Why bioethics needs the philosophy of medicine: Some implications of reflection on concepts of health and disease

Theoretical Medicine

Volumn 18, Issue 1-2, 1997, Pages 145-163

  Khushf, George ^a  

^a UNIVERSITY OF SOUTH CAROLINA   (United States)

Author keywords

bioethics; disease; health; medical epistemology; philosophy of medicine

Indexed keywords

HUMAN; MEDICAL ETHICS; PATIENT CARE; PHILOSOPHY OF MEDICINE; REVIEW;

EID: 0030887560     PISSN: 01679902     EISSN: None     Source Type: Journal    
DOI: 10.1007/978-94-017-3364-9_11     Document Type: Review

References (107)

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12. Ibid: 3.
13. Ibid.
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20. Hesslow: note 3.
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25. This would explain why Hesslow seems willing to accept the Boorsian concept, even though he acknowledges that there are "serious difficulties" with it; Hesslow: note 2.
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42. Those familiar with Hegel's thought will recognize a similarity between my account of the history of medicine and Hegel's account of the history of philosophy. My criticisms of the speculative and empirical stages will also be informed by Hegel's criticisms of the first and second attitudes of thought toward objectivity. My assessment of the dialectical period (the clinic-laboratory dialectic), as well as the role given to conceptual clarification in the further development of medicine, has also benefitted from Hegel. For an overview of these themes,
43. see Hegel, GWF. Hegel's Logic. Wallace W, trans. Oxford: Oxford University Press, 1975.
44. For an overview of some of the issues, see ten Have H, Kimsma G, Spicker S. The Growth of Medical Knowledge. Dordrecht: Kluwer Academic Publishers, 1990.
45. This same qualification would need to be given in a much more detailed historical account, as well. Thus a historian of the stature of Owsei Temkin can note, as he begins his historical overview of concepts of health and disease: "any order can be achieved only be neglecting innumerable details, by paradigmatic use of relatively few opinions and practices, and by admitting that a different point of view may show a different panorama." Temkin: 419.
46. On the externalist/internalist distinction and medical historiography, see Wallace E. Psychiatry and its nosology: a historico-philosophical overview. Sadler J, Wiggins O, Schwartz M, eds. Philosophical Perspectives on Psychiatric Diagnostic Classification. Baltimore and London: The Johns Hopkins University Press, 1994: 16-86.
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48. Ibid.
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50. Ibid.
51. Similar ideas associating the "unnatural" and loss of vitality persisted well into the current century. For a good example, see Engelhardt, 1974.
52. As Hegel notes (1975: 48), the speculative period worked with a metaphysic that "took the laws and forms of thought to be the fundamental laws and forms of things. It is assumed that to think a thing was the means of finding its very self and nature." There is thus little skepticism regarding the general theoretical framework, and a considerable tendency to dogmatism (p. 52). It is this tendency in the Middle Ages that leads to Ackerknecht's harsh appraisal of Medieval medicine (ch. 8).
53. Khushf, 1992.
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56. Sanchez-Gonzalez. For a more detailed discussion of the relation between Locke and Sydenham, see Romanell P. John Locke and Medicine. New York: Prometheus, 1987.
57. Foucault: chs. 1-2.
58. Temkin: ch. 30.
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61. Temkin: 443.
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64. Temkin: 443-444. Sanchez-Gonzalez: 688-690.
65. Khushf, 1992.
66. Engelhardt, 1996.
67. Sanchez-Gonzalez.
68. For a current formulation of this same problem with respect to the inductivism of the DSM and psychiatric nosologies, see Wallace E. What is truth? Some philosophical contributions to psychiatric issues. American Journal of Psychiatry 1988; 145(2): 137-147.
69. Engelhardt, 1996.
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71. Ibid: 85.
72. Taylor: 13.
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74. Khushf, 1992.
75. Engelhardt, 1996; Foucault.
76. Foucault.
77. Taylor: 12.
78. Reiser.
79. Engelhardt, 1996: 216.
80. Engelhardt H. Goals of medical care. In Bell N, ed. Who Decides: Conflicts of Rights in Health Care. Clifton: Humana Press, Inc., 1982: 55.
81. Faber: 28.
82. Engelhardt, 1996.
83. Foucault.
84. Cassell; Leder; Toombs.
85. Canguilhem G. The Normal and the Pathological. New York: Zone Books, 1989.
86. Pellegrino and Thomasma: 75-76.
87. Ibid. See also Temkin: ch. 30.
88. Boorse (1975: 545) argues that the "consensus view" among clinicians and philosophers is a weak normativism. While this may be closer to the truth in philosophy, it is clearly false among clinicians, for whom, since Broussais, a value-neutrality was the orthodoxy. On this, see Canguilhem.
89. Nordenfelt L. Concepts of health and their consequences for health care. Theoretical Medicine 14(3), 1993:277-285: 281-282.
90. This is a function that Hegel attributes to thought, and which he develops as his dialectic; Hegel, 1975.
91. This point is made by Hesslow, when he states that Boorse's concept "captures quite well what medical scientists and practitioners actually mean by the term 'disease' " (p. 3).
92. Boorse, Captures Quite Well What Medical Scientists and Practitioners Actually Mean by the Term 'Disease', Ibid.1977: 543.
93. Ibid: 551.
94. Ibid: 567.
95. Ibid: 544.
96. Ibid: 562.
97. For more extensive criticisms, see Agich G. Disease and value: a rejection of the value-neutrality thesis. Theoretical Medicine 1983; 4: 27-41; also see the next reference.
98. Goosens W. Values, health, and medicine. Philosophy of Science 1980; 47: 100-115.
99. Engelhardt, 1996.
100. Boorse,1977: 559.
101. Margolis J. The concept of disease. The Journal of Medicine and Philosophy 1976; 1(3): 238-255; 252.
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103. Boorse,1977: 560-561.
104. Hesslow: 11.
105. Ibid: 12.
106. Ibid.
107. Cassell; Pellegrino and Thomasma; Khushf, 1992.