Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care

Abstract

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions -about what we should do in any given situation -are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition.

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…Reasoning about mental health has always provided significant challenges to the simple dichotomies embodied by the “modernism” Wieringa et al seek to challenge . Clinicians Michalis Kyratsous and Abdi Sanati apply Miranda Fricker's concept of a distinctively epistemic form of injustice—wronging persons in their capacity as knowers—to persons with borderline personality disorder (BPD) .…”

“…Wieringa et al 17 seek to challenge. 5,7 Clinicians Michalis Kyratsous and Abdi Sanati apply Miranda Fricker's concept of a distinctively epistemic form of injustice-wronging persons in their capacity as knowers-to persons with borderline personality disorder (BPD). 19 Despite recognizing that pathology sometimes justifies epistemic disqualification, the authors use a case vignette to illustrate how valid consideration of persons as unreliable witnesses differs from disqualifying their epistemic status on the basis of negative stereotypes and prejudice.…”

“…Far from being an activity somehow disconnected from practice, it is a precondition of adequate theorising that it enables practitioners to make sense of what they actually do . Such activities as diagnosis, prediction, classification, and treatment embody numerous assumptions about matters including the ontological status of disease, the nature of causality, probability, and the nature of and relationships among rationality, validity, knowledge, value, objectivity, and subjective experience . We have been delighted to publish many excellent articles demonstrating not only that our thinking about these essential underlying matters is not yet settled but offering ways to make substantive progress in the theoretical and practical problems that confront us.…”

“…4 Such activities as diagnosis, prediction, classification, and treatment embody numerous assumptions about matters including the ontological status of disease, the nature of causality, probability, and the nature of and relationships among rationality, validity, knowledge, value, objectivity, and subjective experience. [5][6][7][8] We have been delighted to publish many excellent articles demonstrating not only that our thinking about these essential underlying matters is not yet settled but offering ways to make substantive progress in the theoretical and practical problems that confront us. Even the most apparently reasonable assumption of the "anti-philosophical" authors, that confusion is invariably unhelpful, is not strictly correct.…”

Research Problems and Methods in the Philosophy of Medicine

“…On such a view the philosophy of medicine is presumably something one does if lacking the scientifi c background to do real medicine, and the idea of "research problems and methods in the philosophy of medicine" represents something of an oxymoron. The willingness to examine critically one's own underlying assumptions is a prerequisite for engaging in philosophical thinking and discourse (Loughlin et al, 2015 ). It is therefore not unreasonable to expect authors in any area of applied philosophy to have considered the nature and limitations of their activity and its relationship with the practices it hopes to inform.…”