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Philosophy of medicine
The philosophy of medicine is a branch of philosophy that explores issues in theory, research, and practice within the field of health sciences, more specifically in topics of epistemology, metaphysics, and medical ethics, which overlaps with bioethics. Philosophy and medicine have had a long history of overlapping ideas. It was not until the nineteenth century that the professionalization of the philosophy of medicine came to be. In the late twentieth century, debates among philosophers and physicians ensued of whether the philosophy of medicine should be considered a field of its own from either philosophy or medicine. A consensus has since been reached that it is in fact a distinct discipline with its set of separate problems and questions. In recent years there have been a variety of university courses, journals, books, textbooks and conferences dedicated to the philosophy of medicine.
Epistemology is a branch in the philosophy of medicine that is concerned with knowledge. The common questions asked are "What is knowing or knowledge?", "How do we know what we know?", "What is it we know when we claim we know".[page needed] Philosophers differentiate theories of knowledge into three groups: knowledge of acquaintance, competence knowledge, and propositional knowledge. The knowledge of acquaintance is to be familiar with an object or event. For example, a surgeon would need to know the human anatomy before operating on the body. Competence of knowledge is to use known knowledge to perform a task skillfully. The surgeon must know how to perform the surgical procedure before executing it. Propositional knowledge is explanatory; it pertains to certain truths or facts. If the surgeon is performing an operation on the heart they must know the physiological function of the heart before the surgery is performed.
Metaphysics is the branch of philosophy that examines the fundamental nature of reality including the relationship between mind and matter, substance and attribute, and possibility and actuality. The common questions asked within this branch are "What causes health?" and "What causes disease?". There is a growing interest in the metaphysics of medicine, particularly the idea of causality. Philosophers of medicine might not only be interested in how medical knowledge is generated, but also in the nature of such phenomena. Causation is of interest because the purpose of much medical research is to establish causal relationships, e.g. what causes disease, or what causes people to get better. The scientific processes used to generate causal knowledge give clues to the metaphysics of causation. For example, the defining feature of randomized controlled trials (RCTs) is that they are thought to establish causal relationships, whereas observational studies do not. In this instance, causation can be considered as something which is counterfactually dependent, i.e. the way RCTs differ from observational studies is that they have a comparison group in which the intervention of interest is not given.
There is a large body of work on the ontology of biomedicine, including ontological studies of all aspects of medicine. Ontologies of specific interest to the philosophy of medicine include, for instance: (1) the ontological revolution which made modern science, in general, possible, (2) Cartesian dualism which makes modern medicine, in particular, possible, (3) the monogenetic conception of disease which has informed clinical medicine for a century or so[page needed] and also the chemical and biological pathways which underlie the phenomena of health and disease in all organisms, (4) the conceptualization of entities such as 'placebos' and 'placebo effects'.
The Ontology of General Medical Science (OGMS) is an ontology of entities involved in a clinical encounter. It includes a set of logical definitions of very general terms that are used across medical disciplines, including disease, disorder, disease course, diagnosis, and patient. The scope of OGMS is restricted to humans, but many terms can be applied also to other organisms. OGMS provides a formal theory of disease that is elaborated further by specific disease ontologies which extend it, including the infectious disease ontology (IDO) and the mental disease ontology.
René Descartes made ontological space for modern medicine by separating body from mind — while mind is superior to body as it constitutes the uniqueness of the human soul (the province of theology), body is inferior to mind as it is mere matter. Medicine simply investigated(s) the body as machine. While Cartesian dualism dominates clinical approaches to medical research and treatment, the legitimacy of the split between mind and body has been consistently challenged from a variety of perspectives.[page needed][page needed]
Modern medicine, unlike Galenic medicine (which dealt with humours), is mechanistic. For example, when a bit of solid matter such as a poison or a worm impacts upon another bit of matter (when it enters the human body), this sets off a chain of motions, giving rise to disease, just as when one billiard ball knocks into another billiard, the latter is set in motion. When the human body is exposed to the solid pathogen, it falls ill, giving rise to the notion of a disease entity. Later in the history of modern medicine, particularly by the late nineteenth and twentieth centuries, in nosology (which is the classification of disease), the most powerful is the etiogically defined approach as can be found in the monogenic conception of disease which covers not only infectious agents (bacteria, viruses. fungi, parasites, prions) but also genetics and poisons. While clinical medicine is concerned with the ill health of the individual patient when s/he has succumbed to disease, epidemiology is concerned with the pattern of diseases in populations in order to study their causes as well as how to manage, control, ameliorate the problems identified under study.
Clinical medicine, as presented above, is part of a reductionist approach to disease, based ultimately on Cartesian dualism which says that the proper study of medicine is an investigation of the body when the latter is viewed as machine. A machine can exhaustively be broken down into its component parts and their respective functions; in the same way, the dominant approach to clinical research and treatment assumes the human body can be broken down or analysed in terms of its component parts and their respective functions, such as its internal and external organs, the tissues and bones of which they are composed, the cells which make up the tissues, the molecules which constitute the cell, down to the atoms (the DNA sequences) which make up the cell in the body.
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Philosophy of medicine
The philosophy of medicine is a branch of philosophy that explores issues in theory, research, and practice within the field of health sciences, more specifically in topics of epistemology, metaphysics, and medical ethics, which overlaps with bioethics. Philosophy and medicine have had a long history of overlapping ideas. It was not until the nineteenth century that the professionalization of the philosophy of medicine came to be. In the late twentieth century, debates among philosophers and physicians ensued of whether the philosophy of medicine should be considered a field of its own from either philosophy or medicine. A consensus has since been reached that it is in fact a distinct discipline with its set of separate problems and questions. In recent years there have been a variety of university courses, journals, books, textbooks and conferences dedicated to the philosophy of medicine.
Epistemology is a branch in the philosophy of medicine that is concerned with knowledge. The common questions asked are "What is knowing or knowledge?", "How do we know what we know?", "What is it we know when we claim we know".[page needed] Philosophers differentiate theories of knowledge into three groups: knowledge of acquaintance, competence knowledge, and propositional knowledge. The knowledge of acquaintance is to be familiar with an object or event. For example, a surgeon would need to know the human anatomy before operating on the body. Competence of knowledge is to use known knowledge to perform a task skillfully. The surgeon must know how to perform the surgical procedure before executing it. Propositional knowledge is explanatory; it pertains to certain truths or facts. If the surgeon is performing an operation on the heart they must know the physiological function of the heart before the surgery is performed.
Metaphysics is the branch of philosophy that examines the fundamental nature of reality including the relationship between mind and matter, substance and attribute, and possibility and actuality. The common questions asked within this branch are "What causes health?" and "What causes disease?". There is a growing interest in the metaphysics of medicine, particularly the idea of causality. Philosophers of medicine might not only be interested in how medical knowledge is generated, but also in the nature of such phenomena. Causation is of interest because the purpose of much medical research is to establish causal relationships, e.g. what causes disease, or what causes people to get better. The scientific processes used to generate causal knowledge give clues to the metaphysics of causation. For example, the defining feature of randomized controlled trials (RCTs) is that they are thought to establish causal relationships, whereas observational studies do not. In this instance, causation can be considered as something which is counterfactually dependent, i.e. the way RCTs differ from observational studies is that they have a comparison group in which the intervention of interest is not given.
There is a large body of work on the ontology of biomedicine, including ontological studies of all aspects of medicine. Ontologies of specific interest to the philosophy of medicine include, for instance: (1) the ontological revolution which made modern science, in general, possible, (2) Cartesian dualism which makes modern medicine, in particular, possible, (3) the monogenetic conception of disease which has informed clinical medicine for a century or so[page needed] and also the chemical and biological pathways which underlie the phenomena of health and disease in all organisms, (4) the conceptualization of entities such as 'placebos' and 'placebo effects'.
The Ontology of General Medical Science (OGMS) is an ontology of entities involved in a clinical encounter. It includes a set of logical definitions of very general terms that are used across medical disciplines, including disease, disorder, disease course, diagnosis, and patient. The scope of OGMS is restricted to humans, but many terms can be applied also to other organisms. OGMS provides a formal theory of disease that is elaborated further by specific disease ontologies which extend it, including the infectious disease ontology (IDO) and the mental disease ontology.
René Descartes made ontological space for modern medicine by separating body from mind — while mind is superior to body as it constitutes the uniqueness of the human soul (the province of theology), body is inferior to mind as it is mere matter. Medicine simply investigated(s) the body as machine. While Cartesian dualism dominates clinical approaches to medical research and treatment, the legitimacy of the split between mind and body has been consistently challenged from a variety of perspectives.[page needed][page needed]
Modern medicine, unlike Galenic medicine (which dealt with humours), is mechanistic. For example, when a bit of solid matter such as a poison or a worm impacts upon another bit of matter (when it enters the human body), this sets off a chain of motions, giving rise to disease, just as when one billiard ball knocks into another billiard, the latter is set in motion. When the human body is exposed to the solid pathogen, it falls ill, giving rise to the notion of a disease entity. Later in the history of modern medicine, particularly by the late nineteenth and twentieth centuries, in nosology (which is the classification of disease), the most powerful is the etiogically defined approach as can be found in the monogenic conception of disease which covers not only infectious agents (bacteria, viruses. fungi, parasites, prions) but also genetics and poisons. While clinical medicine is concerned with the ill health of the individual patient when s/he has succumbed to disease, epidemiology is concerned with the pattern of diseases in populations in order to study their causes as well as how to manage, control, ameliorate the problems identified under study.
Clinical medicine, as presented above, is part of a reductionist approach to disease, based ultimately on Cartesian dualism which says that the proper study of medicine is an investigation of the body when the latter is viewed as machine. A machine can exhaustively be broken down into its component parts and their respective functions; in the same way, the dominant approach to clinical research and treatment assumes the human body can be broken down or analysed in terms of its component parts and their respective functions, such as its internal and external organs, the tissues and bones of which they are composed, the cells which make up the tissues, the molecules which constitute the cell, down to the atoms (the DNA sequences) which make up the cell in the body.