Explanation, understanding, objectivity and experience

Loughlin, Michael; Bluhm, Robyn; Stoyanov, Drozdstoy; Buetow, Stephen; Upshur, Ross; Borgerson, Kirstin; Goldenberg, Maya J.; Kingma, Elselijn

doi:10.1111/jep.12060

Cited by 12 publications

(19 citation statements)

References 87 publications

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“…A number of old dichotomies are effectively challenged, including the distinction between facts and values, parts and wholes, psyche and soma and between subjectivity and objectivity [29].…”

Section: Cure Versus Carementioning

confidence: 99%

Evidence-based or person-centered? An ontological debate

Anjum¹

2016

EJPCH

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Evidence-based medicine (EBM) continues to be vigorously debated and person-centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement to or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include specific methods and the biomedical model. In this paper I argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. I will aim to make explicit some of the most fundamental assumptions that motivate EBM and PCH in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology.

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Section: Cure Versus Carementioning

confidence: 99%

Evidence-based or person-centered? An ontological debate

Anjum¹

2016

EJPCH

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“…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) .…”

Section: Reasoning In Mental Healthmentioning

confidence: 99%

“…Just as many authors in our collection emphasize the social nature of knowledge and the centrality of context to practical reasoning, so many challenge, implicitly or explicitly, other modern dichotomies. The strict dichotomy between evidence and value—the former concerned with objective fact and the latter invariably reduced to matters of subjective “preference”—suggests a clear philosophical dividing line between epistemic questions (concerning knowledge, empirical data, and reason) and questions of an evaluative or moral nature (concerning what should be the case, what is preferable, matters of emotion and personal commitment).…”

Section: Concluding Comments: the Direction Of Debatementioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Loughlin¹,

Bluhm

Buetow

et al. 2017

Evaluation Clinical Practice

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When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.

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“…If this really is the current consensus, then it perhaps represents a shift in thinking from models once regarded as mainstream, in which health was primarily a biomedical concept and other uses of the term were considered extensions of its core meaning [2][3][4][5][6][7]. But whatever our view on such issues, and on the wider debate about biomedicine and person-centred care, the very existence of this debate in the public sphere (one involving local authorities, numerous professional organizations, patient advocacy groups as well as all the main political parties) reminds us of something important.…”

Section: Introductionmentioning

confidence: 99%

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

Loughlin¹,

Bluhm

Fuller

et al. 2015

Evaluation Clinical Practice

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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.

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Explanation, understanding, objectivity and experience

Cited by 12 publications

References 87 publications

Evidence-based or person-centered? An ontological debate

Evidence-based or person-centered? An ontological debate

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

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

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