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Questions about the conference can also be sent to: fredrik. Description: Philosophizing about medicine is as old as philosophy and medicine themselves. Despite the long tradition of inquiry and speculation, medical epistemology was until recently not often recognized as an area of research in its own right. In recent years, however, the situation has changed markedly, and an increasing number of philosophers now count themselves as specialists in or active contributors to medical epistemology. Medical epistemology is now well on its way to taking form as a distinct and promising area of research, with a recognized set of problematics and theories.

Considered as one of the most urgent, this problem arises from the fact that the results of the Randomized Controlled Trials RCTs are seldom applied to the whole reference population, which is identified with people needing a medical treatment. Once verified that the results of an RCT are valid, we still have to explain how to apply these results to patients who did not take part in the experiment. As a matter of fact, several individuals who present particular features are excluded from the groups of patients selected for the experiment. Therefore, how can we justify the belief that a certain treatment has the same effect when applied to a different setting?

Without a reasonable answer to this latter question, RCTs would prove less helpful, as they would only show the results related to a particular situation, without any guarantee that the same results could apply to other contexts.

Medical Philosophy | Columbia University Press

The possible advantages of a Bayesian perspective on RCTs will be explored. Finally, even if a way to apply population-based knowledge to a specific case is acknowledged, in order to choose a suitable treatment for a patient, diagnostic and prognostic judgements are traditionally essential. Both diagnosis and prognosis always occur behind a veil of uncertainty, nonetheless they seem to convey different forms of uncertainty. The concept of diagnosis is, in fact, usually affected by the inductive risk of error, while prognosis seems more likely to be associated with fundamental uncertainty towards a future condition, which may be difficult to probabilistically compute.

Submission guidelines: Contributions must be original and not submitted elsewhere. Papers must be in English and should not exceed 8, words references and footnotes included. Each submission should also include a separate title page containing contact details, a brief abstract and a list of keywords for indexing purposes. All papers will be subject to double-blind peer-review, following international standard practices. Please save your manuscript in one of the formats supported by the system e.

Make sure to select the appropriate article type for your submission by selecting: S. Deadline for submissions: August 31, For any further information please contact: Mattia Andreoletti mattia. The Roundtable will include the Ruggles Lecture in the Philosophy of Medicine on June 23, followed by a reception to celebrate recent work in the philosophy of medicine. Attendees are encouraged to register and secure accommodation early as June falls during Pride Week in Toronto, and accommodations will book up soon.

Cecilia M. International Philosophy of Medicine Roundtable. The meanings of the phenomena observed e. As a result of this recasting, medical complaints often came to be considered legitimate only to the extent that they had a demonstrable, underlying pathophysiological or pathoanatomical lesion.

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If certain physiological and psychological functions can be identified as natural or essential to humans, then their absence can be used to define disease states. Leon Kass and Christopher Boorse have argued that one can specify those functions that are integral to being human, and thus secure accounts of disease that are not relative to a particular culture or set of values.


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Such understandings of health and disease could then be used to sort out essential from nonessential if not proper from improper applications of medicine. However, such naturalistic views may depend on particular understandings of what is natural. Others appeal to an evolutionary account of what should count as species-typical levels of species-typical functions appropriate for age and gender Boorse In contrast, Joseph Margolis, H. Tristram Engelhardt, and others have argued that definitions of disease and health depend on sociological, culturally determined value judgments, and that these definitions can be understood only in terms of particular cultures and their ideologies Margolis.

A value-free account of disease cannot be given, some have argued, because diseases are defined not by their causes, but by their effects Resnek —and their effects gain significance within a cultural context. Fulford has also indicated deeply hidden but still crucial evaluative elements in medicine. He has done this through a linguistic-analytic examination of how disease language appears to be value-free, while still entailing values, with the result that controversies in medical health are engendered where relevant values are sufficiently diverse.

Fulford also argues that part-function analysis, which focuses on the proper function of each part of the body, fails with psychotic mental disorders where the rationality of the person as a whole is disturbed. Others have explored the nature of disease through the use of action theory and by placing concerns about disease and illness within the larger holistic context of health Nordenfeldt, , Still others ground disease language in a notion of malady dependent on the universal features of human rationality, thus eliminating culture as a factor Clouser.

The view that the concepts of health and disease are culturally determined has been supported by feminist writings on healthcare. Many authors have pointed out that the practice of medicine has had an androcentric masculine focus, that women's issues have largely been ignored, and that experiences reported by women that could not be documented have been treated as invalid Rosser; Oakley. Partisans of the view that social and cultural ideas influence concepts of health and disease stress that a definition of disease tied to evolution makes disease concepts dependent on particular past environments and past adaptations.

Successful adaptation must always be specified in terms of a particular environment, including a particular cultural context. A culture-dependent account of concepts of health and disease need not deny that there will be great similarities as to what will count as diseases across cultures, for certain symptoms and conditions will probably be understood as diseases in most cultures.

Supporters of a value-infected, culture-dependent account of disease have argued that those who would attempt a purely evolutionary account of disease have not reconstructed the practice of medicine, but rather some practice of characterizing individuals as members of particular biological species Engelhardt, The practice of medicine, in this view, depends on culturally constructed understandings of health and disease. How one understands health and disease will in turn influence how one conceptualizes medical practice.

Henrik Wulff has argued that an exclusively biological or empirical model of illness contributes to paternalistic medical practice, for if concepts of health and disease can be fully understood in biological terms, then there may be no need to assign the patient an active role in the decision-making process. If, however, determinations of health and disease are not just empirical concepts, but are also related to cultures and values, the patient will have a more active role in determining the burden of the disease and the extent of treatment.

The conceptualization of medicine will certainly be influenced by developments in genetic research, which hold the promise not only to correct diseases in patients, but to prevent them in future generations of patients Anderson; Zimmerman. Thus, as the capacities of genetic medicine increase, preventive medicine will expand.

Somatic and germ-line therapies will also be affected as choices are made about which genetic variances should be treated as disease abnormalities e. It has been argued that only somatic diseases are legitimately diseases, while mental diseases are problems with living Szasz. Following similar lines of argument, individuals have contended that enterprises such as psychotherapy are tantamount to applied ethics Breggin , or that the cure of somatic disease constitutes the prime goal of medicine Kass. In response, some argue that such stark dichotomies or dualisms fail to offer satisfactory accounts of reality.

If mental life is dependent on brain function, then all mental diseases can, in some sense, be tied to physical pathology or abnormal anatomy. For example, depression can be presumed to be dependent on a neurophysiological substrate, and thus, in principle, is open to pharmacological treatment.

Health Care Ethics

If one views diseases as explanatory models for the organization of signs and symptoms, then it does not matter whether the signs and symptoms identify physiological states "I have a rash" or psychological states "I feel depressed". Nor does it matter whether models employed to correlate these phenomena are pathophysiological or psychological. Most accounts of disease will, in fact, mingle physical and psychological symptoms. As a consequence, one may come to view distinctions among somatic, psychological, and social models of disease in terms of pragmatic needs—of accenting the usefulness of particular modes of therapeutic intervention.

One may even advance sociological models of disease, construing diseases primarily in terms of social variables and giving secondary place to the pathophysiological. Distinctions between medical and nonmedical models of therapy, unlike somatic, psychological, and sociological accounts of disease, are often meant to contrast the autonomy of clients in nonmedical therapeutic models with the dependence of patients on healthcare practitioners in medical models.


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Talcott Parsons characterized the "sick role" as: 1 excusing ill individuals from some or all of their usual responsibilities; 2 holding them not responsible for being ill though they may be responsible for becoming sick ; 3 holding that they should attempt to become well a therapeutic imperative and seek out experts to treat their illness. Medical models tend to support paternalistic interventions by healthcare practitioners and to relieve patients of responsibility for directing their own care.

Nonmedical models, in contrast, tend to accent the patient's responsibility. Somatic models of disease may be employed within both medical and nonmedical models of therapy. For example, hypertension may be treated with antihypertensive agents or by enjoining the afflicted individuals to find ways to change their lifestyles with regard to stress, eating patterns, and so on. The same is true of psychological models of disease. Depression can be treated chemotherapeutically or by enjoining individuals to make changes in their ways of living.

As predisposing factors toward particular diseases become better known and easier to control or avoid, individuals are held increasingly responsible for becoming ill, even though they will remain nonresponsible for being ill. A person is not held to be responsible for having bronchogenic carcinoma in the same way that one is responsible for being a willful malingerer. In other words, one cannot be told to stop having cancer, but one can be held responsible for having developed cancer through one's smoking habits. As the impact of lifestyle on the development of diseases becomes clearer, the responsibility of individuals for their health may increase the possible scope of nonmedical models of therapy.

Holism and emergence

If concepts of human illness, disease, and health are, in part, social constrictions, there will be differences between the ways in which diseases are identified for humans and the ways they are identified for other animals. Illnesses and diseases in animals will be judged through the social or cultural criteria of human beings. Pets or domestic animals may be regarded as having disease or being healthy depending on how they are viewed through human purposes and constructs. The diseases or illnesses of those animals that are not pets, however, along with those of plants, may be understood less in terms of human social or cultural criteria and more in terms of generalized knowledge about the species.

In the case of animals in the wild, there may not be concern for individual suffering, disability, or deformity, but rather with the general health of the species. Identifying the role human values play in the concepts of animal disease and illness expands the discussion of the ethical treatment of nonhuman animals in bioethics. Concepts of disease have been used to impose political judgments.

For example, in the United States prior to the Civil War it was proposed that the flight of a slave to the North and the absence of a wholesome inclination to do effective plantation work were diseases for which explanatory accounts and treatments could be provided Cartwright. Masturbation was once viewed as a serious disease for which castration, excision of the clitoris, and other invasive therapies were employed.

Individuals were even determined to have died of masturbation, and postmortem findings "substantiated" this cause Engelhardt, In the case of the diseases of slaves, the motivation may have been to protect slaves from punishment. In the case of masturbation, the influence of cultural values on the psychology of discovery was not appreciated. Historical perspective can increase our awareness that medical practitioners and researchers have tended to "discover" what already was assumed. More recent political uses of disease concepts e. Social employment of disease definitions is often meant to be benevolent, however, such as advocating a view of alcoholism and drug addiction as diseases so as to recruit the forces of medicine to aid in their control.

Moreover, such conditions may be termed diseases in order to relieve alcoholics and drug addicts of the social opprobria that attend what is often viewed as immoral behavior. Concepts of health and disease shape descriptions of medical reality, convey explanations, advance value judgments, and structure social reality. They influence not only the scope of medicine, but healthcare policy as well. Because they may involve not only moral values but values associated with physical and mental excellence, they raise questions pertinent to both bioethics and the philosophy of medicine. These special concerns regarding medical explanation may sufficiently define a distinctive problem area so as to establish the philosophy of medicine as a field in its own right, despite arguments to the contrary.

In any event, the concepts of health and disease, as well as their application, will continue to be the subject of debate in societies that are morally and culturally pluralistic. Anderson, W. Boorse, Christopher. James Humber and Robert Almeder. Totowa, NJ: Humana Press. Paris: Mequignon-Marvis. Callahan, Daniel. Cartwright, Samuel A. Clouser, K. Danner; Culver, Charles M. Engelhardt, H. Tristram, Jr. Tristram Engelhardt Jr. Dordrecht, Netherlands: Reidel. The Foundations of Bioethics. New York : Oxford University Press. Foucault, Michel. New York: Pantheon Books. Fowler, Gregory; Juengst, Eric T.

Fulford, K. Kass, Leon R. King, Lester. Arthur L. Caplan, H. Reading, MA: Addison-Wesley.

Table of contents

Margolis, Joseph. Nordenfelt, Lennart. On the Nature of Health, 2nd edition. Dordrecht, Netherlands: Kluwer Academic Publishers. Oakley, Ann. Essays on Women, Medicine, and Health. Edinburgh: Edinburgh University Press.