Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular (...) patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be. (shrink)

The paper explores the relation between reason and action as it emerges from the texts of Āyurveda. Life or Ayus (commonly understood as life-span) is primary subject matter of Ayurveda. Life is a locus of experience, action and disposition. Experiences and actions are differentially determined by dispositions that characterize the organism; otherwise all living organisms will be identical. Ayus of each living being is uniquely individual and remains constant between birth and death. In this journey, upkeep of ayus is the (...) purpose of Āyurveda or science of life. Ayurveda is a science of experienced matter as well as of experienced body. The living body is critically dependent on the influx of matter for its upkeep. Āyurveda offers a conceptual system to reason about balance and imbalances of the system and the causal role of the material flux through the system. This sensate matter is causally open and makes room for definite causal role for the individual and the effective insertion of the felt-purpose of action. Some of the strengths of Ayurveda are brought forth in the paper such as (a) reasoning out the compatibility between the bodily processes and the selection of the natural products for diet and drug, (b) role for heuristics in medical diagnosis, which takes into cognizance the particularity of each living body and the teleology evident in the very act of diagnostic reasoning. The paper shows that Āyurvedic theory is built on experiential datum whereas scientific medical theory is built on experience-independent datum. Āyurveda explores causal efficacy of ‘secondary qualities’ whereas scientific medicine explores causal efficacy of ‘primary qualities’. The actionable experiential reasoning is at the foundations of Āyurveda whereas modern medical science is ab initio saddled with difficult ‘hiatus theoreticus’ between theory and practice. For Ayurveda it is experience of qualities that discloses behavior of matter. The types of qualities that appear in experience have a special significance for theorizing about the actions of matter with the help of qualities. The paper explores the relation between experience of qualities and the method of science. It shows how efficacy of medical practice is based on the foundational stance of experiential realism in theory. To bring the point home, the paper borrows Aristotalian concepts to show how the relation between phantasm and phronesis is honored in the very theory of Āyurveda. (shrink)

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected (...) from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice. (shrink)