The aim of this paper is to discuss a key question in the history and philosophy of medicine, namely how scholars should treat the practices and experimental hypotheses of modern life science laboratories. The paper seeks to introduce some prominent historiographical methods and theoretical approaches associated with biomedical research. Although medical scientists need no convincing that experimentation has a significant function in their laboratory work, historians, philosophers, and sociologists long neglected its importance when examining changes in medical theories or progress (...) in scientific knowledge. The reason appears to have been the academic influence of the then dominant tradition in the history of ideas, but was also due to a misconception of what could usefully be termed the view on “historical ontology.” During the last two decades, there have been many books and research articles that have turned towards the subject, so that the study of experimental practice has become a major trend in the contemporary history and philosophy of medicine. A closer look at the issue of laboratory research shows that concepts in medicine and the life sciences cannot be understood as historically constant, free-standing ideas, but have to be regarded as dependent on local research settings. They often carry particular “social memories” with them and thus acquire important ethical implications. (shrink)

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)

This paper explores some of the important parallels between recent reforms to legal rules for the admissibility of scientific and expert evidence, exemplified by the US Supreme Court's decision in Daubert v Merrell Dow Pharmaceuticals, Inc. in 1993, and similar calls for reforms to medical practice, that emerged around the same time as part of the Evidence-Based Medicine (EBM) movement. Similarities between the “movements” can be observed in that both emerged from a historical context where the quality of medicine and (...) legal approaches to science were being subjected to growing criticism, and in the ways that proponents of both movements have used appeals to “folk epistemologies” of science to help legitimate their reform aspirations. The term folk epistemology is used to describe the weaving together of formal and informal images of scientific method with normative and pragmatic concerns such as eradicating “junk science”, and promoting medical best practice. Perhaps unsurprisingly, given the unfocused breadth of these aspirations the implications of these “reforms” for medical and legal practice have not been straightforward, although they do represent an important new set of rhetorical resources to critique and or legitimate expertise in medical and legal domains. Discussion closes, by noting the growth of calls for these movements to reciprocate in areas where law and medicine intersect, such as medical negligence litigation. (shrink)

Many servicemen and women began suffering from a variety of symptoms and illnesses soon after the 1991 Gulf War. Some veterans believe that their illnesses are related to toxic exposures during their service, though scientific research has been largely unable to demonstrate any link. Disputes over the definition, etiology, and treatment of Gulf War-related illnesses continue. The authors examine the roles of science, policy, and veteran activism in developing an understanding of GWRIs. They argue that the government’s stress-based explanation of (...) GWRIs and its insistence on a scientific link between service in the gulf and veteran illnesses forced veterans to shift from pleas for care, treatment, and compensation on moral grounds to engagement in the scientific process and debates over the interpretation of scientific findings. The authors compare the experiences of veterans to those of breast cancer activists to explain the stages of illness contestation in general. (shrink)

This paper examines some of the processes which have contributed to the development of a ‘total quality’ (TQ) approach within British health care. The paper challenges the idea that TQ is part of a redistribution of power within the NHS. Rather it is argued that through the elaboration of consumer-led market identities TQ misrepresents the interests of management and constructs a version of the self which obscures new forms of management control. TQ constrains alternative forms of social organisation, local knowledge (...) and the social interests invested in them. An example of a competing set of assumptions is discussed. It is suggested that clinical groups — who are primarily motivated by the principles of professional, collegiate control — seek to free themselves from the constraints of TQ. Thus clinical discourse appropriates a professionally led version of the market and protects the traditional autonomy of professionals whilst seeming to render their interests synergistic with those of management. This casts ‘quality’, and perhaps even the ‘market’, as conceptual sites upon which different groups strive to construct and legitimate their own interests. It is concluded that the changes explicitly associated with TQ are not as fundamental as they seem. (shrink)

When a child is born with ambiguousgenitalia it is declared a psychosocialemergency, and the policy first proposed byJohn Money andadapted by the American Academy of Pediatrics requires determination ofunderlying condition, selection of gender,surgical intervention, and a commitment by allparties to accept the ``real sex'' of thepatient, all no later than 18–24 months,preferably earlier. Ethicists have recentlyquestioned this protocol on several grounds:lack of medical necessity, violation ofinformed consent, uncertainty of standards ofsuccess, among others. This suggests that thefaults in the protocol can (...) be addressed andimproved. Through a rhetorical approachinformed by Perelman/Olbrechts-Tyteca, thedisciplinary pathologization and reconstructionof the body are explored as incidents ofconstraining rhetoric that enact theirpersuasion upon the body of intersexedchildren. This essay shows that thepresumptions, judgments, values, andpresuppositions brought by the physician to theidentification, diagnosis, and curativeprocedures create a network of constraints thatexclude alternative possibilities. The resultis a situation wherein parents, physicians, andintersexed patients have ``no choice'' but toaccept the medical treatment guidelines. (shrink)

This paper focuses on the concept of the reified and consensual universes in the theory of social representations, and the relationship between them. Having examined the different ways in which Moscovici discusses this concept, and the different ways in which these discussions have been interpreted, I will suggest that many of the criticisms levelled at this facet of social representations theory appear somewhat misplaced. However, it does seem that some aspects of the concept of the consensual and the reified universes (...) are rather under-developed within the theory as a whole. It will be suggested that the recent addition of the notion of the representational project to the theory of social representations goes some way towards addressing some of these emergent issues, most notably with regards to the relationship between knowledges from different spheres. As an example, the area of representations of health and illness will be considered: drawing on work that takes the perspective of the sociology of scientific knowledge, it will be suggested that the theory of social representations needs to make the possibility of a bi-directional relationship between knowledge from the fields of scientific and common sense understanding more explicit. (shrink)

The English word ‘pain’ is commonly used by lay people in a ‘messy’ life-world of imprecise meanings. It has a complex etymology, including legal and political uses as ‘punishment’. Understandings of pain in the political theory of Hobbes and Bentham are summarized. This wider historical and philosophical account of the uses of ‘pain’ means the IASP definition can be seen in relation to medical history and to present-day clinical challenges. We can consider the misunderstandings that may occur between clinicians and (...) pain sufferers, and the ways in which ‘pain’, although ‘subjective’, is inescapably a political concern. Using Wittgenstein’s approach to meaning, however, we can envisage a context-sensitive and flexible approach to communication about pain. (shrink)

This paper presents a pedagogical framework for teaching cross-cultural clinical ethics. The approach, offered at the intersection of anthropology and bioethics, is innovative in that it takes on the “social sciences versus bioethics” debate that has been ongoing in North America for three decades. The argument is made that this debate is flawed on both sides and, moreover, that the application of cross-cultural thinking to clinical ethics requires using the tools of the social sciences within a principles-based framework for clinical (...) ethics. This paper introduces the curriculum and provides guidelines for how to teach cross-cultural clinical ethics. The learning points that are introduced emphasize culture in its relation to power and underscore the importance of viewing both biomedicine and bioethics as culturally constructed. (shrink)

Though ubiquitous across the medical social sciences literature, the term “biomedicine” as an analytical concept remains remarkably slippery. It is argued here that this imprecision is due in part to the fact that biomedicine is comprised of three interrelated ontological spheres, each of which frames biomedicine as a distinct subject of investigation. This suggests that, depending upon one’s ontological commitment, the meaning of biomedicine will shift. From an empirical perspective, biomedicine takes on the appearance of a scientific enterprise and is (...) defined as a derivative category of Western science more generally. From an interpretive perspective, biomedicine represents a symbolic-cultural expression whose adherence to the principles of scientific objectivity conceals an ideological agenda. From a conceptual perspective, biomedicine represents an expression of social power that reflects structures of power and privilege within capitalist society. No one perspective exists in isolation and so the image of biomedicine from any one presents an incomplete understanding. It is the mutually-conditioning interrelations between these ontological spheres that account for biomedicine’s ongoing development. Thus, the ontological dissection of biomedicine that follows, with particular emphasis on the period of its formal crystallization in the latter nineteenth and early twentieth century, is intended to deepen our understanding of biomedicine as an analytical concept across the medical social sciences literature. (shrink)