Editorial preface to the fourth edition and modified translation -- The text of the Philosophische Untersuchungen -- Philosophische untersuchungen = Philosophical investigations -- Philosophie der psychologie, ein fragment = Philosophy of psychology, a fragment.

Different beliefs about the nature and justification of bioethics may reflect different assumptions in moral epistemology. Two alternative views (put forward by David Seedhouse and Michael H Kottow) are analysed and some speculative conclusions formed. The foundational questions raised here are by no means settled and deserve further attention.

These are exciting times for the defenders of Person-Centred Medicine(PCM). A recent editorial of the International Journal of Person-Centred medicine celebrates the new interest policy-makers are taking in PCM, but worries that: ‘the nomenclature of “person-centred medicine” risks the accusation that such a term represents a further rhetorical addition to the already rhetorically overburdened nature of health services.’ The worries are indeed justified. Practitioners struggling to do their jobs in the resource-constrained environments of contemporary health services may well react cynically (...) to the latest linguistic innovation, especially if it seems, like its predecessors, to combine the blindingly obvious with the ‘revolutionary’. With reference to the case studies of ‘quality theory’ in management studies and Evidence-based medicine, the paper argues that initially promising ideas are compromised when required to meet the agendas of policy-makers looking for a quick fix to what are in fact deep, structural problems in the delivery of health services. We must resist such moves if we are to preserve the intellectual and moral integrity of PCM as a critical perspective on medical practice, and to develop ideas that are actually helpful to practitioners and the users of health services. (shrink)

Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

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)