Proposes a radically reconfigured medical model centered on mind-body interaction.

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long (...) tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question “art or science” are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an ‘empirical healing art’ to a ‘rational, molecular science’ is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable. (shrink)

While medicine is solidly grounded on scientific areas such as biology and chemistry, some argue that it is in its essence not a science at all. With medicine playing a substantial societal role, addressing questions about the scientific nature of medicine is of obvious urgency. This paper takes on such a task and starts by consulting the literature on the “demarcation” problem in the philosophy of science. Learning from failures of earlier approaches, it proposes that we adopt a Deflated Approach, (...) which acknowledges that “science” is a family resemblance concept that admits differences of degrees to nonscientific undertakings. Then, drawing on Paul Hoyningen-Huene’s ; account of systematicity and Alexander Bird’s analysis of examples from the history of medicine, the paper argues that medicine meets the requirement for systematicity on all dimensions and thereby qualifies as a science. The paper then considers and defuses two objections. First, it is shown that nonepistemic differences linked to the distinctive duality of medicine do not warrant thinking that medicine is not science. Second, against some recent criticism, the paper uses homeopathy as an example to show that systematicity can succeed as a demarcation criterion. (shrink)

While medicine is solidly grounded on scientific areas such as biology and chemistry, some argue that it is in its essence not a science at all. With medicine playing a substantial societal role, addressing questions about the scientific nature of medicine is of obvious urgency. This paper takes on such a task and starts by consulting the literature on the “demarcation” problem in the philosophy of science. Learning from failures of earlier approaches, it proposes that we adopt a Deflated Approach, (...) which acknowledges that “science” is a family resemblance concept that admits differences of degrees to nonscientific undertakings. Then, drawing on Paul Hoyningen-Huene’s (Systematicity: The nature of science, Oxford University Press, Oxford, 2013); (Synthese 196: 907–928, 2019) account of systematicity and Alexander Bird’s (Synthese 196: 863–879, 2019) analysis of examples from the history of medicine, the paper argues that medicine meets the requirement for systematicity on all dimensions and thereby qualifies as a science. The paper then considers and defuses two objections. First, it is shown that nonepistemic differences linked to the distinctive duality of medicine do not warrant thinking that medicine is not science. Second, against some recent criticism (Oreskes in Synthese 196: 881–905, 2019), the paper uses homeopathy as an example to show that (synchronic and diachronic) systematicity can succeed as a demarcation criterion. (shrink)

To achieve its goals of managing andrestricting access to psychiatric care, managedcare organizations rely on an instrument, theoutpatient treatment report, that carriessignificant implications about how they viewpsychiatric patients and psychiatric care. Inaddition to involving ethical transgressionssuch as violation of patient confidentiality,denial of access to care, spurious use ofconcepts like quality of care, and harassmentof practitioners, the managed care approachalso depends on an overly technical,instrumental interpretation of human beings andpsychiatric treatment. It is this grounding ofmanaged care in technical reason that I (...) willexplore in this study. I begin with a reviewof a typical outpatient treatment report andshow how, with its dependence on the DSM-IV,on behavioral symptoms and patient`functioning'', on the biomedical model ofpsychiatric illness, and on gross quantitativemeasures, the report results in a crude,skeletonized view of the human being as acongeries of behavioral symptoms and functions. I then develop the managed care construal ofhuman existence further by showing itsgrounding in technical reason, exploring thelatter in its modern embodiment and deriving itand its opposite, practical reason, fromAristotle''s distinction between technical andpractical reason, techne and phronesis. Inthis analysis of the role of technical reasonin managed care, I point out that managed caredid not have to develop its rationale de novobut could rather lift its arguments, e.g. thebiomedical model, from contemporary psychiatryand simply apply them in a restrictive manner. Finally, I conclude this study by arguing forpsychiatry''s status as a discipline ofpractical knowledge. (shrink)

Laudan's normative naturalism' claims to account for the success of science by construing theories and other claims as methodological rules interpreted as defeasible hypothetical imperatives for securing cognitive ends. We ask two questions regarding the adequacy for medicine of Laudan's meta- methodology. First, although Laudan denies that general aims can be assigned to a science, we show that this is not the case for medicine. Second, we argue that Laudan's account yields mixed results as a tool for evaluating methodological rules (...) in medicine. These shortcomings call into question the adequacy of normative naturalism as a meta-methodology for science. (shrink)

After the middle of the twentieth century, symptoms gradually appeared which were collectively called the “crisis of medicine”. This crisis gave philosophy, which had been abstracted from medicine since the mid-nineteenth century, an opportunity to reflect. Medical philosophers attributed the crisis to the inflation of the scientific and technical aspects and, consequently, to the weakening of the human aspects of medicine. Therefore, reflection on the nature of medicine became one of the central issues of philosophy in medicine.In this article, I (...) will first highlight the need to study the nature of medicine, explain the various concpetions of the nature of modern medicine - based on the dichotomy- science vs. art, and show their inadequacy and inappropriatness. Finally, I will provide a model to the nature of medicine beyond the realm of science / art. In this model, medicine is a scientific practice, based on judgment, dialogue, communication and social order. This model faces teleological, epistemological, scientific, political, and professional challenges that require serious and continuous reflection on the nature of medicine. (shrink)

Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine. Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including the nature of clinical reasoning and the question of whether it can be standardized; the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; evidence synthesis ; and the nature and ethics of placebo controls. Philosophical (...) analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice. (shrink)

The Habermasian concept of ‘interest’ has had a profound effect on the characterization of scientific disciplines. Going beyond issues unrelated to the theory itself, intra‐theoretical interest characterizes the specific ways of approaching any science‐related discipline, defining research topics and methodologies. This approach was developed by Jürgen Habermas in relation to empirical–analytical sciences, historical–hermeneutics sciences, and critical sciences; however, he did not make any specific references to health sciences. This article aims to contribute to shaping a general epistemological framework for health (...) sciences, as well as its specific implications for the medical and nursing areas, via an analysis of the basic knowledge interests developed by Habermas. (shrink)

The issue of how to incorporate the individual's first‐hand experience of illness into broader medical understanding is a major question in medical theory and practice. In a philosophical context, phenomenology, with its emphasis on the subject's perception of phenomena as the basis for knowledge and its questioning of naturalism, seems an obvious candidate for addressing these issues. This is a review of current phenomenological approaches to medicine, looking at what has motivated this philosophical approach, the main problems it faces and (...) suggesting how it might become a useful philosophical tool within medicine, with its own individual, but interrelated, contribution to make to current medical debates. After the general background, there is a brief summary of phenomenological ideas and their current usage in a medical context. Next is a critique of four key claims within current phenomenological medical works, concerning both the role phenomenology plays and the supposedly clear divide between phenomenology and other approaches. There are significant problems within these claims, largely because they overlook the complexity of the questions they consider. Finally, there is some more in‐depth examination of phenomenology itself and the true complexity of phenomenological debate concerning subjectivity. The aim is to show that it will be both more productive and truer to phenomenology itself, if we use phenomenology as a philosophical method for explicating and gaining deeper understanding of complex and fundamental problems, which are central to medicine, rather than as providing simple, but flawed solutions. (shrink)

The debate about the appropriate methodology of medical education has been (and still is) dominated by the opposing poles of teaching science versus teaching practical skills. I will argue that this conflict between scientific education and practical training has its roots in the underlying, more systematic question about the conceptual foundation of medicine: how far or in what respects can medicine be considered to be a science? By analyzing the epistemological status of medicine I will show that the internal aim (...) of medicine( promoting health through the prevention and treatment of disease ) differs from the internal aim of science ( the methodological and systematic acquisition of knowledge ). Therefore, medicine as a whole discipline should not be considered as a science. However, medicine can be conceptually and methodologically scientific in so much as it is based on scientific knowledge. There is evidence from cognitive science research that diagnostic reasoning not only relies on the application of scientific knowledge but also — especially in routine cases – on a process of pattern recognition, a reasoning strategy based on the memory of previously encountered patients. Hence, medical education must contain both: the imparting of scientific knowledge and the rich exposure to concrete cases during practical training. Hence, the question of teaching science vs. the apprentice model will not be either-or but rather both — but in which proportion? (shrink)

This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of (...) objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it. (shrink)

Traditional Chinese Medicine has been criticized for being unscientific because the theory on which it is based involves entities like qi and ’meridians’ that appear ambiguous and because the internal ‘organs’ like the kidney and the spleen are very different from those of modern anatomy and physiology. Even more so, TCM methods of therapy based on the yin-yang principle, the model of the five elements, and the classification of illnesses according to standard constellations of symptoms are largely unproven by the (...) protocols of modern evidence-based medicine. This dissertation attempts to reconstruct TCM theory by: providing explanations of TCM entities as abstractions and constructs that relate to observable body functions and illness symptoms and interpreting TCM theory as comprising heuristic models that were constructed from clinical experience to fit empirical observations of illnesses and their treatments with herbal medications and acupuncture. It suggests that scientists should be less concerned with the ontological status of TCM entities and the epistemic credentials of TCM models than with the ability of these concepts and models to guide physicians in therapy. More importantly, it makes the argument that these models are testable using the methods of evidence-based medicine. There are methodological difficulties associated with randomized controlled trials partly because TCM treatments tend to be individualized and syndromes are dynamic in nature; observational trials may be more appropriate in some situations. It is also possible that, for patients who are more culturally attuned to TCM, the placebo effect is strongly at play and may render the real effects of TCM treatments harder to tease out in clinical trials. The dissertation concludes that the main postulates of TCM should be put to rigorous test. The result may be a leaner but more robust theory, with parts that do not stand up to the test being rejected or modified, and a possible acceptance of its more modest therapeutic claims for a limited range of pathological conditions like pain and chronic illnesses. (shrink)

Gegenstand dieses Beitrags ist eine Auseinandersetzung mit der Wissenschaftlichkeit der Medizin. Den Leitfaden der Analyse bildet dabei ein jüngerer Ansatz in der analytischen Wissenschaftstheorie, wonach Systematizität als zentrales Kriterium von Wissenschaft anzusehen ist (Hoyningen-Huene 2013). Ich werde im Detail zeigen, dass die Medizin dieses mehrdimensionale Kriterium insgesamt erfüllt, dass aus der Wissenschaftlichkeit der Medizin aber gleichwohl normative Konsequenzen folgen, die beispielsweise zur Abgrenzung von der Homöopathie und einer kritischen Bewertung des biopsychosozialen Modells führen. Zudem resultieren der Anwendungscharakter der Medizin und (...) die zentrale Bedeutung des Arzt-Patienten-Verhältnisses nicht in einer Schwächung des Anspruchs der Medizin als Wissenschaft. (shrink)