The purpose of this thesis is to provide a robust epistemological justification for Evidence Based Medicine (EMB), and thereby to demonstrate the epistemological short comings of Complementary and Alternative Medicine (CAM). CAM has received support from both philosophers, such as Rorty and Feyerband, and the Sociology and Anthropology of Medicine. The thesis will thus review both the internal coherence and the application of non-realist arguments, and counter non-realism with the realist epistemology and philosophy of science that is represented by C.S. (...) Peirce’s pragmatism. Rorty and Feyerabend and others have developed radical forms of scientific antirealism in the latter 20th century. Subsequently, sociologists developed even more intractable forms of anti-realism, which they applied to the social study of science. This approach served to challenge the legitimacy of orthodox scientific practice (including EMB). A practical expression of this controversy was immediately identified in the question of the role of scientific authority in a democratic society. That question was immediately applied to the status of alternative medical systems and their legitimacy vis-a-vis EBM in terms of the controversy over what has come to be termed "medical pluralism": If scientific medicine has no particular authority, should other, medical systems, epistemically incompatible with EBM, be made available as well? The thesis will suggest that non-realism is in fact a marginal position within the philosophy of science. Scientists, medical researchers and medical practitioners may thus appeal to the philosophy of science in order to justify their authority in the face of challenges from CAM. However, it will be suggested that they are frequently ill-served by a reliance on a simplistic understanding of the philosophy of Karl Popper. An alternative will be proposed in the philosophy of C. S. Peirce. His pragmatism offers to medical research and medical practice a way of understanding and justifying the scientific process, a justification of realism in the face of non-realism, and a resource for the criticism of CAM and medical pluralism, as at once epistemologically ill grounded and potentially dangerous to patients and the general public. (shrink)

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is “unethical.” They have also diminished patients’ perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics—one that fails to account either for the moral worth of care and of (...) relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation—a type of moral calculus—quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)