The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research (...) and regarding the byproducts of basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

The recent literature on the theory of knowledge has taken a distinctive turn by focusing on the role of the cognitive and intellectual virtues in the acquisition of knowledge. The main contours and motivations for such virtue-theoretic accounts of knowledge are here sketched and it is argued that virtue epistemology in its most plausible form can be regarded as a refined form of reliabilism, and thus a variety of epistemic externalism. Moreover, it is claimed that there (...) is strong empirical support in favour of the virtue epistemic position so understood, and an empirical study regarding the cognitive processes employed by medical experts in their diagnosis and treatment of epilepsy is cited in this regard. In general, it is argued that one can best account for 'expert' knowledge in terms of a virtue-theoretic epistemology that retains key reliabilist features. It is thus shown that understanding knowledge along virtue-theoretic lines has important implications for our understanding of how knowledge is acquired, and thus for the philosophy of education. (shrink)

Although American philosophers and physicians are generally familiar with the writings of Claude Bernard (1813–1878), especially his Introduction to the Study of Experimental Medicine (1865), the medicial epistemology of Georges Canguilhem, born in 1904, is virtually unknown in English speaking nations. Although indebted to Bernard for his conception of the methods to be employed in the acquisition of medical knowledge, Canguilhem radically reformulates Bernard's concepts of ‘disease’, ‘health’, ‘illness’, and ‘pathology’. Contemporary exhortations to medical professionals and (...) medical students that they “pay more attention to the whole patient” take on significance in working through the writings of Canguilhem; of crucial importance is the relation that obtains between a patient's unique symptomatology and the proper drug regiment that is required. (shrink)

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical (...) schools are responding to the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training. (shrink)

This chapter aims to shed light on the normative questions raised by medical imaging (MI), paving the way for interdisciplinary dialogue and further philosophical exploration. MI comprises noninvasive techniques aimed at visualizing internal human body structures to aid in explanation, diagnosis, and monitoring of health conditions. MI requires interpretation by specialized professionals, and is routinely employed across medical disciplines. It is entrenched in clinical guidelines and therapeutic interventions. Moreover, it is a dynamic research field, witnessing ongoing technological advancements. (...) After surveying philosophical issues arising from MI, which are relatively unexplored, the chapter focuses on the epistemology of diagnostic imaging. Specifically, it delves into what constitutes an image as evidence and how radiological procedures generate knowledge. The discussion dissects three facets of the radiological process: image interpretation, radiological reporting, and semantic analysis. Each facet carries distinct epistemic implications, as errors can manifest in various ways, affecting the acquisition of patient-relevant knowledge. (shrink)

This essay examines the relationship between slavery and plant knowledge for cultivational activities and medicinal purposes on Isle de France (Mauritius) in the second half of the eighteenth century. It builds on recent scholarship to argue for the significance of slaves in the acquisition of plant material and related knowledge in pharmaceutical, acclimatization, and private gardens on the French colonial island. I highlight the degree to which French colonial officials relied on slaves’ ethnobotanical knowledge but neglected (...) to include such information in their published works. Rather than seeking to explore the status of such knowledge within European frameworks of natural history as an endpoint of knowledge production, this essay calls upon us to think about the plant knowledge that slaves possessed for its practical implementations in the local island context. Both female and male slaves’ plant-based knowledge enriched – even initiated – practices of cultivation and preparation techniques of plants for nourishment and medicinal uses. Here, cultivational knowledge and skills determined a slave’s hierarchical rank. As the case of the slave gardener Rama and his family reveals, plant knowledge sometimes offered slaves opportunities for social mobility and, even though on extremely rare occasions, enabled them to become legally free. (shrink)

This paper addresses a growing concern within the medical humanities community regarding the perceived need for a more empathically-focused medical curricula, and advocates for the use of creative pedagogical forms as a means to attend to issues of suffering and relationality. Drawing from the ethical philosophy of Emmanuel Levinas, I critique the notion of empathy on the basis that it erases difference and disregards otherness. Rather, I propose that the concept of empathy may be usefully replaced with that (...) of ethical responsibility , which suggests a shared sense of humanity outside the boundaries of presumed knowledge of the other. To illustrate this argument, I theorize the importance of theater within medical education. Theater, I argue, may engender ethical responsibility in the Levinasian sense, and thus may allow learners to differently engage with the experience of the suffering other. As such, I examine Margaret Edson’s widely used play Wit as a platform for such an ethical encounter to occur. Thus, rather than working to understand the value of theater in medical education in terms of knowledge and skill acquisition, I theorize that its primacy within medical curricula arises from its ethical/relational potential , or potential to engender new forms of inter-human relationality. (shrink)

Animals are frequently utilized as a teaching-learning tool in multiple educational settings. It is, therefore, important to understand what students think about this topic, in particular medical and veterinary students as “life caregivers” and competent people for a dynamic and responsible social intervention. In this context, this research aims to characterize and disseminate a set of issues related to animal welfare/wellbeing in higher education in the North of Portugal, particularly as regards the teaching of students of the Integrated Master (...) in Medicine (MIM) and Veterinary Medicine (MIMV). After ethical approval, a survey was delivered on paper to 180 undergraduate MIM (n = 100) and MIMV (n = 80) students. After collecting 139 questionnaires partially or fully completed, with varying response rates for each question, it was concluded that most of the students consider that animal experimentation is ethically acceptable when the benefits balance the harms and assuming that refinement of animal procedures is warranted; they also agree to the establishment, maintenance and performance of animal procedures solely for educational purposes as a way of ensuring optimal acquisition of theoretical knowledge, attitudes and behaviors and technical skills. Nevertheless, it is the responsibility of teachers to explore and implement pedagogical methodologies thar are equally effective but more humane and compassionate towards sentient living beings. (shrink)

Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP—to empower women, to provide another risk-reduction option for gay men—as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay (...) men and heterosexual couples but not single women. The PrEP debates reveal the different ideas about “demedicalization” in the earlier gay health and women’s health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market. (shrink)

RESUMEN La educación médica superior tiene la responsabilidad social de formar educandos autónomos, independientes y autorregulados. Por ello las estrategias de aprendizaje permiten la adquisición de información y el establecimiento de relaciones a partir del conocimiento previo; son procesos de toma de decisiones, consciente e intencional. Objetivo: Exponer las necesidades del desarrollo de estrategias de aprendizaje en los estudiantes de primer año de Estomatología. Método: Se realizó una investigación descriptiva transversal. El universo estuvo constituido por los estudiantes de 1er año (...) de la carrera de Estomatología, del que fueron seleccionados 120 educandos que conformaron la muestra y a los que se les aplicó la Escala de Estrategias de Aprendizaje ACRA-Abreviada para alumnos universitarios. Los datos fueron procesados utilizando la estadística descriptiva. Resultados: Las estrategias que más utilizan son las que los llevan a un aprendizaje memorístico y reproductivo, las estrategias de apoyo al aprendizaje son utilizadas por el 47.79% de los educandos y existen inadecuados hábitos de estudios. Discusión: El estudio permitió corroborar que las insuficiencias que presentan los estudiantes en cuanto al uso de estrategias de aprendizaje son similares a las descritas por los autores consultados. ABSTRACT The high medical education has the social responsibility of forming autonomous, independent and auto-regulated pupils. For it the learning strategies allow the acquisition of information and the relations establishment from the previous knowledge; there are processes of decision making, conscious and intentional. Objective: To exhibit the needs for the development of strategies of learning in the students of the first year of Stomatology. Method: A transverse descriptive investigation was carried out. The universe was constituted by the students of 1st year of the career of Dentistry, of which there were selected 120 pupils who shaped the sample and to whom there was applied the Scale of Strategies of Learning ACRA-Abbreviated for university pupils. The information was processed using the descriptive statistics. Results: The strategies that they use more are those which take them to memory and reproductive learning, the support strategies to learning are used by 47.79 % of the pupils and inadequate studies habits exist. Discussion: The study allowed to corroborate that the insufficiencies that the students present as for the use of strategies of learning are similar to the described ones by the consulted authors. (shrink)

The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle (...) suggested that capacities for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels. (shrink)

Attention is essential to the practice of medicine. It is required for expert and timely diagnoses and treatments, is implicated in the techniques and practices oriented toward healing, and enlivens the interpersonal dimensions of care. Attention enables witnessing, presence, compassion, and discernment. The French philosopher and activist Simone Weil (1909–1943) developed one of the most original and important descriptions of attention in the last century. For Weil, attention is not an attitude of strained focus but of perceptive waiting that leads (...) to the acquisition and integration of knowledge. Contrary to activities often foregrounded in clinical medicine, it requires renunciation of the will, gentle directedness toward the origin of actions, and diminishment of the self. This paper critically examines Weil’s concept of attention as it applies to health systems, technical/intellectual work, and interpersonal care, as well as its connection to theology, and considers whether attention might find a home within the contemporary clinic. (shrink)

Introduction The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. Objective The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. Methods Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a (...) retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. Results Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1 – ethics in research (26); 2 – ethical procedures and advanced technology (46); 3 – ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. Conclusion The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education. (shrink)

How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

The aim of the paper is to clarify the concept of scientific ignorance: what is it, what are its sources, and when is it epistemically detrimental to science. While some sources of scientific ignorance come inevitably with the process of knowledge acquisition, others are deliberately created. The former includes selection processes, inductive reasoning, and cognitive biases, while the latter includes scientific fraud. Another important source of scientific ignorance appears when scientists introduce methodological biases through micro-decisions in the research (...) process. I provide three examples from medical research to illustrate this point. I argue further that methodological biases present a challenge, in so far as they are no easily classifiable as deliberate: they might also be the result of entrenched research practices within a scientific community. Strategies to identify and prevent methodological biases in research should take into account such difference. (shrink)

This article compares investigations of the process of vision that were made in early nineteenth-century Britain and the German lands. It is argued that vision studies differed significantly east and west of the North Sea. Most of the German investigators had a medical background and many of them had a firm grasp of contemporary philosophy. In contrast, the British studies on vision emerged from the context of optics. This difference manifested itself in the conceptual tools for the analysis of (...) vision, deception and illusion and shaped the experiments on visual phenomena that were carried out. Nevertheless, both in Britain and in the German lands vision studies were driven by the same impetus, by epistemological concerns with the nature and reliability of knowledge acquisition in experience. The general epistemological conclusions drawn from researches on vision and deception were optimistic. Precisely because mechanisms of deception and illusion could be uncovered, the possibility of acquiring empirical knowledge could be secured. (shrink)

This article presents an interpretive phenomenological study that explores how physicians experience dilemmas of conscience in their day-to-day practice. Eighteen physicians of various ages and professional backgrounds were interviewed and asked to identify and discuss three instances when they experienced a dilemma of conscience. Preliminary findings from narrative analyses of these physician interviews suggest that dilemmas of conscience are ubiquitous, temporal and context-dependent; they cannot be reduced and understood as a focal phenomenon. Moral development appears to parallel acquisition of (...) medical knowledge; participants' specific concerns and their clinical contexts evolved as they gained experience and insight. Participants learned how to negotiate dilemmas of conscience through time, mistakes, examples, actualization, rehearsals and struggles. Remaining engaged in care, developing partnerships and protecting spaces for dialogue can help create practices of accountability when dilemmas of conscience occur. (shrink)

Participation in service-learning courses has always been considered a part of the informal education in tertiary education worldwide. Originating from the assumption that service-learning courses increase students’ civic engagement and bridge the gap between knowledge and practice, service-learning courses have gradually acquired the status of compulsory courses at universities. This being as it may be, it would seem that the nature of such courses would benefit from further analysis and discussion regarding their function in knowledge reproduction, and their (...) role in teaching and education. The aim of this article is to examine and analyze a university service-learning course—the National Taiwan University Star-Rain course with a commitment to serving children with autism—from a Foucaultian perspective, and reflect on how the process of putting knowledge during a service-learning course into practice comes to constitute the subjectivity of students who work with children who are autistic. We argue that the course under investigation has, in effect, become wholly entangled in the medical system’s treatment of autism in Taiwan. The service-learning process involves knowledge acquisition as well as long-term, detailed, concrete hands-on experience, and shapes, in a very complete way, students’ construction of their subject knowledge of autism. (shrink)

Species evolve, very slowly, through selection of genes which give rise to phenotypes well adapted to their environments. The cultures, including the languages, of human communities evolve, much faster, maintaining at least a minimum level of adaptedness to the external, non- cultural environment. In the phylogenetic evolution of species, the transmission of information across generations is via copying of molecules, and innovation is by mutation and sexual recombination. In cultural evolution, the transmission of information across generations is by learning, and (...) innovation is by sporadic invention or borrowing from other cultures. This much is the foundational bedrock of evolutionary theory. But things get more complicated; there can be gene-culture co-evolution. Prior to the rise of culture, the physical environment is the only force shaping biological evolution from outside the organism, and cultures themselves are clearly constrained by the evolved biological characteristics of their members. But cultures become part of the external environment, and influence the course of biological evolution. For example, altruistic cultures with developed medical knowledge reduce the cost to the individual of carrying genes disposing to certain pathologies (such as diabetes); and such genes become more widespread in the populations maintaining such cultures. Assortative mating can affect biological evolution, and particular cultures may influence the factors which are sorted for in mating. (For a careful discussion of the effects of cultural evolution on natural selection, see Cavalli-Sforza and Bodmer, 1971:774- 804). This paper examines mechanisms involved in the co-evolution of a biological trait, the critical period for language acquisition, and a property of human cultures, the size of their languages. A gene/culture interaction will be shown that can be described as a kind of symbiosis, but perhaps more aptly as an `arms race'. In this introduction, we will sketch the basic mechanics of the interaction in very broad terms; the rest of the paper will explain and justify the details. The implications of our model for second language acquisition are given toward the end of the paper. (shrink)

Objective Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. Methods As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed (...) 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants’ understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. Results Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. Conclusions Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials. (shrink)

This article is concerned with the history and current state of research activities into medical expert systems (MES) in Japan. A brief review of expert systems' work over the last ten years is provided and here is a discussion on future directions of artificial intelligence (AI) applications in medicine, which we expect the Japanese AI community in medicine (AIM) to undertake.

News that the first draft of a map of the human genome had been completed was received with great excitement but fears persist about how this knowledge will be used. Such concerns were the basis for an international conference held in Preston, England in December 1997. The issues addressed were non-existent when many of those attending the conference were born, but they are among the most pressing ethical problems we face today. They are philosophically challenging, and the way we (...) deal with them will have far reaching consequences for both individuals and society. The proceedings of the conference are now available in this book. Thirty authors, almost exclusively from Western Europe and North America, have written about the important issues of eugenics, insurance, the effects of market forces and the question of patents, public awareness of genetics and a variety of psychosocial and ethical concerns. Readers with …. (shrink)

The relativist position on knowledge is summarized by Protagoras’ phrase “Man is the measure of all things”. Protagoras’ detractors countered that there was no reason for his pupils to employ him since, by his own admission, his lessons lacked privilege. This the educationist’s relativist paradox. The Enlightenment tradition of Descartes, Locke and Kant solved this paradox by distinguishing given objective knowledge from constructed subjective knowledge, but this position has itself been discredited by the work of Sellars, Quine (...) and many other thinkers. Because the Enlightenment solution to the educationist’s relativist paradox is no longer satisfactory, an alternative solution to this paradox is proposed. This alternative re-examines both the basis of empiricism and the role and origins of language, and introduces the concepts of triggered hallucinations, cognitive evolutionary pressure, and cognitive empathetic resonance. Cognitive empathetic resonance provides a mechanism that can explain how our thoughts and actions are made possible by language; it is language that acts as a creative and generative force and helps us to live in the world we do. This approach inverts the empiricist claim that ideas start off grounded in an external reality and develop into more sophisticated concepts. The view of ideas presented here is that ideas are free-floating and, if they are grounded at all, are grounded as an active post-hoc process. The conclusion is that although facts do exist and are privileged, this is not because they are ‘given’ but because they are the ante required to join a space of discourse. (shrink)

In all European countries, the eighteenth century was characterised by efforts to improve the vernaculars. The Transylvanian case study shows how both codified medical language and ordinary language were constructed and enriched by a large number of medical books and brochures. The publication of medical literature in Central European vernacular languages in order to popularise new medical knowledge was a comprehensive programme, designed on the one hand by intellectual, political and religious elites who urged the (...) improvement of the fatherland and the promotion of the common good by perfecting the arts and sciences. On the other hand, the imperial administration’s initiatives affected local forms of medical knowledge and the construction of vernacular languages. In the eighteenth century, the construction of vernacular languages in the Habsburg Monarchy took on a significant political character. However, in the process of building of the scientific and medical vocabulary, the main preoccupation was precision, clarity and accessibility of the neologisms being invented to encompass the medical phenomena being described. In spite of political conflicts among the ‘nations’ living in Transylvania, physicians borrowed words from German, Hungarian and Romanian. Thus they elevated several words used in everyday language to the upper social stratum of language use, leading to the invention of new terms to describe particular medical practices or phenomena. (shrink)

Said Paracelsus – “All substances are poisonous; there is none that is not a poison. The right dose distinguishes a poison and a remedy.” Most clinical problems can be boiled down to the following practical syllogism: “If a patient has a condition p, then he should be treated with q, r, or t or whatever combination of them. The patient X has the condition p. Therefore, the patient X should be treated with q, or r, or t, or whatever combination (...) of them.” It is evident that the conclusion of this syllogism is a result of two different kinds of knowledge: first, medical knowledge understood as general and universal knowledge of health, disease and treatment which is contained in standard medical textbooks and which, according to the present fashion, is called evidence based medicine; and second, clinical knowledge which is specific knowledge of a particular patient in terms of his unique narrative identity.. Acquisition and application of medical and clinical knowledge are governed by ethical rules. The basic rules of human subjects research ethics are presented and discussed. I conclude that even a perfect evidence based medical knowledge is not enough to make a correct clinical judgment. Because every individual may have a specific reaction to a drug, each treatment is always experimentation on human. One of those rules is respect for moral autonomy of the patient which is reflected in the moral, legal, and clinical doctrine of informed consent; another, the principle of an acceptable risk-benefit balance. Both these principles are examined in the context of psychiatric treatment. (shrink)

Since antiquity, theories of knowledge have had fundamental impacts on understanding the design of the conditions of learning and teaching. As represented in this special issue, these theories may be divided into structural, functional, and biofunctional. Structural models have contributed to knowledge about the organization of information stored in memory. Functional models have contributed to our understanding of how learning occurs and how it can be facilitated. Functional and biofunctional approaches have much in common but differ in their (...) assumptions about the nature of the role of biology in learning. All three types of theories complement one another. This paper focuses on the potential contributions of functional models, including the biofunctional model, to the design of the conditions of learning and teaching. (shrink)

Philosophy of medicine has traditionally examined two issues: the scientific ontology for medicine and the epistemic significance of the types of evidence used in medical research. In answering each question, philosophers have typically brought to bear tools from traditional analytic philosophy. In contrast, this volume explores medical knowledge from the perspective offered by social epistemology.While many of the same issues are addressed, the approach to these issues generates both fresh questions and new insights into old debates. In (...) addition, the broader purview offered by social epistemology opens up opportunities to address new topics such as the role of consensus conferences, epistemic injustice, the value of medical knowledge, continuing medical education, and industry funding. This article situates and summarizes the contributions to this special issue. (shrink)

This essay examines the interrelationship between legal, medical, and public knowledge in the case of Mary Mallon. The author argues that although Mallon was never convicted of any crime, she was under the constant surveillance of medical authorities because of her characterization as a recalcitrant typhoid carrier. Mallon's physical body became a contested site of controversy as various medical and legal communities fought for the legitimization of their own bodies of knowledge. Modern health care theorists (...) and practitioners still use a plethora of Typhoid Mary narratives in their discussions of the relationship between jurisprudence, ethics, and medicine. (shrink)

What follows is a brief comment on Ludwik Fleck's paper on the foundations of medical knowledge translated by Thaddeus J. Trenn in this issue. Since the original is much older than I am, I have some scruples in presenting the critical thoughts which occurred to me when I read it a few years ago. Despite the criticism, I am very sympathetic to most of what Fleck has told us in his tragically neglected work. Two facts make Fleck's tragedy (...) even more disturbing: (i) others have given rise to post-Fleck revolutions in epistemology by exploiting his ideas while omitting proper references to him, and (ii) sociology of science, precisely what Fleck wanted to promote, has emerged without his work being operative in any sense. In my commentary, I shall examine his concept of social conditioning of knowledge. CiteULike Connotea Del.icio.us What's this? (shrink)

During the COVID-19 outbreak, educational institutions were closed, and students worldwide were confined to their homes. In an educational environment, students depend on collaborative learning to improve their learning performance. This study aimed to increase the understanding of social media adoption among students during the COVID-19 pandemic for the purpose of CL. Social media provides a learning platform that enables students to easily communicate with their peers and subject specialists, and is conducive to students' CL. This study addresses the key (...) concept of CL during the COVID-19 pandemic by assessing social media use among students in higher education. The relationship between social media use and students' performance is crucial to understanding the role of social media during a pandemic. This study is based on constructivism theory and the technology acceptance model. Structural equation modeling was used to analyze the conceptual model using SmartPLS. The research findings indicate that social media plays an important role during the pandemic because it provides opportunities for students to enhance CL under the aforementioned situations. This study makes noteworthy theoretical and practical contributions. (shrink)

Because few would object to evidence-based medicine’s (EBM) principal task of basing medical decisionmaking on the most judicious and up-to-date evidence, the debate over this prolific movement may seem puzzling. Who, one may ask, could be against evidence (Carr-Hill, 2006)? Yet this question belies the sophistication of the evidence-based movement. This chapter presents the evidence-based approach as a socio-medical phenomenon and seeks to explain and negotiate the points of disagreement between supporters and detractors. This is done by casting (...) EBM as more than the simple application of research findings to clinical care and improved health outcomes, but rather an umbrella term that harnesses a specific set of pedagogical objectives (some rather radical) under a name that makes it difficult to argue against. (shrink)

Robin Downie has distinguished between two enduring cognitive and practical attitudes that have determined the way that doctors and societies thought about medicine. The Hippocratic tradition attached its faith to empirical observation and rational induction and deduction, while the Asklepian approach was holistic, intuitive and strongly spiritual. Hippocrates sought to generalize from individual observations, to generate rules and guidelines from pooled experience. Asklepian physicians believed that cure lay in understanding the personal experience of each patient, and in providing an ambience (...) of healing centered on temples and sacred ground. Hippocratic medicine emphasized the empirical.. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of (...) this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

The Meno has traditionally been viewed as "one of Plato's earliest and most noteworthy forays into epistemology." In this dialogue, and in the course of a discussion between Socrates and his young interlocutor, Meno, about the nature of virtue and whether it can be taught, “Meno raises an epistemological question unprecedented in the Socratic dialogues.” This question - or rather, dilemma - has come to be known in the philosophical literature as Meno’s Paradox of Inquiry, due its apparently containing an (...) easy-to-detect equivocation of the word ‘know’. Immediately after the paradox, and in an apparent response to it, Socrates recounts a myth: a story told by priests and priestesses about the pre-natal existence and immortality of the soul. From this this myth, Socrates concocts the infamous theory of recollection – a theory according to which the soul has acquired knowledge of everything before it was born, while in a disincarnate state. According to the traditional reading of Meno’s paradox, this theory constitutes Plato’s response to it. The traditional reading has come under fire in recent years by advocates of the epistemological reading (ERM), who argue that the theory of recollection is not Plato’s intended response to the paradox. Instead, they suggest, Plato’s distinction between true belief and knowledge – which appears towards the end of the dialogue – is sufficient for solving the paradox; and as such, it ought to be read as Plato’s response to it. In this thesis, I argue against ERM’s claim that a mere epistemological distinction is all it takes to solve the paradox. To do so, I explore the metaphysics of change in Plato’s ontology. From this, I appeal to our everyday notion of ‘memory’ in order to show that Meno’s paradox, in fact, contains a hidden-premise, which when laid bare, reveals two distinct challenges contained within the argument: a superficial one, and a deeper one. I argue that although it appears at first blush as though the former could easily be dismissed as an equivocation, to which the epistemological distinction between belief and knowledge could provide an answer, the latter cannot. This is because the deeper challenge threatens the very preconditions of knowledge itself – that is to say, it renders cognition impossible – and, as such, it cancels out any effort to provide an epistemological response to the superficial challenge. Hence, unless the deeper-level challenge is satisfactorily disarmed, both challenges remain unanswered. I argue that although the major motivation for the theory of recollection in the Meno is indeed to provide an answer to scepticism about knowledge, nevertheless, it ought to be understood, first, as a theory of cognition – i.e. as a theory about the preconditions and atomic building blocks of knowledge – and not a theory of knowledge per se. This answer comes in the form of a radical theory of the mind and cognition – one that stands in stark opposition to our common-sense views about the mind: a view from which, Plato believed, the paradox arises. Drawing on recent debates between Nativists and Empiricists in the Cognitive Sciences, I argue that it was a great achievement of Plato’s to grasp that our common-sense view about the mind, and its concomitant process of learning, language acquisition and knowledge acquisition, might in fact be at the very root of scepticism about our ability to engage in meaningful philosophical practice, and our ability to acquire objective knowledge – especially, objective moral knowledge. The Meno’s paradox, then – so I contend - is not a puzzle whose solution rests upon merely pointing to an epistemological distinction between true belief and knowledge, as advocates of ERM have suggested. Rather, it is a puzzle about cognition. More precisely, it is a puzzle that targets the rudimentary cognitive stages of initial cognition and truth-recognition - one whose solution entails offering an account of the mind that would make these elementary cognitive processes possible. Accordingly, Plato’s theory of recollection in the Meno ought to be read as an attempt to map the structure of the mind, and as such, to provide an account of cognition. In doing so, he intended to put forward a view about the preconditions of knowledge – the sort of preconditions without which language acquisition and knowledge acquisition would simply not be possible. With this theory, Plato has the beginnings of an argument against the kind of relativism and scepticism prevalent at his time. As such, a correct interpretation of the so-called paradox of inquiry (and Plato’s proposed solution to it via the theory of recollection) should approach it as a puzzle about mind and cognition – and not solely as an epistemological one, as it has previously been treated. (shrink)

At first blush, there would seem to be few ethical problems with knowledge acquisition in a law enforcement context. For that context is one of public safety and criminal justice, both worthy ends,...

A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been (...) suggested to explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public’s best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach. (shrink)

A theory is presented which proposes that knowledge acquisition involves direct perception of schematic information in the form of structural and transformational invariances. Individual components with salient verbal descriptions are considered conscious place-holders for non-conscious invariant schemes. It is speculated that theories positing mental construction have three related causes: The first is a lack of consciousness of the schema processing capacities of the right hemisphere; the second is the paucity of adequate words to express schematic relationships; and the (...) last involves the dominance of verbal processes in consciousness. Philosophical theories are reviewed and schematic data relevant to biological survival is offered. Applications to education are suggested. (shrink)