Abstract

Opening keynote address on “The Philosophy of Person-Centred Healthcare”, Brazil Roundtable in Philosophy of Medicine, Third Symposium in Philosophy of Medicine and Health Care Practices, University of Vale do Rio dos Sinos, São Leopoldo, Rio Grande do Sul, Brazil: What is person-centred healthcare? What are its advocates supporting that is distinctive, different from other approaches to medicine and healthcare? There are at least two alternative versions of PCH, which I characterise as “science plus” additional, “personal” factors and a call for a broader philosophical reframing of the medical enterprise, raising underlying questions about the nature of science and its relationship with value. PCH in this second sense is set up in opposition to “scientism”, a philosophical view about science and its relationship with truth, knowledge and reality. Scientism can be objected to on many grounds, including its implications for mereology and for the ontology of value. Debates about how we conceptualise health, disease and illness are still beset by the suspicion that “value judgements” are in some special sense “subjective”. A motivation for defending biomedical definitions of health and disease that are “value-neutral” is to defend the objectivity of diagnosis. PCH is frequently associated with the idea that medical diagnosis is inevitably value-laden. Until the assumptions of scientism are brought to the fore and rejected, PCH risks being seen as anti-science and associated with relativist accounts of health and illness. All judgement requires a subject, but it does not follow that it is 'subjective' in any sense implying ontological relativity. The implications are substantial: either all medical judgement is relative or realism about value is true. To justify our claims in diagnosis, we need to discuss and defend our value-judgements. We must reject scientism for an openly value-laden account of human functioning. Medical epistemology requires value-realism.