Philosophy, ethics, medicine and health care: the urgent need for critical practice

Medical humanities' challenge to medicine

“…Medical humanities as a field emerged in the USA in the 1970s as a result of a growing sense that there was something inadequate about medicine's understanding of the human, as demonstrated in its approaches to evidence and practice. This journal has done much to raise the importance of philosophy in critiquing ‘moderate‐anti‐intellectualism’ within medicine, and in showing the value of a philosophical approach in revealing underlying unquestioned assumptions within medical policy and practice [1]. There are a number of other humanities and social science disciplines that come within the scope of medical humanities that are also capable of exposing lazy thinking and accepted norms.…”

Virtue, progress and practice

“…Such an answer is in an obvious sense ‘meaningless’ to those who purport to ‘just accept’ or ‘work with’ it, in much the same way that ‘42’ is meaningless as an answer to the question ‘what is the meaning of life, the universe and everything?’ To practice ‘on the basis’ of an answer one has no real understanding of is, in just as obvious a way, to act thoughtlessly. Whatever we mean by a rational, responsible practitioner, the person who ‘never thought of thinking for himself at all’[11] would not seem to be it. We need to think carefully and for ourselves about how to formulate the questions, and about the types of argument we might employ to address them.…”

“…The current climate is, and has for some time been, one of ‘moderate anti‐intellectualism’[11]. It is considered reasonable for human beings – at least, those deemed responsible professionals – to apply their intellectual capacities to the learning of sometimes complex techniques, to know and follow conventions for good practice in their areas of work: ‘how‐to’ questions are the legitimate preoccupations of the rational, professional mind.…”

“…But it is deemed ‘intellectual’ in a derisory sense – somehow strange, bolshy or ‘other worldly’[5,12]– for a professional to want to understand the reasons behind the current conventions and to contribute to the debate about their appropriateness and sustainability. The characteristically philosophical attitude, once thought definitive of the professional outlook [11], of asking ‘why?’ questions – why does that follow? why these goals, rules and assumptions as opposed to others?…”

“…The pages of this journal have for many years supplied ample illustration of the fact that penetrating, intellectually serious discussion of pressing questions facing researchers, clinicians and policy makers is not only possible but necessary, if we are to secure improvements and avoid the pitfalls of dogmatism and the spurious triumphalism that has characterized much of the mainstream debate about progress, evidence, policy and practice in medicine and health care [18–24]. In 2010, the journal presented its first ever philosophy thematic edition, including papers by some of the most original and incisive thinkers the discipline has to offer on a vast range of subjects of urgent practical import [11]. This, the second thematic edition of the Journal of Evaluation in Clinical Practice to focus specifically on the application of philosophical methods and argumentation to medicine and health care, provides an even greater range of papers [25–60] on the themes of progress in medicine, virtue in practice, and evidence and methodology in research and evaluation.…”