An Introductory Philosophy of Medicine

by Marcum

In this book the author explores the shifting philosophical boundaries of modern medical knowledge and practice occasioned by the crisis of quality-of-care, especially in terms of the various humanistic adjustments to the biomedical model. To that end he examines the metaphysical, epistemological, and ethical boundaries of these medical models. He begins with their metaphysics, analyzing the metaphysical positions and presuppositions and ontological commitments upon which medical knowledge and practice is founded. Next, he considers the epistemological issues that face these medical models, particularly those driven by methodological procedures undertaken by epistemic agents to constitute medical knowledge and practice. Finally, he examines the axiological boundaries and the ethical implications of each model, especially in terms of the physician-patient relationship. In a concluding Epilogue, he discusses how the philosophical analysis of the humanization of modern medicine helps to address the crisis-of-care, as well as the question of “What is medicine?” The book’s unique features include a comprehensive coverage of the various topics in the philosophy of medicine that have emerged over the past several decades and a philosophical context for embedding bioethical discussions. The book’s target audiences include both undergraduate and graduate students, as well as healthcare professionals and professional philosophers. “This book is the 99th issue of the Series Philosophy and Medicine…and it can be considered a crown of thirty years of intensive and dynamic discussion in the field. We are completely convinced that after its publication, it can be finally said that undoubtedly the philosophy of medicine exists as a special field of inquiry.”

Genres: Philosophy, Nonfiction

392 pages, Hardcover

First published January 1, 2008

Reviews

[Amirsaman · Rating 2 out of 5]

ریویوی ۲۰۲۲ - بر اساس نسخه‌ی ترجمه

کتاب مشتمل است بر سه بخش. بخش اول که متافیزیک و ارزش‌های غیر علمی پزشکی را توضیح می‌دهد، تنها قسمتی است که یک مقدار به مفاهیم فلسفه‌ی پزشکی نزدیک است. بخش دومْ معرفت‌شناسی است و «آمار زیستی» و «روش تحقیق پزشکی» در آن بیان می‌شود، آن هم به شیوه‌ای سرسری. بخش آخر مربوط به اخلاق پزشکی است و نویسنده‌ی نا-پزشکِ ما بیشتر روی آن تسلط دارد. مکاتب اخلاقی را لیست می‌کند. خلاصه نه حرف تازه‌ای می‌زند و نه حرف حساب.

همه‌ی بحث سر این است که پزشکی باید با انسان‌ها مهربان باشد و رابطه‌ی عشق بین پزشک و بیمار برقرار شود تا همه‌ی مشکلات حل شوند. این کتاب به بهترین شکلی نشان می‌دهد که آرمان‌های اخلاق پزشکی چقدر مضحک و خود-متناقض هستند. نویسنده، درست همان کاری که پزشکی مدرن فعلی دارد انجام می‌دهد را به یک زبان عامه‌پسند و صد البته کاملا غیرفلسفی،بیان می‌کند تا بگوید که پزشکی مدرن بد است و به جایش باید پزشکی انسان‌محور را روی کار آورد؛ تا بدون قرص و با صحبت با مریض، وی را شفای عاجل بخشید. البته که کارآیی خود همین تلقین و رابطه‌ی خوب با مریض بر بهبودی را همان پزشکی مدرن علمی‌ای که نویسنده دارد توی سرش می‌زند فهمیده است، با روش‌های «سرد و خشک» خودش. نشستن بر برج عاج و فتوای اخلاقی برای پزشکان صادر کردن، شیادی است.

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ریویوی ۲۰۱۸ بر اساس بخش نتیجه‌گیری از نسخه‌ی انگلیسی

"Conclusion: What Is Medicine?"

Art of medicine is concernd about the whole person not simply the diseased organ. Swift believed art implies creation of special conditions from available material (which in medicine are prepared by science.) He demarcated two roles for art in medicine; the manner in which knowledge may be applied and also the assist of art in the technique for acquiring new knowledge.

Since antiquity, medicine is connected to natural sciences, but actually it was after William Harvey discovered circulation in 17 century that medicine was accepted as science. For William Welch medicine was rational, observational, inductive, and physical. Later, Fultom said that medicine is the analysis of normal and pathological processes of the body in terms of physical and chemical laws, with the end of therapy.
Some claimed that medicine is not a science beacase its goal is to reliece suffer, but the aim of science is to acquire knowledge.
Some think that medicine is a social science and to understand the patient, doctors should consider the social influences on the origins, explanation, and prevention of disease.

Finally, Pellegrino suggest that every physician himself/herself should deside how to combine these two aspects (art and science).

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Evidence-based medicine should be practised in five steps. Finding patient's problem, searching in PubMed, appraisal, applying the evidence to the patient's problem, and finally an evaluation of the effectiveness of the process.
Some said before EBM, medicine did used evidence. Also in EBM there are different opinions which conflict. Evidence is obtained from population-based studies, so it is not applicable to any individual patient. And there is this ethical question that does the patient wants to undergo the treatment based on the best evidence. Finally, EBM is very much related to clinical judgment which is more akin to casuistry than to scienctific rationality.

In Patient-Centered Medicine, unlike EBM, humanistic and biopsychosocial perspectives are importat. It's not doctor-centered, but the focus is on patient's illness experience.
PCM's goal is effective communocation. A robust medicine will arise when PCM and EBM are combined.

There is also a Narrative-Based Medicine which stress on listening to the illness story.

Value-Based Medicine "integrate the best EBM data with the patient-perceived quality of life improvement by a healthcare intervention". It makes healthcare more cost-effective.

[Brandon Sitch · Rating 2 out of 5]

This book leans more heavily towards the "Introductory Philosophy" and away from the "of Medicine." The book consists of three sections (Metaphysics, Epistemology, and Ethics—simple enough) and each section is divided into five chapters, most of which weren't worth the time (were I to diagnose the book I would say that there is some sort of benign growth). Many of the chapters present a sub-SEP level of philosophy, with some tenuous connection to medicine.

To use as an example (or, a case study, if you will), there is the second chapter in the Metaphysics section: "Medical Causation and Realism." The chapter's first sentence typifies many of the issues with the book as a whole: "Causation and realism are two important notions that are essential for understanding any worldview, especially medical worldviews." The main clause of the sentence concerns philosophy with (a grammatically-incomplete) "especially medical worldviews" thrown on the end for good measure. The rest of the chapter devotes most of its space to either historical understandings of causation or the various positions within realism or anti-realism. The connection to medicine (ostensibly the point of the book) amounts to saying that physicians who use a biomedical approach tend towards realism whereas those who prefer a humanistic approach to medicine tend towards anti-realism.

The final problem I'll mention is that the connections to medicine invariably involve breaking physicians into two categories: those who prefer the biomedical approach on the one hand, and humanistic ones on the other. From this point, he then will comment how the biomedical approach has been useful and effective thus far, but has contributed to the quality-of-care crisis. He's almost certainly correct that the biomedical approach has contributed to the quality-of-care crisis, but this is hardly groundbreaking (or worth writing a dozen times). Thus, the book becomes reductive and formulaic—which funnily enough, is the major failing of the biomedical approach.

[Mahmoud El · Rating 3 out of 5]

The book presents a comperhensive philosophical overview over the major issues concerning the philosophy of medicine by contrasting mainly two models of medical practice ; realistic, scientific based, and value-free biomedical model, and paryially subjetive, narrative-based, value - laden humanistic practice with a good overview of models and approaches in between those two extremes. The book is more about philosophy than about medicine so it requires a little bit of a background in philosophy. I recommend it if ur interested in the subject of the common space between medicine and philosophy though I have to admit it was a little bit boring.

[Mahsa · Rating 2 out of 5]

نقد مفصل و اساسی این کتاب روی تکیه بیش از حدش به پزشکی روایی هست. چیزی که فلسفه پزشکی رو ظریف ونوشتنش رو دشوار می‌کنه رعایت مرز تئوری پردازی و احترام به ماهیت پرکتیکال این حوزه‌ست که این کتاب به سختی توش شکست خورده. اگر به عنوان پزشک کتاب رو بخونید احتمالا فکر میکنید یک عارف قرن هفتم داره از طبیب ایده آلش صحبت میکنه.
بهترین بخش کتاب برای من بخش رئالیسم و آنتی رئالیسم بود که حقیقتا از خیلی کتاب های introductory فلسفه علم بهتر کار شده بود.