Abstract

This work examines the character of clinical explanation. The claim is that the basic concepts in clinical explanation are contingent on three kinds of commitments: ontological, axiological, and societal. Corresponding to the three kinds of commitments are three dimensions of clinical explanation. Clinical explanation necessarily involves all three. The interplay among these dimensions is such that clinical explanation is theory and value-laden in a way that is context-dependent. To defend this thesis, I argue that various philosophical accounts of clinical explanation differ depending on the extent they explicitly or implicitly hold that the character of clinical reality is theory-ladened, or discloseable apart from theoretical assumptions brought by explainers, value-laden, or discloseable without reference to moral and non-moral values, and context-dependent due to the theoretical and value assumptions or interests of particular explainers, or stateable in terms of universal, non-relative epistemic and value commitments. The first can be seen as involving the traditional controversy in the history of medicine regarding the extent to which knowledge describes structures in reality independent of the categories of the knower . The second can be seen as involving the recent debate in the philosophy of medicine regarding the nominalist versus neutralist character of disease concepts. The third restates the first two but in terms of whether the theoretical and value assumptions are universal or context-dependent. Clinical explanation is, in short, tri-dimensional. Thus, the thesis is not just that clinical explanation is best understood in terms of this three-fold analysis, but that clinical explanation is theory and value-laden in a way that is context-dependent. Clinical explanation is theory-ladened in that clinical reality is seen within a vision, a framework for the purpose of interpreting the world; value-ladened in the sense that values are inseparably bound to clinical facts; and contextual in that socio-cultural influences condition clinical theory and values. This view of clinical explanation raises major bioethical issues concerning the co-participation of patients and communities with clinicians in using classifications that are created, not simply discovered