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THE PHILOSOPHY OF MEDICINE: CUNICAL SCIENCE AND ITS ETHICS DANIEL A. MOROS* Of central concern to the philosophy of medicine is an understanding of the relationship that arises between science and ethics when decisions involve human beings. To examine this relationship, we must consider the status of claims to medical knowledge and whether there exists within medical practice a style of collecting and analyzing data and making therapeutic decisions that is properly called science. Since ideally, in medicine, knowledge guides practice, to a significant extent our factual claims will legislate our behavior toward our fellowman. Clearly, other considerations compete with science for influence over medical decisions —for example, law, custom, patient preferences, convenience. However, without a "science of clinical medicine" and without a clear understanding of how we distinguish between valid and invalid factual claims, medical opinion loses much of its moral force. These introductory remarks reflect a belief that a clinical science does indeed exist. This view of medicine is not universally shared, and an examination of this assumption will be the primary task of the first two sections of this essay. There I will briefly survey well-known material in the phUosophy and history of science and attempt to demonstrate the scientific status of good clinical thought. This is followed by a discussion of the concept of reasonableness in medical decision making. It is this further concept that links science to practice, ultimately raising a variety of ethical issues. The concluding section explores more specifically the intimate link between clinical science and ethics, both the ethical demands created by science and the need to structure scientific work so as to be consonant with our moral perspectives. ?Department of Neurology, Mount Sinai Medical School, One Gustave L. Levy Place, New York, New York 10029.©1987 by The University of Chicago. AU rights reserved. 0031-5982/88/3101-0550$01.00 134 I DanielA. Moras ¦ The Philosophy ofMedicine Some Remarh on the Philosophy of Science Before delineating those aspects of the physician's daily thought and behavior that might validly be called a science of clinical medicine, we should have at hand some general characterization of scientific activity. It is not necessary to explore problematic areas and open questions for our needs are more limited. AU that is required is a reasonably sophisticated characterization of science so that we have a common vantage point from which to compare clinical work with more paradigmatic examples of scientific activity. There are at least two different, though not contradictory, views of science. One focuses on science as a creative process generating an everimproving picture of the world. The other focuses more on the issue of justification, emphasizing that science is a way of organizing our knowledge of the world and evaluating the relative merits of our beliefs and claims. At a minimum, science involves the careful collection of data and the explicit organization of data and presuppositions to create a theory that in turn provides an "explanation" ofobservable phenomena. There are, ofcourse, many kinds ofexplanation—scientific, historical, theological . To be scientific, the organization of data must be such that we can, at least in principle, test the truth ofour claims. The common intuition is that facts are somehow pure and clear and that theory represents the man-made part ofscience. However, our choice ofwhat to accept as data is a complex decision and to an extent is determined by our theoretical viewpoints. Consider the claim that the moon revolves around the earth. No ancient seafarer or nomadic wanderer could conceptualize the moon as a distant spherical body traveling through empty (frictionless) space around the earth. For a high school student with a telescope in 1987 the position of the moon is a simple observation, but this simplicity exists only within the context ofan elaborate theory. As a second example consider a common medical encounter. When a patient states that vitamin C always cures his cold, we do not accept tfiis testimony as data. An appreciation of die unreliability ofsuch a claim and an understanding ofdie need for controlled observation (i.e., the choice of what are to be accepted as data) is determined by our more general theories and beliefs. In addition to...


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