)
A less analytic and more wholistic approach to philosophy, described as best overall fit or seeing how things all hang together, is defended in recent works by John Rawls and Richard Rorty and can usefully be applied to problems in philosophy of medicine. Looking at sickness and its impact upon the person as a central problem for philosophy of medicine, this approach discourages a search for necessary and sufficient conditions for being sick, and instead encourages (...) a listing of true and interesting observations about sickness which reflect the convergence of a number of different viewpoints. Among the relevant viewpoints are other humanities disciplines besides philosophy and the social sciences. Literature, in particular, provides insights into the meaning and the uniqueness of episodes of sickness in a way that philosophers may otherwise fail to grasp. (shrink)
In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.
The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine (...) as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images. (shrink)
This is a review of the literature in the philosophy of medicine published in China from 1930 to 1980. The topics dealt with include the relationship between medicine and philosophy, the basic concepts of medicine, etiology and causality, the bearing of psychology on physiology and pathology, epistemology in diagnostics, methodology of medical sciences, philosophical and methological problems in traditional Chinese medicine, philosophical problems in health policy, and medical ethics.
Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the vagueness of unexplicit interrelations between (...) class='Hi'>medicine''s stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as Hiatus theoreticus in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine. (shrink)
The social ethics of medicine is the study and ethical analysis of social structures which impact on the provision of health care by physicians. There are many such social structures. Not all these structures are responsive to the influence of physicians as health professionals. But some social structures which impact on health care are prompted by or supported by important preconceptions of medical practice. In this article, three such elements of the philosophy of medicine are examined in (...) terms of the negative impact on health care of the social structures to which they contribute. The responsibilities of the medical profession and of individual physicians to work to change these social structures are then examined in the light of a theory of profession. (shrink)
This report explores the relationship between philosophy and medicine in the U.K. We note that medical training involves very little formal instruction in philosophy and ethics, and that, with few exceptions, philosophers in the U.K. do not contribute to the instruction of physicians or the philosophy of medicine. However, reviewing the problems arising out of recent developments within scientific medicine we find a pressing need for future philosophical analysis in the following areas: psychiatry, organ (...) transplantation, abortion, euthanasia, experiments on living subjects, consent, confidentiality, the relationship between medicine and political authority, and the provisions for social justice in medicine. (shrink)
In addition to the neglect of philosophy by medicine, emphasized in a recent editorial in this journal, there has been an equally important neglect of medicine by philosophy. Philosophy stands to gain from medicine in three respects: in materials, the conceptual difficulties arising in the practice of medicine being key data for philosophical enquiry; in methods, these data, through their problematic character, being ideally suited to the technique of linguistic analysis; and in results, (...) the practical requirements of medicine placing a direct demand for progress on philosophical theory. The future of the relationship between philosophy and medicine depends on the development of a positive two-way trade between them. (shrink)
Caplan has argued that the philosophy of medicine does not exist. Although I will not deny the points he makes, I will argue that the philosophy of medicine has characteristics of a developing field with the potential to meet all of Caplan's criteria. The argument is based on Dewey's established views on logical development for a field of inquiry, as well as pointing out how other criteria Caplan imposes can be fulfilled.
This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.
The article tries to demonstrate how the tools and perspectives of action theory may be used in philosophy of medicine and medical ethics. In the first part, some concepts and principles of action theory are reconstructed and used to sketch a view of medicine as a science of actions. The second part is a contribution to the discussion on medical ethics in the same issue of this journal and consists in a detailed analysis of the main arguments (...) and critical remarks from the point of view of action theory. (shrink)
The problem of developing a moral philosophy of medicine is explored in this essay. Among the challenges posed to this development are the general mistrust of moral philosophy and philosophy in general created by post-modernist philosophical and even anti-philosophical thinking. This reaction to philosophical systematization is usually called antifoundationalism. I distinguish different forms of antifoundationalism, showing that not all forms of their opposites, foundationalism, are alike, especially with regards to claims made about the certitude of moral (...) thought. I conclude that we are correct to mistrust absolutist principles in a moral philosophy of medicine, but can find some center within the practice of medicine itself for a moral foundation. (shrink)
Can Pellegrino and Thomasma's book, A Philosophical Basis of Medical Practice (1981), rightfully claim to be a step forward towards a systematic philosophy of medicine? We try to answer this question by focusing our comment upon three related aspects of the book, namely (1) the problem of philosophical method(s), (2) the alleged Aristotelian-Thomistic orientation, (3) the view of philosophical anthropology of the authors. It is first argued that it is doubtful whether there is as much philosophical method in (...) the authors' book as their reflections on philosophical method suggest. Second, we argue that if Aristotelian-Thomistic philosophy is important to the authors, it is not so much because of its methods and content, as because it supplies them with a very convenient framework for didactically ordering and transmitting their views about what they consider to be — philosophically speaking — basic about medicine. Third we argue that the authors' conception of philosophical anthropology bears (in point of method and ontology) more resemblance to the humanistic naturalism of John Dewey, than to any of the European philosophical traditions (Aristotelism, (Neo)Thomism, Merleau-Pontyian phenomenology) listed in support of their philosophical enterprise. (shrink)
It seems impossible to completely cover the field indicated by the title of this report because of the many contributions of individual physicians and non-physicians to problems of the philosophy of medicine in Austria, and to their solution. The main trends are rooted in historic developments and in the current problems of medicine and health care, which are similar world-wide. In Austria famous names like empress Maria Theresia or the physician Ignaz Semmelweis have to be mentioned in (...) connection with the development of the ideas of a philosophy of medicine. In recent times again influential and well-known persons in related fields of medicine and health care are Austrians. However, the main line of new developments goes mostly unseen by the public: activities in medical ethics with the goal to humanize health care, carried on by groups of young physicians, biomedical engineers and students. (shrink)
Two challenges face European philosophy of medicine. The first is to counterbalance what is seen as an overemphasis on social analysis of medicine with greater attention to its personal and individual dimensions. The second, related challenge, is to more fully understand the clinical realities of modern medicine, which in turn, give rise to the scope and limits of physician duties, patient obligations, and social concerns.
Major Polish authors writing on the philosophy of medicine in the period under discussion are briefly presented, namely Tytus Chaubiski Wadysaw Biegaski, and Edmund Biernacki. General background of their work and possible influences are described. The views of the above authors on the meaning, scope and importance of the philosophy of medicine are outlined.
The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered (...) to be fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)
This article presents a brief general view of the recent literature and the scholarly activity in the field of philosophy of medicine in Scandinavia. The focus of attention is not on medical ethics, but on studies on topics like decision theory, medical classification, causality, causal explanations, concept formation, and on analyses of different ideals of medical science and clinical practice. A few principal works on medical ethics are mentioned by way of introduction and a brief account of a (...) highly topical debate on the legislation on artificial insemination in Sweden is given at the end. (shrink)
In the late twentieth century the impressive achievements of modern medicine are obvious, yet medicine seems to have failed to satisfy public expectation. Government regulation of hospitals and doctors is tightening in most Western countries and health funding is a divisive political issue. Medical complaints departments are increasingly busy. In the United States medical litigation has reached alarming levels, and a similar trend can be seen in other developed countries. Is there something wrong with medical research and practice? (...) This book, written by a surgeon with more than thirty years experience of clinical medicine, examines what it is that doctors do, and what it is that patients expect of them. It finds that in the face of uncertainty, expectation and reality ofen often diverge. Starting from the communication difficulties that exist between doctors and patients, Humane Medicine explores the roles of science, ethics and the humanities in medical practice. It forcefully argues that more science cannot heal this rift, nor can better education in ethics. To foster better communication, medical teachers must change their philosophy and methods, so that value-laden issues in clinical medicine are interwoven with the necessary science. Professor Little outlines some possible ways to achieve this. This important book will be of interest to medical students and their teachers, clinicians, health policy planners and other readers concerned about the direction of the medical profession. (shrink)
Obviously medicine should be evidence-based. The issues lie in the details: what exactly counts as evidence? Do certain kinds of evidence carry more weight than others? (And if so why?) And how exactly should medicine be based on evidence? When it comes to these details, the evidence-based medicine (EBM) movement has got itself into a mess – or so it will be argued. In order to start (...) to resolve this mess, we need to go 'back to basics'; and that means turning to the philosophy of science. The theory of evidence, or rather the logic of the interrelations between theory and evidence, has always been central to the philosophy of science – sometimes under the alias of the 'theory of confirmation'. When taken together with a little philosophical commonsense, this logic can help us move towards a position on evidence in medicine that is more sophisticated and defensible than anything that EBM has been able so far to supply. (shrink)
Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal’s Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors (...) seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the “no lose philosophy” in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal’s Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the “belts and braces” approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal’s Wager, are based on faith rather than evidence. (shrink)
To cite this Article: , 'Two Dogmas of Research Ethics and the Integrative Approach to Human-Subjects Research', Journal of Medicine and Philosophy, 32:2, 99 - 116 To link to this article: DOI: 10.1080/03605310701255727 URL: http://dx.doi.org/10.1080/03605310701255727..
Philosophy of medicine: between clinical trials and mechanisms Content Type Journal Article Category Book Review Pages 1-4 DOI 10.1007/s11016-011-9630-5 Authors Federica Russo, Philosophy-SECL, University of Kent, Canterbury, CT2 7NF UK Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796.
A unique relationship exists between physicians and philosophers â one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages â a sense of how medicine has adapted (...) to the social cultural and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary. (shrink)
Papers presented at a symposium on philosophy and medicine at the Institute for the Medical Humanities at the University of Texas Medical Branch in 1974 were published in the inaugural volume of this series.
É corrente se afirmar que antes da Modernidade não há registro de mulheres na construção do pensamento erudito. Que, se tomarmos, po exemplo, a Filosofia e a Teologia, que foram as duas áreas do conhecimento que mais produziram intelectuais, durante a Idade Média, não encontraremos aí a presença de mulheres. Entretanto, apesar de todas as evidências, se vasculharmos a construção do Pensamento Ocidental, veremos que é possível identificar a presença de algumas mulheres já nos tempos remotos, na Antiguidade Clássica e (...) na Patrística (ou Alta Idade Média). Mas é na Escolástica (Baixa Idade Média) que encontramos as primeiras Pensadoras, responsáveis por um sistema autônomo, distinguindo-se como fecundas escritoras, donas de obras tão profundas e importantes quanto as produzidas pelos homens de seu tempo, com os quais muitas vezes dialogaram em pé de igualdade. Dentro desse maravilhoso universo feminino de intelectuais, destacamos, na Escolástica, a figura de Hildegarda de Bingen (1098-1165), da qual trataremos um pouco neste artigo. It is common to say that before modernity there is no record of women in the construction of classical thought. What if we take, for example, to philosophy and theology, which were the two areas of knowledge that produced more intellectuals during the Middle Ages, we find there the presence of women. However, despite all the evidence, if we search the construction of Western Thought, we see that it is possible to identify the presence of some women already in ancient times, in Classical Antiquity and Patristics (or Middle Ages). But it is in Scholastic (Middle Ages) we find the first thinkers, responsible for an autonomous system, especially as fertile writers, owners of works so profound and important as those produced by men of his time, who often conversed on an equal footing. In this wonderful universe of female intellectuals, highlight, in Scholastic, the figure of Idelgarda of Bingen (1098-1165), which is discussed a bit in this article. (shrink)
Because “evidence” is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on what counts as evidence, the critics miss important and desirable pragmatic features of the evidence-based approach. This article redirects critical attention toward EBM’s rigid hierarchy of evidence as the (...) culprit of its objectionable epistemic practices. It reframes the EBM discourse in light of a distinction between objectivist and pragmatic epistemology, which allows for a more nuanced analysis of EBM than previously offered: one that is not either/or in its evaluation of the decision-making technology as either iconoclastic or creedal. -/- . (shrink)
Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first (...) edition "Well written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)
It is in the interest of the totalitarian state that subjects not think for themselves, much less confer about their thinking. Writing under the hostile watch of the Prussian censorship, Immanuel Kant dared to argue the need for open argument, in the university if nowhere else. In this heroic criticism of repression, first published in 1798, he anticipated the crises that endanger the free expression of ideas in the name of national policy. Composed of three sections written at different times, (...) The Conflict of the Faculties dwells on the eternal combat between the "lower" faculty of philosophy, which is answerable only to individual reason, and the faculties of theology, law, and medicine, which get "higher" precedence in the world of affairs and whose teachings and practices are of interest to the government. Kant makes clear, for example, the close alliance between the theological faculty and the government that sanctions its teachings and can resort to force and censorship. All the more vital and precious, then, the faculty of philosophy, which encourages independent thought before action. The first section, "The Conflict of the Philosophy Faculty with the Theology Faculty," is essentially a vindication of the right of the philosophical faculty to freedom of expression. In the other sections the philosopher takes a long and penetrating look at medicine and law, the one preserving the physical "temple" and the other regulating its actions. (shrink)
This book examines the extremely important issue of the consistency of medical involvement in ending lives in medicine, law and war. It uses philosophical theory to show why medical doctors may be involved at different stages of the capital punishment process. The author uses the theories of Emmanuel Kant and John S. Mill, combined with Gerwith's principle of generic consistency, to concretize ethics in capital punishment practice. This book does not discuss the moral justification of capital punishment, but rather (...) looks at the possible forms of involvement and shows why consistency would demand medical involvement. The author takes a general approach, using arguments that may apply universally. The book broaches different academic fields, such as medicine, ethics, business, politics and defense. The Ethics of Medical Involvement in Capital Punishment is of interest to students, teachers, lecturers and researchers working in the areas of capital punishment, medical, legal and business ethics, and political philosophy. (shrink)
The article offers an approach to inquiry about, the foundation of medical ethics by addressing three areas of conceptual presupposition basic to medical ethical theory. First, medical ethics must presuppose a view about the nature of medicine. it is argued that the view required by a cogent medical morality entails that medicine be seen both as a healing relationship and as a practical art. Three ways in which medicine inherently involves values and valuation are presented as important, (...) i.e., in being aimed at the good of health, in being a cognitive art evaluating towards that good, and as a manifestation of a virtuous disposition concerning that good. Finally, a value ontology drawn from these considerations is seen as necessarily underlying medical ethics. A set of three such basic values are promoted as crucial: the value of health; the value of the individual patient; and the value of altruism that mediates the class of potential patients. (shrink)