Clinical medicine is the application of scientific principles, rules of thumb, and a store of practical wisdom embodied in narratives of individual cases to the care of a person who is ill. Physicians are taught to observe and report the individual case both as a means of fitting nomothetic generalizations to the given circumstances and as a way of refining those generalizations. This narrative construction of illness is a principal way of knowing in medicine. In this view, disease is not (...) so much an entity as an identifiable chronological organization of the events of illness, and medicine, rather than a science, a rational science-using activity in the service of the ill. Keywords: medical epistemology, casuistry, clinical judgment, narrative CiteULike Connotea Del.icio.us What's this? (shrink)

Since the time of Hippocrates, medical science sought to develop a practice based on "knowledge rather than opinion". However, in the light of recent alternative approaches to healing and a philosophy of science that, through thinkers like Kuhn, Rorty, and Foucault, is critical of claims to objective truth, we must reappraise the way in which medical interventions can be based on proven pathophysiological knowledge rather than opinion. Developing insights in Foucault, Lacan, and Wittgenstein, this essay argues for a recovery of (...) the Aristotelian idea of a techne, where there is a dynamic interplay between praxis and conceptualization. The result is a post-Kuhnian epistemology for medical science that recognizes the evaluative dimension of knowledge, but that also looks to a Platonic conception of the good as the ultimate constraint on human thought, thus avoiding the radically self-contained accounts of truth found in some post-modern thinkers. Keywords: normal science, power, truth, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, (...) in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient. (shrink)

There has been a growing interest in casuistry since the ground breaking work of Jonsen and Toulmin. Casuistry, in their view, offers the possibility of securing the moral agreement that policy makers desire but which has proved elusive to theory driven approaches to ethics. However, their account of casuistry is dependent upon the exercise of phronesis. As recent discussions of phronesis make clear, this requires attention not only to the particulars of the case, but also to the substantive goods at (...) stake in the case. Without agreement on these goods attention to cases is unlikely to secure the productive consensus that Jonson and Toulmin seek. (shrink)