Normativity concerns what we ought to think or do and the evaluations we make. For example, we say that we ought to think consistently, we ought to keep our promises, or that Mozart is a better composer than Salieri. Yet what philosophical moral can we draw from the apparent absence of normativity in the scientific image of the world? For scientific naturalists, the moral is that the normative must be reduced to the nonnormative, while for nonnaturalists, the moral is that (...) there must be a transcendent realm of norms. _Naturalism and Normativity_ engages with both sides of this debate. Essays explore philosophical options for understanding normativity in the space between scientific naturalism and Platonic supernaturalism. They articulate a liberal conception of philosophy that is neither reducible to the sciences nor completely independent of them—yet one that maintains the right to call itself naturalism. Contributors think in new ways about the relations among the scientific worldview, our experience of norms and values, and our movements in the space of reason. Detailed discussions include the relationship between philosophy and science, physicalism and ontological pluralism, the realm of the ordinary, objectivity and subjectivity, truth and justification, and the liberal naturalisms of Donald Davidson, John Dewey, John McDowell, and Ludwig Wittgenstein. (shrink)

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a (...) phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

Patient support tools have drawn on a variety of disciplines, including psychotherapy, social psychology, and social care. One discipline that has not so far been used to support patients is philosophy. This paper proposes that a particular philosophical approach, phenomenology, could prove useful for patients, giving them tools to reflect on and expand their understanding of their illness. I present a framework for a resource that could help patients to philosophically examine their illness, its impact on their life, and its (...) meaning. I explain the need for such a resource, provide philosophical grounding for it, and outline the epistemic and existential gains philosophy offers. Illness often begins as an intrusion on one’s life but with time becomes a way of being. I argue that this transition impacts on core human features such as the experience of space and time, human abilities, and adaptability. It therefore requires philosophical analysis and response. The paper uses ideas from Husserl and Merleau-Ponty to present such a response in the form of a phenomenological toolkit for patients. The toolkit includes viewing illness as a form of phenomenological reduction, thematizing illness, and examining illness as altering the ill person’s being in the world. I suggest that this toolkit could be offered to patients as a workshop, using phenomenological concepts, texts, and film clips to reflect on illness. I conclude by arguing that examining illness as a limit case of embodied existence deepens our understanding of phenomenology. (shrink)

Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain philosophical approaches, on (...) the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (shrink)

Thomas S. Kuhn's classic book is now available with a new index.

For the last forty years, two claims have been at the core of disputes about scientific change: that scientists reason rationally and that science is progressive. For most of this time discussions were polarized between philosophers, who defended traditional Enlightenment ideas about rationality and progress, and sociologists, who espoused relativism and constructivism. Recently, creative new ideas going beyond the polarized positions have come from the history of science, feminist criticism of science, psychology of science, and anthropology of science. Addressing the (...) traditional arguments as well as building on these new ideas, Miriam Solomon constructs a new epistemology of science. After discussions of the nature of empirical success and its relation to truth, Solomon offers a new, social account of scientific rationality. She shows that the pursuit of empirical success and truth can be consistent with both dissent and consensus, and that the distinction between dissent and consensus is of little epistemic significance. In building this social epistemology of science, she shows that scientific communities are not merely the locus of distributed expert knowledge and a resource for criticism but also the site of distributed decision making. Throughout, she illustrates her ideas with case studies from late-nineteenth- and twentieth-century physical and life sciences. Replacing the traditional focus on methods and heuristics to be applied by individual scientists, Solomon emphasizes science funding, administration, and policy. One of her goals is to have a positive influence on scientific decision making through practical social recommendations. (shrink)

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

This book offers an in-depth analysis of the cognitive and ethical role of emotion, particularly empathy, in medical practice. The author explains how doctors can use empathy in diagnosing and treating patients without jeopardizing their objectivity or projecting their own values on to patients.

This essay argues that philosophical phenomenology can provide important insights into the patient-physician relationship. In particular, it is noted that the physician and patient encounter the experience of illness from within the context of different "worlds", each "world" providing a horizon of meaning. Such phenomenological notions as focusing, habits of mind, finite provinces of meaning, and relevance are shown to be central to the way these "worlds" are constituted. An eidetic interpretation of illness is proposed. Such an interpretation discloses certain (...) essential characteristics that pertain to the experience of illness, per se , regardless of its manifestation in terms of a particular disease state. It is suggested that, if a shared world of meaning is to be constituted between physician and patient, the eidetic characteristics of illness must be recognized by the physician. Keywords: phenomenology, patient-physician relationship, illness-as-lived, habits of mind, relevance, eidetic CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre’s Being and Nothingness ( 1956 ). The three steps identified by Sartre in this process are analysed, developed further and brought to a five-step model: (1) pre-reflective experience of discomfort, (2) lived, bodily discomfort, (3) suffered illness, (4) disease pondering, and (5) disease state. To fall ill is to fall victim to a gradual process of alienation, and (...) with each step this alienating process is taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre’s focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one’s own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one’s own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel (and perhaps also patients) about the ways of the lived body. (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre's Being and Nothingness. The three steps identified by Sartre in this process are analysed, developed further and brought to a five- step model: pre-reflective experience of discomfort, lived, bodily discomfort, suffered illness, disease pondering, and disease state. To fall ill is to fall victim to a gradual process of alienation, and with each step this alienating process is (...) taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre's focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one's own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one's own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel about the ways of the lived body. (shrink)

In this paper I present and compare the ideas behind naturalistic theories of health on the one hand and phenomenological theories of health on the other. The basic difference between the two sets of theories is no doubt that whereas naturalistic theories claim to rest on value neutral concepts, such as normal biological function, the phenomenological suggestions for theories of health take their starting point in what is often named intentionality: meaningful stances taken by the embodied person in experiencing and (...) understanding her situation and taking action in the world.Although naturalism and phenomenology are fundamentally different in their approach to health, they are not necessarily opposed when it comes to understanding the predicament of ill persons. The starting point of medical investigations is what the patient feels and says about her illness and the phenomenological investigation should include the way diagnoses of different diseases are interpreted by the person experiencing the diseases as an embodied being. Furthermore, the two theories display similarities in their emphasis of embodiment as the central element of health theory and in their stress on the alien nature of the body displayed in illness. Theories of biology and phenomenology are, indeed, compatible and in many cases also mutually supportive in the realm of health and illness. (shrink)

The relevance of the Aristotelian concept ofphronesis – practical wisdom – for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle’s practical philosophy was of central importance toHans-Georg Gadamer and to the development of his philosophical hermeneutics, and how,accordingly, the concept of phronesiswill be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring (...) the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing todo for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle’s point is exactly that problems of praxis cannot be approached in this way. It can also point theway for alternative forms of medical ethics, such as virtue ethics or a phenomenological andhermeneutical ethics. The latter alternative would have to address the phenomena of healthand the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised. (shrink)

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general (...) critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates. (shrink)

"--Richard Grandy, Rice University "This is the first compelling diagnosis of what has gone awry in the raging 'science wars.

Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

The traditional contrast between naturalist and normativist disease concepts fails to capture the most salient features of the health concepts debate. By using health concepts as a window on background notions of medical science and ethics, I show how Christopher Boorse (an influential naturalist) and Lennart Nordenfelt (an influential normativist) actually share deep assumptions about the character of medicine. Their disease concepts attempt, in different ways, to shore up the same medical model. For both, health concepts function like demarcation criteria (...) in the philosophy of science: they mark off the jurisdiction of medical science, and protect it from an inappropriate intrusion of socioeconomic factors, which threaten the integrity of modern medicine. These views are challenged by new developments in healthcare such as managed care and total quality review. To frame the health concepts debate in a way that better captures the issues integral to these new developments, I advance a new way of reading the distinction between weak and strong normativists. Strong normativists are skeptical of the demarcation project, think facts and values cannot be disentangled, and hold that socioeconomic conditions unavoidably influence how pathology is understood. The new health concepts debate should be framed as one between weak and strong normativists, and it concerns how we should respond to the current developments in health care. (shrink)

La médecine ne se contente pas de diagnostiquer et de traiter des maladies : elle vise aussi à les expliquer. En cela, elle prend pied de plein droit dans le domaine de la science. En quoi consistent les explications médicales, et qu'est-ce qui les singularise au sein des explications en biologie? La première caractéristique des explications médicales est leur pluralité. La médecine semble en effet réunir sous un même label des explications très diverses, voire hétérogènes, unies seulement par l'objet d'application (...) et la visée thérapeutique. Le propre de l'explication scientifique médicale, c'est sa pluridisciplinarité.Un canevas théorique est nécessaire pour mettre en évidence ce qui, dans une explication scientifique, peut permettre une telle diversité des explications. Celui-ci est fourni par la notion de " valeur explicative " : une croyance, injustifiable, mais bien fondée, en l'exhaustivité des conditions initiales dont une explication doit tenir compte. Bien qu'elle tende par elle-même à tout expliquer sans reste, et qu'elle exclut du domaine disciplinaire qu'elle définit ainsi tout autre type d'explication, une valeur explicative n'exclut jamais en droit la possibilité d'explications scientifiques d'autres types. Un nombre indéfini de valeurs explicatives, exclusives les unes des autres, fondatrices de domaines scientifiques distincts, est donc possible. La médecine présente ainsi la particularité de rassembler plusieurs valeurs explicatives différentes et qui plus est, de les contraindre à la convergence ou à la collaboration. Quelques-unes des principales valeurs explicatives de la médecine sont présentées, de même que les enjeux de leur confrontation. Clinique, épidémiologique, mécanique, génétique, cytologique, infectiologique, pharmacologique, l'explication médicale se fonde à chaque fois sur une manière différente de considérer le phénomène pathologique. (shrink)

_The_ _Routledge Companion to Philosophy of Medicine _is a comprehensive guide to topics in the fields of epistemology and metaphysics of medicine. It examines traditional topics such as the concept of disease, causality in medicine, the epistemology of the randomized controlled trial, the biopsychosocial model, explanation, clinical judgment and phenomenology of medicine and emerging topics, such as philosophy of epidemiology, measuring harms, the concept of disability, nursing perspectives, race and gender, the metaphysics of Chinese medicine, and narrative medicine. Each of (...) the 48 chapters is written especially for this volume and with a student audience in mind. For pedagogy and clarity, each chapter contains an extended example illustrating the ideas discussed. This text is intended for use as a reference for students in courses in philosophy of medicine and philosophy of science, and pairs well with _The_ _Routledge Companion to Bioethics_ for use in medical humanities and social science courses. (shrink)

How is medical knowledge made? There have been radical changes in recent decades, through new methods such as consensus conferences, evidence-based medicine, translational medicine, and narrative medicine. Miriam Solomon explores their origins, aims, and epistemic strengths and weaknesses; and she offers a pluralistic approach for the future.

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness raises some (...) uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel shows how the concepts and language (...) used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. "Illness" unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (shrink)

In this long-awaited compendium of new and newly revised essays, Alison Wylie explores how archaeologists know what they know. -/- Preprints available for download. Please see entry for specific article of interest.

In this book the author explores the shifting philosophical boundaries of modern medical knowledge and practice occasioned by the crisis of quality-of-care, especially in terms of the various humanistic adjustments to the biomedical model.

Yet, the central conviction that informs this volume is that phenomenology provides extraordinary insights into many of the issues that are directly addressed ...

The term ‘naturalism’ has no very precise meaning in contemporary philosophy. Its current usage derives from debates in America in the first half of the last century. The self-proclaimed ‘naturalists’ from that period included John Dewey, Ernest Nagel, Sidney Hook and Roy Wood Sellars. These philosophers aimed to ally philosophy more closely with science. They urged that reality is exhausted by nature, containing nothing ‘supernatural’, and that the scientific method should be used to investigate all areas of reality, including the (...) ‘human spirit’ (Krikorian 1944, Kim 2003). (shrink)

This paper suggests that the paradigm of lived body (as it is developed in the works of Merleau-Ponty, Sartre and Zaner) provides important insights into the experience of illness. In particular it is noted that, as embodied persons, we experience illness primarily as a disruption of lived body rather than as a dysfunction of biological body. An account is given of the manner in which such fundamental features of embodiment as bodily intentionality, primary meaning, contextural organization, body image, gestural display, (...) lived spatiality and temporality, are disrupted in illness causing a concurrent disorganization of the patient's self and world. The paradigm of lived body has important applications for medical practice. It provides a fuller account of illness than does the prevailing reductionist Cartesian paradigm of body, more directly addresses the existential predicament of illness, and orients the clinical focus around the personhood of the patient. (shrink)

In this essay I discuss Edith Stein's analysis of empathy and note its application in the field of clinical medicine. In identifying empathy as the basic mode of cognition in which one grasps the experiences of others, Stein notes, 'I grasp the Other as a living body and not merely as a physical body'. The living body is given in terms of five distinctive characteristics - characteristics that disclose important facets of the illness experience. Empathy plays an important role in (...) clinical practice in aiding physicians to grasp the content of first-person reports of bodily disorder, and to comprehend the meaning of illness-as-lived. I suggest that an important task for medical education should be that of developing students' capacity for empathic understanding and I note several ways in which this task might be accomplished. (shrink)