We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...) of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve. (shrink)

Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud Principialismo, bioética personalista e princípios de ação em medicina e serviços de saúde Since there is a gap and differences between bioethical concepts and other principles of action arising from the practice of modern medicine, their comparison is reasonable. Modern medicine has created principles of action based on evidence and principles of quality in medicine, and bioethical argumentation frequently resorts to principlism or personalist bioethics. This article (...) intends to illustrate the characteristics of the relationships between these concepts and their potential mutual enrichment. A simple, practical comparison matrix is proposed to compare the relationship between principles. These concepts have a significant overlap; however, both in the history of ideas and in their formulation, they are very dissimilar. Emphasis is placed on the contextual value of this analysis given by global health trends and some implications for medicine from personalist bioethics. Para citar este artículo / To reference this article / Para citar este artigo Insua JT. Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud. pers. bioét. 2018; 22: 223-246. DOI: 10.5294/pebi.2018.22.2.3. (shrink)

The importance of values in occupational therapy is generally agreed, however there is no consensus about their nature or their influence on practice. It is widely assumed that occupational therapists hold and act on a body of shared values, yet there is a lack of evidence to support this. The research tested the hypothesis that occupational therapists’ responses to ethically challenging situations would reveal common values specific to the occupational therapy profession. 156 occupational therapists were asked to decide what should (...) be done in 5 common-place yet ethically complex situations, presented as scenarios for debate. The results show that while most occupational therapists share very general values, they frequently disagree about what to do in practice situations, often justifying their choices with different and sometimes conflicting specific values. In some cases, the same respondents espouse contradictory values in similar situations. The extensive literature about decision-making - together with the study’s results – confirm that when occupational therapists make decisions, they draw on multiple factors, consciously and unconsciously. These factors vary between individuals. Value judgements are one part only of a complex process which includes personal experience, intuition, social influences, culture, psychological influences and relationships with both colleagues and clients. (shrink)

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)

My doctoral project is a study of epistemological and ethical issues in Evidence-Based Medicine, a movement in medicine which emphasizes the use of randomized controlled trials. Much of the research on EBM suggests that, for a large part of the movement's history, EBM considered expertise, mechanisms, and values to be forces contrary to its goals and has sought to remove them, both from medical research and from the clinical encounter. I argue, however, that expertise, mechanisms and values have important epistemological (...) and ethical roles to play and can be incorporated into the current EBM movement. (shrink)