"More Things in Heaven and Earth": The Worldly Situated Human Person Perspective

It might seem too obvious to start with this quotation:

Horatio:

O day and night, but this is wondrous strange!

Hamlet:

And therefore as a stranger give it welcome.
There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.

Shakespeare (1951), Hamlet, 1.5.164–167

But then, I think it is obviously correct, as Professor Waterman suggests, that "There are more things in heaven and earth" than simply the application of the scientific method to medical practice. Perhaps there are two quick comments to make about the quotation. First, in Shakespeare's time, "philosophy" would have included science; second, Shakespeare apparently contemplated using "our" rather than "your." So Hamlet is speaking to us, not just to Horatio, and he's speaking about our philosophy and our science.

Waterman has identified an important clash of cultures. On the one hand, we have the scientific approach as used in conventional Western clinical practice (but actually used all over the world); and, on the other hand, we have the approach of complementary and alternative medicine (CAM) (also used all over the world). Waterman is not, however, simply pointing out that there is a clash of cultures; and, I suspect, he'd rather avoid thinking in terms of a "clash." He's pointing to something more nuanced.

But I have to say that I am not completely sure about the nuance. What is required, according to Waterman, is epistemic humility. Clinicians need to be both intellectually honest (applying the scientific method) as well as useful (in the manner of CAM). We have to reconcile pluralism (complementary and alternative approaches) with safety (the scientific approach). The hope is that thinking about honesty and usefulness will motivate a solution to the problem of reconciling–whilst recognizing the importance of pluralism and protection.

This sounds all very well, but how will it be realized? In one sense it poses no problems at all. I can well imagine working in a very good chronic pain clinic where I have plenty of time to listen very actively and with great empathy to people. I can be entirely honest with them about the pros and cons of different treatments. I can reflect on what seems to have been helpful to others. I can ensure that any decisions reflect the facts, but also the values of those who attend the clinic. And so on (perhaps also some scented candles and soft background music). About craniosacral therapy, I can again be honest and say that plenty of people have found it useful, despite the lack of an evidence base. Maybe we could have a laugh about how the upshot of much evidence-based medicine is that there is not enough good-quality evidence, which is why (more seriously now) we must also think about values-based practice (Fulford et al., 2012). In doing all of this I demonstrate my epistemic humility. I show honesty. I acknowledge what has been useful. I encourage a plurality of approaches whilst simultaneously keeping safety in mind.

What if, however, the CAM is not so benign? Now in a private center for cancer care, perhaps the adjunctive treatment includes regular coffee enemas. Would epistemic humility mean that I should blithely encourage people to undergo this regime? After all, I could take the same attitude that I had in the chronic pain clinic. Except, now I am more worried about side effects, death even (Eisele & Reay, 1980). I can explain that some people think coffee enemas are good for you and that some people find them helpful. In reality, however, I am not going to be so pluralistic. Just for the fun of it, I might undergo craniosacral therapy myself, but I am not having any coffee enemas! And I am not going to commend them to anyone else. Am I still demonstrating epistemic humility?

My first substantive point, therefore, is that I do not know what "epistemic humility" really amounts to. If my refusal to entertain the idea of coffee enemas for cancer shows a lack...