Abstract
In this paper, we outline a framework for understanding the different kinds of knowledge required for medical practice and use this framework to show how scientism undermines aspects of this knowledge. The framework is based on Michael Polanyi’s claim that knowledge is primarily the product of the contemplations and convictions of persons and yet at the same time carries a sense of universality because it grasps at reality. Building on Polanyi’s ideas, we propose that knowledge can be described along two intersecting “dimensions”: the tacit–explicit and the particular–general. These dimensions supersede the familiar “objective−subjective” dichotomy, as they more accurately describe the relationship between medical science and medical practice. Scientism, we argue, excludes tacit and particular knowledge and thereby distorts “clinical reality” and impairs medical practice and medical ethics.
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Notes
In the appraisal of a result using the null hypothesis, a low “p-value” suggests a true relationship and a high value suggests a result caused by chance. The degree of justification (in terms of p-value) required to qualify a result as knowledge is not an “objective” truth but is assigned conventionally (p < 0.05 in most situations).
The inherent uncertainty of science—and resultant need for judgement—is also reinforced by the theory-laden nature of observation. Although intersubjective agreement might rationally strengthen a claim to truth (as happens with peer review), this does not lead to mind independent “objectivity,” as this agreement is still conditional on each individual’s judgement.
Polanyi, who trained as a doctor before becoming a physical chemist and philosopher, also claimed that medicine’s purpose is to attend to suffering (Polanyi 1965).
There have been more recent iterations of evidence-based medicine that claim to equally acknowledge other forms of knowledge (e.g., patient preferences and clinical judgement) (Buetow 2009). However, this rhetoric is at odds with evidence-based medicine’s fundamental tenets, as if other knowledge is equally important it is unclear why medicine must be “evidence-based” and not “preference-based” or “judgement-based,” etc. For a detailed argument, see McHugh (2013).
Whether such a computer could be said to have “knowledge” at all (i.e., whether it could be artificially intelligent) is a different question that is outside the scope of this paper. Polanyi’s philosophy is certainly relevant to this debate (Blum 2010), and it would seem that as long as computers are unable to grasp the tacit element (and see meaning), true artificial intelligence will be elusive.
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McHugh, H.M., Walker, S.T. “Personal Knowledge” in Medicine and the Epistemic Shortcomings of Scientism. Bioethical Inquiry 12, 577–585 (2015). https://doi.org/10.1007/s11673-015-9661-5
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DOI: https://doi.org/10.1007/s11673-015-9661-5