Even though medics in the present day may think that clinical pathology is derived from normal physiology, I argue here that this is not necessarily the case. Historically, physiology may have been derived from clinical pathology. After deriving physiological knowledge like this, medics can reverse the conceptual priority, to make believe that physiological knowledge is at the foundation of medical practice. This implies that supposedly objective physiological knowledge can be influenced by the evaluative judgements made to define practical concepts (...) of clinical pathology. I argue for this view using the history of the disease heart failure, drawing on an argument made by Georges Canguilhem. (shrink)

Richard Koch1 became known in the 1920s with works on basic medical theory. Among these publications, the character of medical action and its status within the theory of science was presented as the most important theme. While science is inherently driven by the pursuit of knowledge for its own sake, medicine pursues the practical purpose of helping the sick. Therefore, medicine must be seen as an active relationship between a helping and a suffering person. While elucidating this relationship, (...) Koch discusses the fundamental elements of medicine found in natural philosophy and the relationship of medicine to its own history. One of his aims is to unite natural history and the history of ideas without reducing intellectual processes to biological ones. Koch considers free will as something intuitively certain. It must serve as an axiom which will capture human as well as non-human reality. Based on the fact that human free will, considered a psychic quality, evolved out of inanimate matter, Koch grants matter (proto-) psychic qualities. They are evoked through specific constellations of matter. – With regard to history, Koch rejects the notion of constant progress. The history of medicine has provided insights that cannot be surpassed but can be obscured. Historical self-contemplation serves as a means for avoiding any deviations which may prevent medicine from fulfiling its ultimate purpose. Koch connects nature and history through the concept of a unity between natural history and the historical development of medicine. Medicine is considered an especially complex development of a purposive reaction to harmful stimuli, a reaction which can already be encountered in unicellular organisms. Without intending to reduce historical and mental processes to biological ones, Koch sets for himself the aim of gathering different phenomena and presenting them in one encapsulating unity. (shrink)

Getting physical: Empiricism’s medical History Content Type Journal Article DOI 10.1007/s11016-010-9474-4 Authors John Gascoigne, School of History and Philosophy, University of New South Wales, Sydney, NSW 2056, Australia Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796.

The Cambridge World History of Medical Ethics is the first comprehensive scholarly account of the global history of medical ethics. Offering original interpretations of the field by leading bioethicists and historians of medicine, it will serve as the essential point of departure for future scholarship in the field. The volumes reconceptualize the history of medical ethics through the creation of new categories, including the life cycle; discourses of religion, philosophy, and bioethics; and the relationship between medical (...) ethics and the state, which includes a historical reexamination of the ethics of apartheid, colonialism, communism, health policy, imperialism, militarism, Nazi medicine, Nazi "medical ethics," and research ethics. Also included are the first global chronology of persons and texts; the first concise biographies of major figures in medical ethics; and the first comprehensive bibliography of the history of medical ethics. An extensive index guides readers to topics, texts, and proper names. (shrink)

Ethical issues are inherent in medicine. Morally appropriate forms of medical behaviour, the thorough communication of diagnosis and prognosis, and carefully evaluated treatment promising recovery have been among the standards of medical ethics down to the present day. The testimonies of a lively tradition, which since antiquity has contributed to the permanent critical reflection of medicine, constitute the cultural background of contemporary bioethics. They demonstrate how fertile the dialogue between medicine and philosophy on ethical questions can be. This (...) also includes the critical examination of the objects, aims, methods and boundaries of the physicians profession and of medical research. These boundaries have had throughout history to be constantly renegotiated and defined, and not only in the 21st century. --- Eine Reflexion uber die moralischen Fragen und Probleme, die die arztliche Praxis begleiten, ist der Medizin immanent. Die sittlich angemessene arztliche Haltung, die "gute" und hilfreiche Behandlung und das arztliche Ethos stehen im Zentrum zahlreicher Schriften, die zwischen Humanismus und fruher Neuzeit verfasst wurden. Es sind Zeugnisse einer lebhaften Tradition, die ununterbrochen seit der Antike zur Selbstvergewisserung der Medizin beigetragen hat. Zwischen Mittelalter und Humanismus sahen sich Mediziner den Herausforderungen des mannigfaltigen und lebhaften Heilkunde-Marktes ausgesetzt und dementsprechend verpflichtet, sich umso starker zu behaupten. Die hier prasentierten Beitrage befassen sich mit der uber sich selbst reflektierenden Medizin. Dazu gehoren die kritische Auseinandersetzung mit Gegenstand, Ziel, Methoden und Grenzen des arztlichen Berufes und der medizinischen Forschung. Diese mussten - nicht anders als heute - immer wieder neu definiert und verhandelt werden. (shrink)

Answering the call made by Frederic L. Holmes to introduce the concept of the longue durée in the history of science and medicine, this essay sets out to weigh the pros and cons of the concept for the field. It argues that four genres (or traditions) can be distinguished in medical historiography, each with their own ambitions, methods, perspectives and audiences. It concludes by calling for articulated and lively debate between the protagonists of the different genres as the royal (...) way to historical understanding. (shrink)

Exploring Renaissance humanists’ debates on matter, life and the soul, this volume addresses the contribution of humanist culture to the evolution of early modern natural philosophy so as to shed light on the medical context of the ...

The Hippocratic texts and other contemporary medical sources have often been overlooked in discussions of ancient psychology. They have been considered to be more mechanical and less detailed than poetic and philosophical representations, as well as later medical texts such as those of Galen. This book does justice to these early medical accounts by demonstrating their richness and sophistication, their many connections with other contemporary cultural products and the indebtedness of later medicine to their observations. In addition, (...) it reads these sources not only as archaeological documents but also in the light of methodological discussions that are fundamental to the histories of psychiatry and psychology. As a result of this approach, the book will be important for scholars of these disciplines as well as those of Greek literature and philosophy, strongly advocating the relevance of ancient ideas to modern debates. (shrink)

This is a fundamental re-assessment of the world-view of the alchemists, natural philosophers and intelligencers of the mid 17th century. Based almost entirely upon the extensive and hitherto little-researched manuscript archive of Samuel Hartlib, it charts and contextualises the personal and intellectual history of Johann Moriaen (c.1592-1668), a Dutch-German alchemist and natural philosopher. Moriaen was closely acquainted with many of the leading thinkers and experimenters of his time, including René Descartes, J.A. Comenius, J.R. Glauber and J.S. KÃ1⁄4ffler. His detailed reports (...) of relations with these figures and his response to their work provide a uniquely informed insight into the world of alchemy and natural philosophy. This study also illuminates the nature and mechanisms of intellectual and technological exchanges between Germany, The Netherlands and England. (shrink)

Empiricism has many different faces. As the contributions to this volume demonstrate, in the 17th and 18th century demonstrate medical and philosophical empiricism is less about an "essence" and more a series of specifically modern "acts" or "gestures.".

Medico-philosophical reflections were developed in the 19th and the 20th centuries by three consecutive generations of Polish physicians, active in what was later named the Polish School of Philosophy of Medicine. The second generation of this school published its own journal, Medical Critique [Krytika Lekarska], from 1897 to 1907. Medical Critique included numerous articles on the nature of medical knowledge, the reductionism versus holism debate in biology and medicine, the importance of teleologically-oriented approaches in medicine, the influence (...) of theories and of a priori ideas on clinical observations and on ‘clinical facts’, the problem of classification of diseases, the normative and ethical dimension of medicine, and the ion relationships between philosophy, history and medicine. The existence of a journal dealing specifically with theoretical reflections on medicine undoubtedly contributed to the propagation of original work in the philosophy of medicine in Poland. (shrink)

Introduction I The Portrait of an Ideal II The Rise of Galenism as a Medical Philosophy III Authority and Challenge IV Fall and Afterlife.

A unique relationship exists between physicians and philosophers — one that expands on the constructive potential of the liaison between physicians and, for example, theologians, on the one hand, or, social workers on the other. This liaison should focus in the scientific aspects of medicine, not just the ethical aspects. Philosophers can provide physicians with a perspective on both the philosophy and the history of medicine through the ages — a sense of how medicine has adapted to the social cultural (...) and ethical needs of each period. This perspective, while emphasizing medicine asscience, should not be limited to matters of methodology, or to criteria for distinguishing science from other intellectual pursuits, but should be concerned also with the history, sociology and politics of science. Both physicians and philosophers stand to gain from a strengthening of their active liaison now as never before; but most of all, the public will be the beneficiary. (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and (...) the body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature (...) of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children... let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]). (shrink)

Much of what has been written about the history of medical genetics in North America has focused on physician involvement in eugenics and the transition from heredity counseling to genetic counseling in the United States. What are typically missing in these accounts are details concerning the formation of a new medical specialty, i.e., medical genetics, and Canada’s involvement in specialty formation. Accordingly, this paper begins to fill in gaps by investigating, on the one hand, the history of (...) American and Canadian geneticists working together to support the creation of examining and teaching positions in human genetics in North American medical schools and, on the other, working independently of one another to monitor the rate and direction of workloads and patient access to local genetic counseling and laboratory services and, subsequently, achieve recognition for medical genetics as a medical specialty at the national level. (shrink)

Medical schools are among the most important spaces for the history of the body. It is here that students come to know the anatomical bodies of their future patients and, through a process of cognitive and embodied practice, that the knowing bodies of future clinicians are also shaped. Practical and theoretical understandings of medicine are formed in these affective and historied buildings and in collaboration with a broad material culture of education. Medical schools are, however, both under-theorised and (...) under-historicised. This article integrates ‘materialist’ considerations of the body with Henri Lefebvre’s philosophy of space and rhythm in order to compare two markedly different spaces – the 19th-century Anatomy Department at Semmelweis University in Hungary and the mid-20th-century ‘skills laboratory’ at Maastricht University in the Netherlands. This comparison suggests that biomedical bodies are variously shaped by the agential and affective material histories present in the everyday experience of contemporary medical education. (shrink)

This volume reprints in a scholar's edition the first English-language texts on bioethics, John Gregory's (1724-1773) Observations on the Duties and Offices of a Physician and on the Method of Prosecuting Enquiries in Philosophy (London, 1770) and Lectures on the Duties and Qualifications of a Physician (London, 1772). Five previously unpublished manuscripts of Gregory's lectures are also included. An introduction places Gregory's medical ethics and philosophy of medicine in their eighteenth-century contexts of Scottish Enlightenment history and culture, Baconian science (...) and philosophy of medicine, medical practice, the feminine and feminist philosophy of the Bluestocking Circle, and moral sense philosophy, particularly David Hume's concept of sympathy, and provides a bibliography of primary and secondary sources as an aid to teaching and future scholarship. The book's index provides access to Gregory's texts, by using both historical terms and current terminology of bioethics. A volume in the subseries Classics of Medical Ethics. (shrink)

The paper provides a critical commentary on the article by Baker and McCullough on Medical Ethic's Appropriation of Moral Philosophy. The author argues that Baker and McCullough offer a more "pragmatic" approach to the history of medical ethics that has the potential to enrich the bioethics field with a greater historical grounding and sound methodology. Their approach can help us to come to a more nuanced understanding about the way in which medical ethics has connected, disconnected, and (...) reconnected with philosophical ideas throughout the centuries. The author points out that Baker and McCullough's model can run the danger of overemphasizing the role of medical ethicists whilst marginalizing the influence of philosophers and of other historical actors and forces. He critically reviews the two case studies on which Baker and McCullough focus and concludes that scholars need to bear in mind the levels of uncertainty and ambivalence that accompany the process of transformation and dissemination of moral values in medicine and medical practice. (shrink)

In the course of the long 18th century, medical theory and theories underwent profound changes. These in turn reflected discontinuities and often conflicting assumptions and premises, engendering divergent concepts of physiology and pathology. However, most theoretical considerations were only very inconsistently and partially reflected in therapeutic practice, which continued to be governed by experience with traditional and known medicinals and by patient expectations regarding provider practices. Additional factors in therapeutic decision making were economic considerations and preferences for particular therapies (...) in certain social and religious networks. The present volume deals with some aspects of this complex relationship between medical theory and therapeutic practice, using a transatlantic perspective. Individual essays reflect the current state of historical research in Germany, the US and Great Britain. (shrink)

Medical Assistance in Dying (MAiD) in Canada has had a tumultuous social and legal history. In the 6 years since assisted dying was decriminalized by the Canadian Parliament in June 2016, the introduction of this practice into the Canadian healthcare system has been fraught with ethical challenges, practical hurdles and grass-roots innovation. In 2021, MAiD accounted for approximately 3.3% of all Canadian deaths annually, and more patients are seeking MAiD year over year as this option becomes more widely know. (...) Unfortunately, some patients who want MAiD are unable to access it in a timely manner because of a lack of willing MAiD providers. This introduction describes statistics about the uptake of MAiD in Canada and the challenges presented by Canadians’ rapid acceptance of this end of life care option. In this special edition of HEC Forum about the implementation of MAiD in Canada, authors depict a range of ethical challenges and strategies to address issues related to MAiD access and quality, organizational engagement, clinician recruitment and retention, and support for a morally diverse workforce. In each article, the authors reflect on the question: What are the practical ethics involved in introducing assisted dying into a new healthcare context, and how can ethicists and ethics resources collaborate with stakeholders to ensure the integration of ethical considerations as this practice continues to evolve? (shrink)

The concept of medicine as a profession in the English-language literature of medical ethics is of recent vintage, invented by the Scottish physician and medical ethicist, John Gregory (1724-1773). Gregory wrote the first secular, philosophical, clinical, and feminine medical ethics and bioethics in the English language and did so on the basis of Hume's principle of sympathy. This paper provides a brief account of Gregory's invention and the role that Humean sympathy plays in that invention, with reference (...) to key texts in Gregory's work. The paper also considers two interesting and perhaps provocative ways in which Hume can be read through Gregory: first, sympathy as a principle of scientific discovery in Hume's science of man and moral physiology; and sympathy as gendered feminine in Hume's moral philosophy. Hume's principle of sympathy is at the core of Gregory's medical ethics and the histories of Western medical ethics and bioethics pivot on Gregory - and, therefore, on Hume - as it does on few other figures. (shrink)

Using fictionalized case studies this series follows four patients through the medical process, from onset through Diagnosis, Treatment and PrognosisVolume 1: Symptom. Examines the idea of 'symptom' as a route to understanding the structure of clinical practice -- Volume 2: Diagnosis. Explores the meaning of 'diagnosis' as a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. -- Volume 3: Treatment. Considers the concept of treatment as an active process which produces an outcome, be it (...) effective, inappropriate or inadequate. Enlightening reading. -- Volume 4: Prognosis. Contemplates the challenge of the prognosis, attempting to make sense of life and death. Considers, through personal and professional perspectives, the role of the medical profession in guiding patient experience.--. (shrink)

Purpose: To examine the historical dimensions and ethical boundaries of medical repatriation, particularly as they relate to patients, health care providers, and hospitals. Methods: The methods employed in this analysis are rooted in the traditions and techniques of modern philosophy, medical ethics, and applied ethical theory. Results: After exploration and critical evaluation of the history and motivations behind medical repatriation, considerations against the practice are advanced. Drawing on the ethical dimensions of informed consent, equality, distributive justice, transparency, (...) and trust, the tension between medical repatriation and the ethical duties of health care providers is assessed. Conclusions: At this time of great change in health care and immigration policy, clarity about our ethical obligations to undocumented immigrants is crucial if we are to create systems that are not only efficient, coordinated, and technologically sophisticated but also equitable for those who are vulnerable. (shrink)

The discovery of dietetics -- Philosophy of the nature of man -- Therapy of body and soul -- The philosophical legacy of On regimen.

Modern health care relies extensively on the use of technologies forassessing and treating patients, so it is important to be certain that health care technologies (i.e., pharmaceuticals, devices, procedures, and organizational systems) perform their professed functions in an effective and safe manner. Philosophers of technology have developed methods to assign and evaluate the functions of technological products, the major elements of which are described in the ICE theory. This paper questions whether the standard of evidence advocated by the ICE theory (...) is adequate for ascribing and assessing technologies employed in health care. The paper proposes that the general problem with the standard of evidence embodied in the ICE theory (i.e.,testimony and evidence of mechanisms) is too permissive for assessing medical technologies, in that it does not take into account the relative benefit and harm of medical technologies in ensuring safe functional performance in patients. The paper illustrates how evidence-based medicine (EBM) has demonstrated the value of clinical research methods, including observational studies, randomized and non-randomized clinical trials, and formal techniques, such as meta-analysis, to measure therapeutic effectiveness. I argue, therefore, that evidence from clinical research studies should take precedence over the testimonial evidence and other types of non-clinical evidence, inproviding justification for health technologies. (shrink)

This book offers a comprehensive study of the views of ancient philosophers on mental disorders. Relying on the original Greek and Latin textual sources, the author describes and analyses how the ancient philosophers explained mental illness and its symptoms, including hallucinations, delusions, strange fears and inappropriate moods and how they accounted for the respective roles of body and mind in such disorders. Also considered are ethical questions relating to mental illness, approaches to treatment and the position of mentally ill people (...) in societies of the times. The volume opens with a historical overview that examines ancient medical accounts of mental illness, from Hippocrates' famous Sacred Disease to late antiquity medical authors. Separate chapters interpret in detail the writings of Plato, Aristotle, Galen and the Stoics and a final chapter summarises the views of various strains of Scepticism, the Epicurean school and the Middle and Neo-Platonists. Offering an important and useful contribution to the study of ancient philosophy, psychology and medicine. This volume sheds new light on the history of mental illness and presents a new angle on ancient philosophical psychology. (shrink)

The early history of thermometry is most commonly described as the result of a continuous development rather than the product of a single brilliant mind, and yet scholars have often credited the Italian physician Santorio Santori with the invention of the first thermometers. The purpose of using such instruments within the traditional context of Galenic medicine, however, has not been investigated and scholars have consistently assumed that, being subject to the influence of atmospheric pressure and en­vironmental heat, Santorio’s instruments provided (...) unreliable measurements. The discovery that, as early as 1612, Santorio describes all vacuum-related phenomena as effects of the atmospheric pressure of the air, provides ample room for reconsidering his role in the development of precision instruments and the early history of thermometry in particular. By drawing on a variety of written and visual sources, some unpublished, in the first part of this article I argue that Santorio’s appreciation of phenomena related to the weight of the air allowed him to construct the first thermometers working as sealed devices. Finally, in the second part, I consider Santorio’s use of the thermometer as related to the seventeenth-century medical practice and his way to measure the temperature as based on a wide sample of individuals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of medicine has (...) generated such turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

The papers in this number of the Journal originated in a session sponsored by the American Philosophical Association's Committee on Philosophy and Medicine in 1999. The four papers and two commentaries identify and address philosophical challenges of how we should understand and teach bioethics in the liberal arts and health professions settings. In the course of introducing the six papers, this article explores themes these papers raise, especially the relationship among professional medical ethics, the "long history" of medical (...) ethics, and bioethics. The tendency of bioethics to deprofessionalize medical ethics is rejected, in favor of an historically informed professional medical ethics. It is suggested that bioethics should be critically reconsidered from the perspective of medical ethics as professional ethics. (shrink)

This paper examines the deployment of science studies within the field of medical ethics. For a short time, the discourse of medical ethics became a fertile ground for a dialogue between philosophically minded bioethicists and the philosophers of science who responded to Thomas Kuhn's challenge. In their discussion of the validity of Kuhn's work, these bioethicists suggested a distinct interpretation of Kuhn, emphasizing the elements in his account that had been independently developed by Michael Polanyi, and propelling a (...) view of science that retreated from idealizations of scientific method without sacrificing philosophical realism. Appropriating Polanyi, they extended his account of science to biology and medicine. The contribution of Karl Popper to the debate on the applicability of philosophy of science to the issues of medical ethics provides the opportunity to discuss the ways in which political agendas of different epistemologies of science intertwined with questions of concern to medical ethics. (shrink)