Karl E. Rothschuh is one of the most important,but, on an international scale, relativelyunknown representatives of German philosophy ofmedicine in the 20th century. This paperpresents and discusses his central conceptssystematically, especially those ofanthropology, theories of health and disease.Rothschuh distinguishes two methodologicalapproaches to anthropology: a causal analysisthat considers human organism as complex causalsystems, and a so-called bionomicalinvestigation that clarifies the meaning orfunction of single processes in respect to thewhole organism. These two perspectivescomplement each other. From a naturalisticpoint of view, Rothschuh (...) conceptualisesdiseases as disorganisatorial or disbionomic processes;nevertheless, he stresses the culturalinterweavement, and, hence, the normativefoundation of diseases. ‘Disease’ is both arelational and a gradual term: It can beexperienced and conceptualised subjectively bypatients (aegritudo), clinically byphysicians (nosos, pathos) and bysociety (insalubritas). Further,Rothschuh differentiates between the verydefinition, a notion and a concept ofdisease. Because of the normative character ofdisease, medicine cannot be a science strivingfor pure theoretical knowledge like physics orchemistry. Medicine is a practical science,oriented towards its goals of healing. Becauseof the societal position of medicine, Rothschuhdescribes it as task (Aufgabe). Withregard to modern developments in philosophy ofmedicine, this paper discusses Rothschuh’stheories critically and offers somestarting points for necessary enhancements. (shrink)
This paper is a criticalexamination of the development of thephilosophy of medicine as a discipline. Ithighlights two major themes in the contemporarydebate about the philosophy of medicine: thescope of the discipline and the relation of thediscipline to its cognate disciplines. A broadview of the philosophy of medicine is defendedand the philosophy of medicine is seen as aphilosophical sub-discipline. These viewsdepend in important ways on three factors: ageneral metaphysical world view, particularunderstandings of the cognate (...) disciplines, andthe perspective from which one asks thequestions about the nature of the discipline. It is proposed that the future of thephilosophy of medicine may follow thephilosophy of science in that philosophical,sociological and historical studies may combinein a mutually enriching way to form ‘‘medicinestudies.’‘. (shrink)
The article examines the statements made by Immanuel Kant with reference to medicine as well as the impact of his philosophy on medicine. It describes the initial reaction of Kantian philosophy on medicine in the late 18th and early 19th century and its influence in the late 20th century.
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)
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)
Design research has been positioned as an important methodological contribution of the learning sciences. Despite the publication of a handbook on the subject, the practice of design research in education remains an eclectic collection of specific approaches implemented by different researchers and research groups. In this paper, I examine the learning sciences as a design science to identify its fundamental goals, methods, affiliations, and assumptions. I argue that inherent tensions arise when attempting to practice design research as an analytic science. (...) Drawing inspiration and insight from Chinese philosophy and the practice of Chinese medicine, I propose that the learning sciences may better attain its claims to science through greater reliance on inductive synthesis rather than linear causal analysis. In so doing, I reposition the endeavor of science making within the metaphysics of process philosophy instead of classical Western philosophy. I suggest that theory building will be strengthened empirically and pragmatically by more careful observation and systematic generalization of the stability patterns of design related phenomena. It also needs to be more situated in its orientation. (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)
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)
SummaryThe congruence between medicine and philosophy which we find in the Protagoras and the Treatise on Ancient Medicine as well as the tensions symbolized in the dialectic between Eryximachus and Diotima will always be with us. The congruence and the divergence of these ancient disciplines are both important to human well-being. By opposing one another, medicine and philosophy can each balance the other's pretension to universality. By converging, they illumine some of the most important questions (...) of human existence. This essay has examined ways in which medicine and philosophy can converge in our times as philosophy and medicine, philosophy in medicine, and philosophy of medicine. The present moment in our intellectual history is particularly propitious for the nurture of the engagement of medicine and philosophy. The most fruitful form of that interaction may be in the philosophy of medicine, which is a definable discipline with a set of issues specific to it. If the obvious intellectual dangers can be avoided, those who practice medicine, those who think about it, and those who are served by it can gain deeper insight into the nature and the purpose of medicine as well as the nature of the profession and of man himself. Perhaps—positioned as it is, at the intersection of the sciences, the humanities, and technology—medicine can become “… a medium and the focus in which the problems of wisdom and science meet” (Buchanan 1938, p. 194). (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)
John Locke's philosophy was deeply affected by medicine of his times. It was specially influenced by the medical thought and practice of Thomas Sydenham. Locke was a personal friend of Sydenham, expressed an avid interest in his work and shared his views and methods. The influence of Sydenham's medicine can be seen in the following areas of Locke's philosophy: his “plain historical method”; the emphasis on observation and sensory experience instead of seeking the essence of things; (...) the rejection of hypotheses and principles; the refusal of research into final causes and inner mechanisms; the ideal of irrefutable evidence and skepticism on the possibilities of certainty in science. The science which for Locke held the highest paradigmatic value in his theory of knowledge was precisely medicine. To a great extent, Locke's Essay on Human Understanding can be understood as an attempt to justify, substantiate, and promote Sydenham's medical method. This method, generalized, was then proposed as an instrument for the elaboration of all natural sciences. (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 ...
Medico-philosophical reflections were developed in the 19th and the 20th centuries by three consecutive generations of Polish physicians, active in what was later named the Polish School of Philosophy of Medicine. The second generation of this school published its own journal, Medical Critique [Krytika Lekarska], from 1897 to 1907. Medical Critique included numerous articles on the nature of medical knowledge, the reductionism versus holism debate in biology and medicine, the importance of teleologically-oriented approaches in medicine, the (...) influence of theories and of a priori ideas on clinical observations and on ‘clinical facts’, the problem of classification of diseases, the normative and ethical dimension of medicine, and the ion relationships between philosophy, history and medicine. The existence of a journal dealing specifically with theoretical reflections on medicine undoubtedly contributed to the propagation of original work in the philosophy of medicine in Poland. (shrink)
: 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 question of whether the universe is expanding or contracting serves as a model for current questions facing the medical humanities. The medical humanities might aptly be described as a metamedical multiverse encompassing many separate universes of discourse, the most prominent of which is probably bioethics. Bioethics, however, is increasingly developing into a new interdisciplinary discipline, and threatens to engulf the other medical humanities, robbing them of their own distinctive contributions to metamedicine. The philosophy of medicine considered as (...) a distinct field of study has suffered as a result. Indeed, consensus on whether the philosophy of medicine even constitutes a legitimate field of study is lacking. This paper presents an argument for the importance of a broad conception of the philosophy of medicine and the central role it should play in organizing and interpreting the various fields of study that make up the metamedical multiverse. (shrink)
Richard Koch1 became known in the 1920s with works on basic medical theory. Among these publications, the character of medical action and its status within the theory of science was presented as the most important theme. While science is inherently driven by the pursuit of knowledge for its own sake, medicine pursues the practical purpose of helping the sick. Therefore, medicine must be seen as an active relationship between a helping and a suffering person. While elucidating this relationship, (...) Koch discusses the fundamental elements of medicine found in natural philosophy and the relationship of medicine to its own history. One of his aims is to unite natural history and the history of ideas without reducing intellectual processes to biological ones. Koch considers free will as something intuitively certain. It must serve as an axiom which will capture human as well as non-human reality. Based on the fact that human free will, considered a psychic quality, evolved out of inanimate matter, Koch grants matter (proto-) psychic qualities. They are evoked through specific constellations of matter. – With regard to history, Koch rejects the notion of constant progress. The history of medicine has provided insights that cannot be surpassed but can be obscured. Historical self-contemplation serves as a means for avoiding any deviations which may prevent medicine from fulfiling its ultimate purpose. Koch connects nature and history through the concept of a unity between natural history and the historical development of medicine. Medicine is considered an especially complex development of a purposive reaction to harmful stimuli, a reaction which can already be encountered in unicellular organisms. Without intending to reduce historical and mental processes to biological ones, Koch sets for himself the aim of gathering different phenomena and presenting them in one encapsulating unity. (shrink)
Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical (...) literature. It finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)
The paper first defines palliative treatment and distinguishes it from symptomatic treatment. Then, the palliative situation is delineated as inseparably linked to the finitude of human life. Given the objectives of palliative treatment â responding to symptoms, damage to the patients' self-image, and the proximity of death â a subjective concept of disease is described, that is regarded as the focus of palliative treatment. The essence of the concept of disease is analysed as the patient's experience with a tendency of (...) reduction of her or his vitality. Palliative medicine is shown not to be symptom-oriented, but disease â directed as other domains of medicine. Implications and practical consequences, especially the status of objective findings, of this concept are discussed and therapeutic opportunities in the palliative situation reconsidered. (shrink)
To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified—the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the ‘Postmodern’ Era—which can be seen, à (...) la Foucault, as ‘fragments between philosophical fractures’. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care. (shrink)