In recent years, society has come to recognize that the work performed by scientists, like that of journalists and politicians, may be influenced by the interests they serve. As a result, scientists' research is increasingly contested as a source of reliable knowledge. Such has been the case in issues concerning the climate debate, for example, where research results are at times perceived to comfortably fit in with the viewpoints of interested parties outside science. In medicine, governmental as well as (...) commercial organizations influence the public health research agenda (McGarity and Wagner 2008). Also, studies sponsored by pharmaceutical companies, for example, often yield biased, favorable results for .. (shrink)

人のいのちと向き合う医学は、冷徹な科学的思考と人間哲学の激突する現場である。哲学としての医学概論を創始した澤瀉久敬の思想を繙き、分子生物学や臨床疫学、フランクルの人間論、さらには近藤誠のがんもどき理論 やスピリチュアリティなど現代の諸問題をも論じつつ、科学と哲学の葛藤を調停し、医学のあるべき思想的立脚点を探る。.

Partiendo de las deficiencias detectadas en la realización de la discusión diagnóstica por los estudiantes de Medicina, determinadas en un estudio previo realizado en la Facultad de Ciencias Médicas de Camagüey, se diseñó una metodología para perfeccionar la realización de la discusión diagnóstica en la carrera de Medicina, en la cual se incluyeron un sistema de tareas y las acciones que permiten alcanzar el desarrollo de las habilidades relacionadas con la misma. También se reflejaron las formas organizativas de enseñanza y (...) las actividades de educación en el trabajo en las que se deben abordar los elementos de la metodología, así como la propuesta de criterios evaluativos para estas habilidades, y otros aspectos como la ejecución y evaluación de la metodología. Se consideró que esta propuesta metodológica puede constituir una herramienta útil para los profesores en la conducción del proceso de adquisición de las habilidades de razonamiento clínico en los estudiantes. On the basis of the deficiencies identified in the realization of the diagnostic discussion by medical students, which were determined in a previous study carried out in the Faculty of medical sciences of Camagüey, a methodology was designed to improve the realization of the diagnostic discussion in Medicine degree, which included a set of tasks and actions that allow the development of skills related to it. Also, the teaching organization forms and education activities at work that must deal with methodology elements were stated, as well as the proposal of assessment criteria for these skills and other aspects like assessment and implementation of methodology. It was considered that this methodology can be used as a useful tool for teachers as guides in the process of students´ acquirement of clinical reasoning skills. (shrink)

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but critcisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral (...) decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case. (shrink)

Se realizó una estrategia para el perfeccionamiento del trabajo educativo en la Universidad de Ciencias Médicas de Camagüey y elevar la preparación científico-pedagógica de los profesores guías de la carrera de Medicina. En el trabajo se presenta como una de sus acciones la realización de talleres metodológicos interactivos, sus funciones y la metodología elaborada para su implementación. Se constató que la preparación y la experiencia de estos profesores es insuficiente para asumir la labor educativa, asimismo, se confirmó la necesidad de (...) asumir los talleres, como una de las formas del trabajo docente metodológico. A strategy in order to improve the educational work at the Medical University of Camagüey and to raise the scientific-pedagogical training of Medicine guide teachers was carried out. The research shows interactive methodological workshops as one of its main actions, its functions and the methodology designed for its implementation. It was found out that teachers training and experience was not enough to assume the educational work; likewise, the need to consider workshops, as one of the ways of the teaching methodological work was confirmed. (shrink)

This paper explores the phenomenon of moral distress in veterinary practice, particularly in environments like animal husbandry, where real-life barriers are in conflict with veterinarians’ moral beliefs. This paper draws controversial parallels, at least on first sight, with Just War Theory, which is understood as a non-ideal theory in response to morally non-ideal circumstances. The paper examines how veterinarians, corresponding to combatants, can navigate moral conundrums within their profession. It discusses the limitations of general ethics in guiding professionals like veterinarians (...) who operate, just like soldiers, in morally non-ideal circumstances. It argues that while general ethics offers universal claims, it fails to address the complexities of real-world barriers faced by veterinarians, such as conflicting interests, economic pressures, and legal regulations. Using Just War Theory as a framework, the paper distinguishes between systemic factors and individual conduct in understanding moral distress. It suggests that veterinarians are not responsible for changing the system but are best advised to ensure ethical conduct within their profession. This perspective acknowledges the tension between moral beliefs and professional demands, highlighting the importance of maintaining agential integrity while recognizing the limitations in effecting systemic change. Ultimately, the paper concludes that veterinarians are permitted to focus on fulfilling their professional duties while remaining cognizant of their moral beliefs. (shrink)

Drawing on and extending the Foucaultian philosophical framework that Jeffrey Bishop develops in his masterful book, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying, we undertake a sociological analysis of the neurological procedure—deep brain stimulation —which implants electrodes in the brain, powered by a pacemaker-like device, for the treatment of movement disorders. Following Bishop’s work, we carry out this analysis through a two-fold strategy. First, we examine how a multidisciplinary team evaluates candidates for this implant at (...) a major medical center. We present excerpts from an ethnographic study of the “case conference” where disease entities are presented, contested, ratified, and made objects for intervention with this technology. The case conference becomes the key site in the transition from “person-with-illness” to “person-with-brain-implant” as a team of health professionals determines a plan of action by interpreting both statistical and “quality of life” data regarding their patients. Second, this article explores these decision-making processes through Bishop’s conceptualization of evidence-based medicine, which relies on statistical approaches as the ultimate authority in knowledge production and medical decisions. We then reflect on Bishop’s critique of the social sciences and the methodological, analytical, and substantive ramifications that The Anticipatory Corpse can offer future sociological work. (shrink)

Woodger first gives a rough account of the "Boole-Frege" movement in modern logic and persuasively argues as to the importance of formalized language-systems for the methodology of science. Some of these arguments are as follows: A natural language such as English, he notes, "is not only used for purposes of communication in the scientific sense. It is also used for the writing of poetry, for religious devotion, for political controversy, and for persuading people to buy some of the products (...) of industrial activity which they would not otherwise want. But these pursuits make demands upon language which are very different from those made by science. The requirements of science prove on investigation to be quite surprisingly meagre and the excessive riches of a natural language like English are a source of embarrassment. They tempt us to employ linguistic devices borrowed from extra-scientific usages which can have unfortunate consequences. Metaphors, for example, with which some branches of biology abound, are often suggestive and may be harmless enough if they are recognized for what they are. But at best they are makeshifts and substitutes for genuine biological statements, and the fact that recourse is had to them is surely a sign of immaturity. Science demands great linguistic austerity and discipline, and the canons of good style in scientific writing are different from those of good writing in other kinds of literature." Another argument is that "sooner or later the linguistic habits of everyday life will cease to do justice to... the... increasing complexity and novelty of observation and hypothesis." A third argument is that scientific language is used not only for the purpose of communication, for recording observations, or for formulating general laws or hypotheses. It is also used for calculation and the unearthing of the consequences of our assumptions. The logic underlying a formalized language is explicitly designed to enable us to calculate easily and efficiently. The important, and now thoroughly established, methodological distinction between object-language and meta-language is blurred for natural language and is best maintained in terms of formalized language-systems. And, finally, in natural language the important distinction between syntax and semantics also tends to be blurred. "From both the syntactical and the semantical points of view natural languages are incredibly complicated and unruly. The rules of ordinary gram mar are quite insufficient from the standpoint of the requirements of science, and the problems connected with meaning and truth in relation to natural languages are enormously complicated and perhaps insoluble.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Microaggressions in Medicine:Narratives, Trauma, and SilenceElizabeth Lanphier (bio)Lauren Freeman and Heather Stewart (2024) have written a richly researched and argued, while also highly engaging and accessible, book with Microaggressions in Medicine. They argue for why microaggressions are best understood on a harm-based account and situate this view within timely examples from a range of healthcare experiences. In their view, focusing on the harms produced by microaggressions shifts (...) the locus of concern from the agent committing a microaggression to the agent receiving it, and it enables an attribution of a microaggression regardless of an agent's intent or even awareness.Freeman and Stewart leave the reader with an expanded understanding of what microaggressions are and how they function. They also offer concrete and actionable suggestions for how healthcare environments and healthcare providers can work to prevent patients from receiving microaggressions in clinical care. Thinking alongside this book, I raise three points intended to further a conversation. The first is about narrative medicine as an additional resource. The second is the possibility for trauma-informed care to address background structural conditions that were beyond the book's scope. The third is to briefly inquire about whether this harm-based account could characterize certain cases of individual and institutional silence as a microaggression.1. Narrative medicineFreeman and Stewart situate their book within the philosophical literature on epistemic injustice, social justice, and feminist theory. So, it is not necessarily surprising that they only mention "narrative medicine," a term coined by Rita Charon (2001) about twenty-five years ago, in passing. They do cite core narrative medicine literature, including Sayantani DasGupta's (2008) account of "narrative humility," Arthur Frank's (1995) book The Wounded Storyteller, and a paper on listening to patient stories (Goldie 2011) in their recommendations and resources for mitigating microaggressions. When they do reference narrative [End Page 163] medicine, it is to suggest that "attending to the identities of patients ought to be more widely recognized as constitutive of good care" (Freeman and Stewart 2024, 182). But beyond illustrating the caring capacities of compassionate and skilled clinicians, narrative medicine offers a potential roadmap for how to get there.What I have elsewhere called a "technical definition of narrative medicine" (Lanphier 2021, 2024) is the narrative medicine methodology of close reading and reflective writing intended to produce three aims: attention (to texts or story), representation (trying to see the perspective of a story), and affiliation (partnering with a story's teller in a solidaristic way). This technical understanding of narrative medicine provides a method for developing skills of "ethical listening" and "medical humility" that Freeman and Stewart recommend. It also affords a structured form of training and practice that institutions can support to better enable healthcare workers to implement individual and environmental correctives to address microaggressions.Although narrative medicine is a resource poised to counter and respond to the very kinds of failures of listening, epistemic injustices, and quick assumptions with which Freeman and Stewart are concerned, narrative practices are not necessarily a fix for epistemic failures or bias. They also run their own risks, including narrative presumptions (Lanphier and Anani 2019), or narrative neglect (Saulnier 2020). Moreover, while the potential exists to scale narrative medicine through structured learning opportunities and broader institutional support, it primarily remains a tool for individual edification and enactment, not systems change.2. Trauma-informed careFreeman and Stewart (2024) describe how "microaggressions occur at the individual level and can be perpetrated by individuals, environments, or institutions" but that "ultimately, they are manifestations or symptoms of structural-level problems. Regardless of the level on which they occur, microaggressions always happen against the backdrop of social and structural oppression" (12). As other commentators point out, the authors recommend correctives primarily at individual and environmental levels (i.e., changing individual behaviors, making small modifications to clinical environments). Freeman and Stewart understand the limits of this scope, saying, "[W]e are well aware that such individual-level fixes can only ever take us so far and that they alone will never dismantle the oppressive structures themselves" (13). It is reasonable to identify achievable individual actions for the "unjust meantime" (Jaggar 2019) concurrent with social and structural... (shrink)

This volume approaches the philosophy of medicine from the broad naturalist perspective that holds that philosophy must be continuous with, constrained by, and ...

The philosophy of evidence-based medicine -- What is EBM? -- What is good evidence for a clinical decision? -- Ruling out plausible rival hypotheses and confounding factors : a method -- Resolving the paradox of effectiveness : when do observational studies offer the same degree of evidential support as randomized trials? -- Questioning double blinding as a universal methodological virtue of clinical trials : resolving the Philip's paradox -- Placebo controls : problematic and misleading baseline measures of effectiveness -- (...) Questioning the methodological superiority of "placebo" over "active" controlled trials -- Examining the paradox that traditional roles for mechanistic reasoning and expert -- Judgment have been up-ended by EBM -- A qualified defence of the EBM stance on mechanistic reasoning -- Knowledge that versus knowledge how : situating the EBM position on expert clinical judgment -- Moving EBM forward. (shrink)

Perez-Rodriguez and de la Fuente (2017) assume that although human races do not exist in a biological sense (“geneticists and evolutionary biologists generally agree that the division of humans into races/subspecies has no defensible scientific basis,” they exist only as “sociocultural constructions” and because of that maintain an illusory reality, for example, through “racialized” practices in medicine. Agreeing with the main postulates formulated in the article, we believe that the authors treat this problem in a superficial manner and have (...) failed to capture the current state of the field of knowledge in science and the humanities. In our commentary, we want to highlight two main omissions, and to notice three important implications for “a postracial medicine.”. (shrink)

의학 현상학은 질병의 원인을 단순하게 환자의 신체 밖에 존재하는 병원체에서만 찾는 것이 아니라 신체 내부의 환경에서도 찾으려고 시도한다. 의학 현상학은 현상학적 세계 고찰을 통해서 환자의 내면적 체험을 중시하게 되었다. 최근 의학과 간호학에서 현상학적 연구 방법에 기초해서 이러한 환자의 체험에 대한 분석을 담은 연구들을 진행하고 있다. 그러나 전통 현상학 자체에 대한 이해 부족으로 연구 명칭은 현상학적 방법론이지만 그 내용은 형식적인 틀에 머물고 있는 연구물들이 많이 등장하고 있다. 이에 현상학자들의 텍스트 분석을 통해서 현상학의 기본 개념들이 어떻게 의학 현상학에서 응용될 수 있는지에 대한 (...) 기초 작업이 요구된다. 실재로 국내에는 현상학자들의 텍스트에 기초해서 의학 현상학을 소개하는 전문적인 논문들이 매우 적은 편이다. 이런 기초 작업을 위해서 연구자는 이 논문에서 하이데거의 『시간과 존재』에 기술된 ‘내집에 없음’(Unheimlichkeit)이란 개념과 질환 체험과 건강 체험의 유사성에 대해서 고찰하고 있다. 하이데거의 현상학적 존재론의 몇 가지 중요한 개념들을 분석하면서 이것들이 어떻게 의학 현상학에서 응용될 수 있는지를 밝히는 것이 이 논문의 최종 목표이다. (shrink)

This book makes Classical Chinese Medicine intelligible to those who are not familiar with the tradition and who may choose to dismiss it off-hand or to assess it negatively. Keekok Lee uses two related strategies: arguing that all science and therefore medicine cannot be understood without excavating its philosophical presuppositions and showing what those presuppositions are in the case of CCM compared with those of biomedicine.

In this paper, I argue (i) that there are certain methodological practices that are epistemically significant, and (ii) that we can test for the success of these practices empirically by examining case-studies in the history of science. Analysing a particular episode from the history of medicine, I explain how this can help us resolve specific cases of underdetermination. I conclude that, while the anti-realist is (more or less legitimately) able to construct underdetermination scenarios on a case-by-case basis, he will (...) have to abandon the strategy of using algorithms to do so, thus losing the much needed guarantee that there will always be rival cases of the required kind. (shrink)

My talk will be guided by the idea that there are some familiar scientific practices that are epistemically significant. I will argue that we can test for the success of these practices empirically by examining cases in the history of science. Specifically, I will reconstruct one particular episode in the history of medicine – John Snow's reasoning concerning the infectiousness of cholera – and offer this case as a concrete example of the sort of empirical research that needs to (...) be done in order to discover what kinds of methodological practices and rules are actually of epistemic interest. Analysing this case, I will explain how it (and other cases like it) can help us resolve specific cases of underdetermination. After exploring some possible anti-realist responses to this argument, I will conclude that, while the anti-realist is (more or less legitimately) able to construct underdetermination scenarios on a case-by-case basis, he will likely have to abandon the strategy of using algorithms to do so, thus losing the much needed guarantee that there will always be rival cases of the required kind. (shrink)

This book collects most of the invited papers presented at the 12th International Congress of Logic, Methodology and Philosophy of Science in Oviedo, August 2003. It contains state of the art accounts of ongoing work by a selection of the most renowned researchers in the field. The papers in the Logic section deal with topics in mathematical logic, as well as philosophical logic, and the area of logic and computation. The section on General Methodology contains articles on models, (...) theories, probability, induction, causation, and other topics. A number of papers discuss Philosophical Issues of Particular Sciences, such as mathematics, physics, linguistics, psychology, biology, and medicine. There is also a section on Ethics of Science, and papers from a special symposium on the Emergence of Scientific Medicine in the 19th-20th Century. (shrink)

The pluralism of methodologies and severe time constraints pose important challenges to pedagogy in clinical ethics. We designed a step-by-step student handbook to operate within such constraints and to respect the methodological pluralism of bioethics and clinical ethics. The handbook comprises six steps: Step 1: What are the facts of the case?; Step 2: What are your obligations to your patient?; Step 3: What are your obligations to third parties to your relationship with the patient?; Step 4: Do your obligations (...) converge or conflict?; Step 5: What is the strongest objection that could be made to the identification of convergence in step 4 or the arguments in step 4? How can this objection be effectively countered?; and Step 6: How could the ethical conflict, or perceived ethical conflict, have been prevented? (shrink)

Semmelweis’ discovery of the etiology of childbed fever has long attracted the attention of historians of medicine and biographers. In recent years it has also become of increasing interest to philosophers. In this paper I discuss the interpretation of Semmelweis’ methodology from the viewpoint of the inference to the best explanation and argue that Popperian methodology is better at capturing the dynamics of the growth of knowledge. Furthermore, I criticize the attempts to explain the failure of Semmelweis (...) to have his discovery accepted on the basis of the Kuhnian concept of paradigms, and warn that this view may endorse dogmatism as the norm The Kuhnian position also raises the problem of the authoritarian nature of scientific institutions which defend a paradigm against unorthodox, rebellious views, such as in the case of Semmelweis. Popperian philosophy is seen as a challenge to promote a link between an open society and open science with its main aim being to cherish a free critical spirit. (shrink)

This paper discusses two methodological notions, the concepts Gegenprobe (countercheck) and Gegenversuch (counter-trial), which were widely applied, discussed, relied upon, and defended in German-language writings about empirical inquiry. In the decades around 1800, they were common in physiology; medicine; agriculture; chemistry; various technologies, such as printing, metallurgy, and mining; accounting; and legal and political argumentation. The ubiquity of those concepts signals a broad concern with securing empirical findings and empirical knowledge. Gegenproben and Gegenversuche – the terms as well as (...) the practices – are evidence for the close connection among explicitly knowledge-seeking endeavors and crafts and technologies. Physiological experiments, chemical analyses, agricultural or vaccination trials were indebted to applied and practical procedures of making and assaying. What united these different fields was the fact that the problems that had to be solved were very complex yet at the same time of immediate relevance to everyday lives (like diseases or crops) or highly controversial (like vital forces or spontaneous generation). We know that late eighteenth-century and early nineteenth-century practices of inquiry were firmly embedded in applied, technical contexts; this essay shows that methodological notions were anchored in applied, technical contexts as well. (shrink)

Proponents of evidence-based medicine have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the (...) emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. (shrink)

Concepts. Health ; Disease ; Death -- Models and kinds. Causation and kinds ; Holism and reductionism ; Controversial diseases -- Evidence and inference. Evidence in medicine ; Objectivity and the social structure of science ; Inference ; Effectiveness, skepticism, and alternatives ; Diagnosis and screening -- Values and policy. Psychiatry: care or control? ; Policy ; Public health.

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we (...) consider whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

Sports Medicine as an apparent sub-class of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments and postgraduate courses. Although this field of enquiry and practice lays claim to the title ‘sports medicine’ this paper queries the legitimacy of that claim. Depending upon how ‘sports medicine’ and ‘medicine’ are defined, a plausible-sounding case can be made (...) to show that sports medicine is not in fact a branch of medicine. Rather, it is sometimes closer to practices such as non-therapeutic cosmetic surgery. The argument of the paper is as follows. It begins with a brief statement concerning methodology. We then identify and subscribe to a plausible defining goal of medicine taken from a recognised authority in the field. Then two representative, authoritative, definitions of sports medicine are discussed. It is then shown that acceptance of these definitions of sports medicine generates a problem in that if they are accepted, no necessary commitment to the defining goal of medicine is present within sports medicine. It seems to follow that sports medicine is not medicine. In the final part of the paper a critical response to that conclusion is presented and rebutted. The response is one which rejects the identification of the defining goal of medicine upon which our argument rests. (shrink)

This report explores the relationship between philosophy and medicine in the Netherlands. In Section 1 we outline the ups and downs of medico-philosophical research in our country: pre-war flourishing, post-war decline, and modern renaissance. In Section 2 we review recent Dutch literature in the philosophy of medicine. The topics dealt with include methodology of medical science, alternative medicine, the basic concepts of medicine, anthropological medicine, medicalization, medicine and culture, and health care ethics.

The development of the philosophy of medicine in the Federal Republic of Germany since 1945 is presented in a thematic form. The first two decades were characterized by the evolution of an anthropological school of thought that aimed at relating physician and patient in a more personal and existential form than had hitherto been the case. In the last years, this tendency to demand deeper psychic and broader social involvement with medical problems had increased. Somatic disorders were considered to (...) be fundamentally caused by socially induced mental stress. After a brief period during which the theme of organisms in general and phenomenologically grasped living-body of human beings in particular were discussed, there followed since the mid-seventies an essential preoccupation with the methodology and epistemology of medicine. According to this trend, medicine is to be analyzed in terms of the theory of action, with its conceptual and strategic orientation towards practice and not, as generally believed, towards the standards of scientific truth. The concepts of disease, diagnosis and therapy are therefore relative and their validity is dependent on time, persons and circumstances involved. Thus, the highest criteria of utility for medical actions cannot but be the affected patient and society. (shrink)

This textbook introduces the reader to basic problems in the philosophy of science and ethics, mainly by means of examples from medicine. It is based on the conviction that philosophy, medical science, medical informatics, and medical ethics are overlapping disciplines. It claims that the philosophical lessons to learn from the twentieth century are not that nature is a 'social construction' and that 'anything goes' with respect to methodological and moral rules. Instead, it claims that there is scientific knowledge, but (...) that it is never completely secure; that there are norms, but that they are situation-bound; and that, therefore, it makes good sense to search for scientific truths and try to act in a morally decent way. Using philosophical catchwords, the authors advocate 'fallibilism' and 'particularism'; a combination that might be called 'pragmatic realism'. (shrink)

Research on the human microbiome has gen- erated a staggering amount of sequence data, revealing variation in microbial diversity at the community, species (or phylotype), and genomic levels. In order to make this complexity more manageable and easier to interpret, new units—the metagenome, core microbiome, and entero- type—have been introduced in the scientific literature. Here, I argue that analytical tools and exploratory statisti- cal methods, coupled with a translational imperative, are the primary drivers of this new ontology. By reducing the (...) dimensionality of variation in the human microbiome, these new units render it more tractable and easier to interpret, and hence serve an important heuristic role. Nonetheless, there are several reasons to be cautious about these new categories prematurely ‘‘hardening’’ into natural units: a lack of constraints on what can be sequenced metagenomically, freedom of choice in taxonomic level in defining a ‘‘core microbiome,’’ typological framing of some of the concepts, and possible reification of statistical constructs. Finally, lessons from the Human Genome Project have led to a translational imperative: a drive to derive results from the exploration of microbiome variation that can help to articulate the emerging paradigm of per- sonalized genomic medicine (PGM). There is a tension between the typologizing inherent in much of this research and the personal in PGM. (shrink)

Through a critical analysis of the work of Henry Davis, S.J. and Francis, C.SS.R., this study examines the Catholic tradition in respect to the moral responsibilities of physicians. It first reviews the historical formation of the manuals of moral theology in order to historically situate Davis and Connell in the twentieth century. The study then examines the work of Davis and Connell in light of David Kelly's The Emergence of Roman Catholic Medical Ethics in North America, wherein he posits a (...) shift in moral methodology in 1940 from physicalism to ecclesiastical positivism. Contrary to Kelly's thesis, this study finds essentially no methodological difference between Davis' commandment-centered methodology and Connell's virtue-centered method. In actuality, both theologians throughout their careers focused upon the physical nature of the action and employed the traditional principles of double effect and cooperation when determining the morality of an intrinsically evil act. ;Through a comparison of the work of Davis and Connell, the study concludes with a description of the moral responsibilities of physicians for a contemporary practice of medicine. These duties include basic responsibilities, social responsibilities and the responsibilities to the dying patient. (shrink)

This essay announces the inauguration of a section ofTheoretical Medicine and invites submissions on the topic Method and Methodology in Medical Ethics. It offers some sketches of plausible meanings of method and of methodology and their relationships as these might apply to work in biomedical ethics. It suggests a broad range of issues, dilemmas or conflicts that may be addressed for help via method and/or methodology.

This book examines the various norms for the logic and methodology of science, placing them in the context of the cognitive interests and explanatory ideals that motivate science. Various themes in the philosophy of science are examined, including the views of K. Popper, T. Kuhn, and L. Laudan. Characteristic cases of scientific theories are examined in order to illustrate and justify the proposed norms. These include, on the one hand, the emergence of the science of Galileo, Kepler, and Newton (...) from the older metaphysical style of explanation to be found in Aristotle and, on the other hand, Darwin's theory of natural selection. Also included are characteristic cases of pseudoscience, including creation science, Lysenkoism, Velikovsky, UFOs and ancient astronauts, astrology, parapsychology, and various kinds of alternative medicine. From these examples and the more theoretical discussion, there emerges a series of norms for demarcating science and pseudoscience. Various aspects of the scientific method are examined in detail, including the role of hypotheses, the logical structure of theories, and how these relate to the experimental methods of John Stuart Mill. collection; for example, what do we say about observational reports of the existence of UFOs? In this context there is a discussion of some of the issues raised in the so-called science wars. It is concluded that the sociology of science can at times be helpful to the scientific community in improving their methods of investigation. (shrink)

Dr Kottow in his paper Classical medicine v alternative medical practices (1) places the alternative/orthodox medicine debate within an historical context of anti-quackery literature. My paper explores the nature of science as it is applied to clinical practice and challenges the narrow view of the diagnostic process as outlined by Dr Kottow. Research methodologies more appropriate to 'whole person' medicine are suggested as having more ethical value than those based on the clinical trial.

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have (...) anything in common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)

This book provides a systematic analysis of the ethical implications of traditional and complementary medicine, focusing on pragmatic solutions. The author uses a bioethical methodology called the “Ethical Matrix,” to consider the impact of T&CM use for animals and the environment as well as for humans. A systematic search of the literature reveals that most published ethical concerns are related to the safety of T&CM use for humans. However, application of the Ethical Matrix demonstrates that the ethical implications (...) for T&CM use are much broader. In this book, the author analyses the most serious implications, including adverse events related to homeopathy, the use of animals in T&CM products, and the impact of herbal medicine on the environment. Comparisons with the ethical implications of conventional biomedicine help readers to contextualise debate, and highlight aspects that may be unique to T&CM. Globally, many high-level health policy makers promote T&CM as an accessible and affordable healthcare option. However, their use is considered by some to be a waste of resources, unscientific, and unethical. Offering a frank analysis of this largely ignored field of healthcare ethics, this book is both timely and essential. It helps patients, policy makers, practitioners, researchers, and students gain the knowledge they need to make more informed decisions. (shrink)

The rapid growth of human population and associated industrialisation creates strains on resources and climate. One way to understand the impact of human activity is to quantify the total environmental pressures by measuring the ‘footprint’. Footprints account for the total direct and/or indirect effects of a product or a consumption activity, which may be related to e.g. carbon, water or land use, and can be seen as a proxy for environmental responsibility. Footprints shape climate and resource debates, especially concerning environmental (...) strategies. However, in general, footprints hold a dichotomous producer–consumer perspective that is not unanimously accepted. In addition, the current footprinting system transmits a simplistic message about environmental responsibility that taints the justice debate and jeopardises the validity of policies based on them. Consequently, it is crucial to question who is accountable for adverse environmental effects. It is also critical to investigate how the methodological characteristics of footprints shape and affect the efficacy of policies on climate and natural resources. This article examines these challenges, focusing on negative justice and policy implications resulting from assigning environmental responsibility to a sole agent. The article proposes, and morally justifies, the development of a footprinting method that includes justice parameters in an attempt to render fair results that are more meaningful for environmental action. The second objective is to establish the potential of this new framework to promote environmental responsibility and justice while facilitating policymaking. The suggested justice elements aim at turning footprints into a concrete environmental policy instrument framed under the value of environmental fairness. (shrink)

This chapter brings some much-needed conceptual clarity to the debate about Locke’s scientific methodology. Instead of having to choose between the method of hypothesis and that of natural history (as most interpreters have thought), he would resist prescribing a single method for natural sciences in general. Following Francis Bacon and Robert Boyle, Locke separates medicine and natural philosophy (physics), so that they call for completely different methods. While a natural philosopher relies on “speculative” (causal-theoretical) hypotheses together with natural-history (...) making to explicate phenomena, a medical practitioner must prioritize collecting data about what remedies tend to cure what diseases over hypothesizing about the causes of the latter. (shrink)

The often-emphasized tension between the singularity of the patient and technical–scientific reproducibility in medicine cannot be resolved without a discussion of the epistemological and methodological status of the human sciences. On the one hand, the rules concerning human action are analogous to the scientific laws of nature. They are de facto sufficiently stable to allow predictions and explanations similar to those of experimental sciences. From this point of view, it is only a trivial truth, but still a methodological irrelevancy, (...) that the patient and the doctor–patient relationship represent an ontologically irreproducible reality. On the other hand, however, one can never exclude that one can fail in the application of "laws" of the human sciences to the individual patient, for such laws are by no means wholly separated from a patient's personal-hermeneutic mediation, and can at any time be revoked by becoming aware of them. This requires a synergistic collaboration of clinical and statistical methods, and shows a methodologically relevant sense in which one cannot disregard the singularity of the patient. The reason for the crucial role of the patient's singularity in medicine is every individual patient's capacity to revoke, in principle, routines and quasi-automatisms, even though the personal mediation by the patient's consciousness de facto changes them in such a small degree that predictions and explanations modeled in experimental science remain possible. (shrink)

Systems medicine is a promising new paradigm for discovering associations, causal relationships and mechanisms in medicine. But it faces some tough challenges that arise from the use of big data: in particular, the problem of how to integrate evidence and the problem of how to structure the development of models. I argue that objective Bayesian models offer one way of tackling the evidence integration problem. I also offer a general methodology for structuring the development of models, within (...) which the objective Bayesian approach fits rather naturally. (shrink)

Over the last decade, personalized medicine has become a buzz word, which covers a broad spectrum of meanings and generates many different opinions. The purpose of this article is to achieve a better understanding of the reasons why personalized medicine gives rise to such conflicting opinions. We show that a major issue of personalized medicine is the gap existing between its claims and its reality. We then present and analyze different possible reasons for this gap. We propose (...) an hypothesis inspired by the Windelband’s distinction between nomothetic and idiographic methodology. We argue that the fuzzy situation of personalized medicine results from a mix between idiographic claims and nomothetic methodological procedures. Hence we suggest that the current quandary about personalized medicine cannot be solved without getting involved in a discussion about the complex epistemological and methodological status of medicine. To conclude, we show that the Gadamer’s view of medicine as a dialogical process can be fruitfully used and reveals that personalization is not a theoretical task, but a practical one, which takes place within the clinical encounter. (shrink)

In this essay, I look back at some of the earliest attempts by the first generation of literature-and-medicine scholars to answer the question: Why teach literature and medicine? Reviewing the development of the field in its early years, I examine statements by practitioners to see whether their answers have held up over time and to consider how the rationales they articulated have expanded or changed in the following years and why. Greater emphasis on literary criticism, narrative ethics, narrative (...) theory, and reflective writing has influenced current work in the field in ways that could not have been foreseen in the 1970s. The extraordinary growth of interest and work in the field nationally and, especially since 1996, internationally has included practitioners in many additional areas such as disability studies, film studies, therapeutic writing, and trauma studies. Along with the emergence of narrative medicine, this diverse community of scholars and practitioners—affiliated more through their use of narrative methodologies than the teaching of literature—makes the perennial challenge of evaluation and assessment even more complicated. (shrink)

Methodological concerns are moving to the top of the bioethics agenda for the next decade. This paper examines some of those concerns: (1) medical ethics as a subset of bioethics versus medical ethics as a subset of professional ethics; (2) a more in-depth examination of some methodological problems in treating medical ethics as professional ethics; (3) the senses in which bioethics constitutes an inquiry into secular undertakings in a pluralistic society; (4) ‘federal ethics’, the emergence to prominence of public commissions (...) and study groups; and (5) the institutional impact of bioethics on the relationship between medical schools and the liberal arts core of their sponsoring universities. Keywords: bioethics, medical ethics, methodology, pluralism, federal ethics CiteULike Connotea Del.icio.us What's this? (shrink)

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence (...) between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM. (shrink)

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, (...) we need a phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

Objectives—To assess the relationship between the approval of trials by a research ethics committee and the fact that informed consent from participants was obtained, with the quality of study design and methods.Design—Systematic review using a standardised checklist.Main measures—Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and (...) published by at least one Spanish author during the same period in any other journal were also included.Results—We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groupsConclusion—Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects. (shrink)

Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. (...) Nevertheless, in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare — namely expensive innovative treatments and medicines —may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)