Intuition in medical and moral reasoning -- Moral intuitionism -- The place of Aristotelian phronesis in clinical reasoning -- Aristotle's practical syllogism: accounting for the individual through a theory of action and cognition -- Individual and statistical physiognomy: the art and science of making the invisible visible -- Clinical intuition versus statistical reasoning -- Contingency and correlation: the significance of modeling clinical reasoning on statistics -- Abduction: the intuitive support of clinical induction -- Conclusion: medical ethics beyond ontology.
Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through (...) analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine. (shrink)
I will apply dietetic measures for the benefit of the sick according to my ability and judgment. I will keep them from harm and injustice. The Hippocratic Oath formulates the ethical principle of medical beneficence and its negative formulation non-maleficence. It relates medical ethics to the traditional end of medicine, that is, to heal, or to make whole. First and foremost, the duty of the physician is to heal, and if this is not possible at least not to harm. This (...) ethical principle helped to establish the necessary trust between physician and patient in the pre-modern era when most of medicine was nothing more than a set of placebos (Shapiro 1960). Beginning in the seventeenth-century, Western .. (shrink)
The title of my paper, “Affecting the Body and Transforming Desire,” (Braude 2012a) is inspired from Plato’s Symposium, where the physician Eryximachus presents a purely neurophysiological discourse on love. James Giordano’s and Gerrit Glas’s commentaries on my paper have the timbre of a contemporary symposium, in this instance to discern the nature of suffering. Thus, I take Giordano’s and Glas’s commentaries to be generally sympathetic to my offering, although providing further critical insights that deepen the multidimensional understanding of suffering and (...) the correct ethical and medical response. From different perspectives both commentators zone in on one central aspect of my analysis, that is .. (shrink)