Does the philosophy of medicine exist?

There has been a great deal of discussion, in this journal and others, about obstacles hindering the evolution of the philosophy of medicine. Such discussions presuppose that there is widespread agreement about what it is that constitutes the philosophy of medicine.Despite the fact that there is, and has been for decades, a great deal of literature, teaching and professional activity carried out explicitly in the name of the philosophy of medicine, this is not enough to establish that consensus exists as to the definition of the field. And even if consensus can be obtained as to what constitutes the philosophy of medicine, this does not mean that it exists as a field.     

On the aims of medicine: Comments on ‘philosophy of medicine as the source for medical ethics’

Health defined as the psychophysiological capacity to act or respond appropriately in a wide variety of situations, is enhanced by many means other than preventing and treating disease and injury. Therefore no choice of a particular medical intervention is likely to maximize health for all people with (or at risk for) a given disease. As a result, if medical practitioners are to be fully competent in the sense of knowing not only how to perform procedures but when and when not to do so, they must be able to support patients (and those who know and care about them) in weighing all of the many factors which bear upon the decision as to which, if any, medical interventions are likely to improve the person's health.     

The criticism of medicine at the end of its “golden age”

Theoretical Medicine and Bioethics - Medicine is increasingly subject to various forms of criticism. This paper focuses on dominant forms of criticism and offers a better account of their normative...     

Does the philosophy of medicine exist? A commentary on Caplan

Caplan has argued that the philosophy of medicine does not exist. Although I will not deny the points he makes, I will argue that the philosophy of medicine has characteristics of a developing field with the potential to meet all of Caplan's criteria. The argument is based on Dewey's established views on logical development for a field of inquiry, as well as pointing out how other criteria Caplan imposes can be fulfilled.The U.S. Government right to retain a non-exclusive, royalty free licence in and to any copyright is acknowledged.     

Yearning for certainty and the critique of medicine as “science”

A debate has simmered concerning the nature of clinical reasoning, especially diagnostic reasoning: Is it a “science” or an “art”? The trend since the seventeenth century has been to regard medical reasoning as scientific reasoning, and the most advanced clinical reasoning is the most scientific. However, in recent years, several scholars have argued that clinical reasoning is clearly not “science” reasoning, but is in fact a species of narratival or hermeneutical reasoning. The study reviews this dispute, and argues that in a theoretical sense, the dispute rests upon a naïve—but very popular—caricature of what constitutes “science reasoning.” But, if the dispute rests upon just such a caricature, why is it so persistent? The study concludes by suggesting that we, as patients and as physicians, have deep psychological tendencies that incline us to adopt the very naïve “science” concept/model of diagnostic reasoning, even if (or when) we understand its inaptness.     

Is laughter the best medicine?

Abstract

One hundred patients with chronic arthritis were interviewed and completed questionnaires about coping, well-being and their use of humour. A comparison of patients scoring high or low on each of 3 measures of humour showed that those who reported they used humour least, had most difficulty recognising it and valued it least. They also reported more depressive symptoms and lower personal self-esteem. Regressions showed that depression was best predicted by the inactive use of humour in coping. and to a lesser extent, pain intensity. Cluster analysis of data on general coping strategies showed that valuing humour distinguished two-thirds of patients who were relatively normal and cautiously optimistic, from the other third, where the outlook was negative and hopeless. Those with a more positive view tended to be younger, less disabled, in less pain and with several social advantages on a number of indicators. However they also had a longer duration of disease. Two-thirds of patients said they were able to laugh when in pain but those most able to do this had less intense pain during the previous week. Furthermore the most disabled arthritis patients found laughter to be a most effective strategy. The research has implications for preventing depression and coping with disability.     

Engaging Pellegrino’s philosophy of medicine: Can one of the founders of the field still help us today?

Theoretical Medicine and Bioethics -     

Why should medicine consider a theory of practice? Introduction to the issue

In reference to historical developments, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the relationship(s) between theory and practice. The authors emphasize the need for scientific research in this neglected area for the sake of both clinical practice and medical education.     

What is the place for philosophy within the field of medicine? A review of contemporary issues in medical ethics

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry.

The main claims are as follows:

1. 1.
   The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles.
    
2. 2.
   Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that dodges common objections to either.
    
3. 3.
   Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine.
    

Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically.     

About signs and symptoms: Can semiotics expand the view of clinical medicine?

Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. With special reference to a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand.     

On the disenchantment of medicine: Abraham Joshua Heschel’s 1964 address to the American Medical Association

In 1964, the American Medical Association invited liberal theologian Abraham Joshua Heschel (1907–1972) to address its annual meeting in a program entitled “The Patient as a Person” [1]. Unsurprisingly, in light of Heschel’s reputation for outspokenness, he launched a jeremiad against physicians, claiming: “The admiration for medical science is increasing, the respect for its practitioners is decreasing. The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself” [1, p. 35]. Heschel’s reference to “disenchantment” suggests that he may have been familiar with the work, or at least the outlook, of sociologist Max Weber, whose 1917 address “Science as a Vocation” portrays the modern world as disenchanted by the progress of rationalism. Heschel’s life’s vocation had been to uncover the inner meaning of religious faith and to translate that faith into principled action. Heschel saw disenchantment not as an inescapable aspect of modern life but rather as the byproduct of physicians’ conscious choices to seek worldly success and material comfort. Yet, because of their privileged position as witnesses to human vulnerability, physicians possess an obligation to develop their own personhood, to re-enchant medicine, and through medicine to spark a positive transformation in all of modern life. As Heschel says, “The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul. … The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society” [1, pp. 34, 38]. While Heschel’s conception of the physician’s role is romanticized and idealized, changes in the organization and practice of medicine have validated his concerns.     

Is medicine hermeneutics all the way down?

Several recent publications have suggested that hermeneutics, the method of literary criticism, might prove to be useful in medicine. In this essay I consider this thesis with particular attention to the claim that medicine is hermeneutics all the way down. After examining an anti-positivist critique of positivist medicine and arguing that hermeneutic interpretation involves a more radical critique of modern medicine, I examine the supposed consequences of hermeneutical universalism:relativism, skepticism andantirealism which further evaluation reveals to be only potential consequences of hermeneutics. A brief discussion ofphronesis and of the possible texts of medicine concludes the article.     

Philosophy of medicine — From a medical perspective

In this commentary on the article by Arthur L. Caplan [1] the philosophy of medicine is viewed from a medical perspective. Philosophical studies have a long tradition in medicine, especially during periods of paradigmatic unrest, and they serve the same goal as other medical activities: the prevention and treatment of disease. The medical profession needs the help of professional philosophers in much the same way as it needs the cooperation of basic scientists. Philosophy of medicine may not deserve the status of a philosophical subspecialty or field, but it so closely linked to the main trends of contemporary medical thinking that it must be regarded as an emerging (or reemerging) medical subdiscipline.     

The use of the placebo effect in clinical medicine — ethical blunder or ethical imperative?

The current debate in medical ethics on placebos focuses mainly on their use in health research. Whereas this is certainly an important topic the discussion tends to overlook another longstanding but nevertheless highly relevant question, namely if and how the placebo effect should be employed in clinical practice. This paper describes the way the placebo effect is perceived in modern medicine and offers some historical reflections on how these perceptions have developed; discusses elements of a definition of the placebo effect; and suggests some conditions under which making use of the therapeutic potential of the placebo effect can be ethically acceptable, if not warranted. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003. Nikola Biller-Andorno, MD, PhD, is Assistant Professor in the Dept. of Medical Ethics and History of Medicine, University of Goettingen, Germany. Dr. Biller-Andorno also serves as an ethicist for the World Health Organization (WHO). This paper does not necessarily reflect the views of the World Health Organization.     

What does the character of medicine as a social practice imply for professional conscientious objection?

The dispute over professional conscientious objection presumes a picture of medicine as a practice governed by rules. This rule-based conception of medical practice is identifiable with John Rawls’s conception of social practices. This conception does not capture the character of medical practice as experienced by practitioners, for whom it is a sensibility or “form of life” rather than rules. Moreover, the sensibility of medical practice as experienced by physicians is at best neutral, and at worst hostile, to the demands of those who would override physician conscientious objection to the provision of currently contested services. That being so, calls for overriding physician conscientious objection are much more demanding of the medical profession than they appear in light of Rawls’s view. As such overriding may entail the forcible transformation of medicine’s form of life, the author contends that it would be more prudent to provide contested services by circumventing the medical profession than by compelling it.     

Ethics in medicine: Are we blind? In support of teaching medical ethics at the bedside

The ability to recognize and respond to the ethical dimension of medicine is integral to providing health care that is comprehensive and humane. However, this aspect of medical practice is underemphasized in clinical and academic medicine, despite attempts to devise curricula in this field. This paper examines the origins and consequences of this deficiency through a case history of a Jehovah's Witness who reluctantly accepted a blood transfusion. It emphasizes the ubiquity of the ethical context in medicine and argues that blindness to this context stems from the prevailing scientific and technological paradigm in medicine. Innovations in medical education are called for to enhance health care providers' abilities to appreciate and cope with these complex situations.     

‘A spoonful of sugar helps the medicine go down’: Gillian Brock on global justice

Abstract

A review essay of Gillian Brock Global Justice: A Cosmopolitan Account (Oxford University Press, 2009)