Scientism is a philosophy which purports to define what the world ‘really is’. It adopts what the philosopher Thomas Nagel called ‘an epistemological criterion of reality’, defining what is real as that which can be discovered by certain quite specific methods of investigation. As a consequence all features of experience not revealed by those methods are deemed ‘subjective’ in a way that suggests they are either not real, or lie beyond the scope of meaningful rational inquiry. This devalues capacities that (...) (we argue) are in fact essential components of good reasoning and virtuous practice. Ultimately, the implications of scientism for statements of value undermine value-judgements essential for science itself to have a sound basis. Scientism has implications, therefore, for ontology, epistemology and also for which claims we can assert as objective truths about the world. Adopting scientism as a world view will have consequences for reasoning and decision-making in clinical and other contexts. We analyse the implications of this approach and conclude that we need to reject scientism if we are to avoid stifling virtuous practice and to develop richer conceptions of human reasoning. (shrink)

Editors' introduction to 3rd thematic issue on philosophy of medicine.

Effective person-centred care requires recognition of the personhood not only of patients but of practitioners. This chapter explores the consequences of this recognition for major debates in medical epistemology, regarding clinical reasoning and the relationship between research and practice. For too long these debates have been dominated by false dichotomies - subjectivity versus objectivity, judgement versus evidence, reason versus emotion. Based on flawed understandings of such core concepts as “objectivity” and “engagement”, this distorted dissection of the subject-object relationship has served (...) to depersonalise practice. The costs of this depersonalisation include over-regulation and micromanagement of healthcare processes by administrators and payers at the same time that information from clinical research remains under-utilized and the personhood of patients risks being ignored. Science is a human practice, founded in a broader conception of human reasoning, ontologically dependent on human beings living and engaging with the world in social, emotional and ethical contexts. After looking at different conceptions of epistemic hierarchies and their uses in the analysis and evaluation of reasoning in a range of practice contexts, we propose a “nested hierarchy” that effectively turns upside-down the flawed evidence hierarchies that have helped to depersonalise care. T.S. Eliot’s “wisdom, knowledge, information” scheme (to which we add “data” below “information”) provides a model for a person-centred epistemic hierarchy. This crucial, person-centred inversion represents levels of awareness that characterise more or less developed thinking and judgement on the part of the particular practitioner. (shrink)

Fulford’s chapter discusses the conceptual challenges facing person-centred care and the role of philosophy in addressing these challenges. He is right that this role - to investigate underlying meanings and reveal assumptions - need not and should not be restricted to the search for definitions of key terminology. The methods of “ordinary language philosophy” enable us to understand the meanings of terms by systematically examining their use in context, with a view to mapping a term's “logical geography”. He makes effective (...) use of this methodology to show that alternative accounts of what it means to be “person-centred” need not be contradictory and can indeed be fully complementary. The approach of mapping the usage of the key terms is necessary if we are to understand the discourse, but it is by no means sufficient in gaining a coherent understanding of the meaning and value of PCC - let alone one that could provide the basis for its effective implementation. While it is true that distinct accounts can reveal different and compatible “aspects” of PCC, the language of PCC - like that of “evidence” and “ethics” - is not simply diverse, it is contested. Fulford argues that “genuine” PCC provides a proper balance between the “extremes” of paternalism and consumerism. This language is clearly normative, going beyond what he characterises as the “empirical” exercise of mapping usage. A broader inquiry, based on the distinction between philosophy as a body of theory and as dialogue, and incorporating a direct engagement with normative questions, is necessary if we are to address the challenges Fulford identifies. The exercise of “mapping logical geography” reminds us that health discourse has no clear borders such that, by following its links to their logical limits, we will find ourselves inevitably in the midst of broader dialogues about the social nature of persons, the nature of value, agency and the basis for our obligations to one another. (shrink)