Introduction

I have occasion to supervise medical students enrolled in a fourth-year elective called “Philosophy of Medicine.” This offering defies what a colleague once said to me about the subject: “Our students are not interested in philosophy, and in any case, it only confuses them.” She may be correct for most, but a small number do in fact seek me out, and they divide almost equally along the following lines. Half have taken some philosophy courses in college and want to renew their earlier interest and apply those lessons to the educational tasks at hand. The appeal of taking time to think more deeply about what they are learning seems to strike them as important. A second group elects the course for emotional reasons. Lacking philosophical training, their interest usually reflects some confusion about their chosen profession, typically arising from the jolt of entering the world of the sick and dying. They intuit that philosophical reflection might guide them.

To the first group, I explain that philosophy of medicine is an orphan subject: no textbook is currently in print; articles are scattered through a labyrinth of journals; even those journals devoted to the subject are dominated by medical ethics; the books published in philosophy of medicine do not comprise a coherent listing because the field is so fragmented along subject divides and discourses; and finally, philosophers of medicine are few in number and are frustrated by the absence of a robust community of scholars of similar interests. Being duly warned, off these students go to the library to seek their intellectual fortune.

To the second group, I suggest counseling; if that fails, I urge a shift from studying philosophy to doing something else, as did Wittgenstein, who maintained that being a mechanic was preferable to such contemplation. If they are still in the office after those two recommendations, I explain that philosophy offers no final answers, only interesting ways of asking questions and probing problems. If they remain in the chair, I enthusiastically also explain that philosophy is a therapeutic endeavor and I welcome them aboard Battleship Socratica.

The third group, the silent (vast) majority, never call. They are probably the ones my colleague identified, and who am I to shake them from their philosophical doldrums? Yet philosophers of medicine have a public role to perform, and to enlist young physicians in that effort strikes me as a crucial service to health care. If the practitioners of medicine fail to clearly articulate their craft’s conceptual foundations and define the ethos of practice, others will do so instead. Market forces, political expediencies, and competing interests each vie to establish their respective agendas. Without some conceptual grounding, the game will be played and won by rules other than those governing the priority of the patient. Philosophy of medicine, by and large, serves the patient by elucidating the way in which health care might be formulated and enacted for the patient’s benefit.

As with any philosophical subject, philosophy of medicine must contribute to public debate in order to fulfill its own larger social purposes. Publishing a representative set of philosophy of medicine papers in Perspectives in Biology and Medicine addresses that wider arena. The authors assembled in a conference on “Future Horizons for Philosophy of Medicine,” which was held on September 24–25, 2007, under the auspices of the Boston Colloquium for Philosophy of Science at Boston University. These papers cover a wide expanse, reaching from the science of medicine to the pathos that would guide its practice, and each contribution has been written with a generalist reader in mind.

The collection begins with a group of papers concerned with particular epistemological issues that direct clinical science and its practice. Peter Schwartz examines the rise of risk determination as a criterion of disease and the implications of this expansion of the pathological; Paul Thagard argues why the promise of the neurosciences might triumph over non–naturalist-based accounts of the mind; and Jeremy Simon and Harold Kinkaid write of the underlying conceptual structures that orient contemporary medical epistemologies. Such papers are representative of contemporary philosophy of medicine that is not classified as medical ethics...