The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, (...) and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise. (shrink)

Today there is a thriving 'emotions industry' to which philosophers, psychologists and neuroscientists are contributing. Yet until two centuries ago 'the emotions' did not exist. In this path-breaking study Thomas Dixon shows how, during the nineteenth century, the emotions came into being as a distinct psychological category, replacing existing categories such as appetites, passions, sentiments and affections. By examining medieval and eighteenth-century theological psychologies and placing Charles Darwin and William James within a broader and more complex nineteenth-century setting, Thomas Dixon (...) argues that this domination by one single descriptive category is not healthy. Overinclusivity of 'the emotions' hampers attempts to argue with any subtlety about the enormous range of mental states and stances of which humans are capable. This book is an important contribution to the debate about emotion and rationality which has preoccupied western thinkers throughout the eighteenth and nineteenth centuries and has implications for contemporary debates. (shrink)