North South University

Department of History & Philosophy

North South University

Philosophy of Medicine

Name : Md.Minhajul Islam

NSU Id : 2211022042
Section : 11
Semester : Summer 2024
Course Code : PHI104
Course Title : Introduction to Ethics
Faculty : Prof. Dr.Md. Manzoor Elahee
Faculty Initial : MmEe
Submission Date : 28/12/2024

Philosophy of Medicine
Introduction:

Philosophy of medicine is the investigation into big issues in medical theory,

research, and practice. It addresses deep questions, such as what health and disease
really are, and how we know what we know in medicine. The roots of this subject
go back to ancient traditions, such as the writings of Hippocrates. Although the
legitimacy of its standing was once debated, the presence of dedicated journals,
professional organizations, and extensive literature now clearly establishes its
importance. One of the strongest contributions of philosophy of medicine,
however, is with its closely relatedness to bioethics. It forms a backdrop for the
debates involved in bioethics by means of discussing concepts such as disease and
health. Traditional thinkers, including Hippocrates and Galen, focused on the
importance for patient care to integrate both the moral and practical elements of
medicine with knowledge of the science involved in treatment. Philosophy of
medicine has over time incorporated insights from sociology, ethics, and the
philosophy of science. In so doing, it contributes to dealing with contemporary
issues in healthcare inequalities, ethical dilemmas in medical technology, and
artificial intelligence use in healthcare. It also shapes broader discussions in the
philosophy of science, contributing to our understanding of explanation, causation,
and scientific methods. Philosophy has continuously contributed to medicine
through reconsiderations of the purposes and methods of research and clinical
practice. Philosophy lets the physician understand that all sciences, ethics, and
human well-being are deeply interfaced with one another in extremely complex
ways; that is an essential discussion core of modern healthcare.

Existence of the philosophy of medicine:

The existence philosophy of medicine is a debated topic.Scholar like Tristram
Englhardt and Edmund Pellegrino argue that it exist. Pellegrino said medicine is
special because it combines different fields to heal patients and Engelhardt
identified two sense of philosophy of medicine:

1.Weak sense: Deals with bioethics and mind body dualism.

2.Strons Sense: It focused on concepts specific to medicine, such as health and
disease.

On the other hand, Arthur Caplan argued that philosophy of medicine does not
exist as a distinct discipline rather it should be a sub-field of philosophy of science,
focusing on epistemological issues. Caplan listed some rules for being a field of
study and said that philosophy of medicine doesn't follow these rules.However
philosophers like Henrik Wulff and William Stempsey proposed broader ideas of
the philosophy of medicine. Wulff said it's important to consider the social part of
medicine, while Stempsey focused on medical ethics and health ideas.

Insipte of significant debate, many scholars support the existence of the philosophy
of medicine by viewing it as a developing field that addresses unique and
important issues within the medical profession.

Models of Medical Knowledge and Practice:

The philosophy of medicine is considered as s sub-descipline of philosophy.It

analyze different models like biomedical and human model to understand the
nature of medicine.These model can explain medical knowledge and practice.

1.Biomedical Model: Focuses the treatment of physical body with sciences, but it
lacks oof personal connection between doctors and patients.

2.Humanistic Model: this model treat the whole person including mind and social
aspects.this model have aim to make medicine more caring and think about
psychological and social aspects.
Metaphysics In Medicine

Metaphysics in medicine involves the study of the nature of reality and existence
that enables us to understand various concepts about health, disease, and the way
our bodies function. The biomedical model views the mind and body as physical
matter, much like a machine with interdependent parts. On the other hand, the
Humanistic model views the mind and body as separate-dualism-and considers the
whole person by including their body, mind, and social context-holism.

Medical Worldviews

The metaphysical position , presuppositions, and ontological commitments of

medical worldviews vary.These worldviews shape the development and
application of medical knowledge.
1. Metaphysical Positions:
o Mechanistic Monism:It is focused on physicailism,materialism and belived
that everything can be explained as a matter of physical process.
o Dualism/Holism: They view patients as whole beings whose health cannot
be fully understood by examining physical parts alone.

2. Metaphysical Presuppositions:
o Naturalism: This view believe everything we see created by natural
events and forces and this can be understood by human without the need
of supernatural explanations.
o Reductionism: This idea says that complex things can be understood by
breaking them down into simpler parts. The model helps to understand
diseases at a molecular level.
o Emergentism: This suggests higher level properties come from lower
level properties but they can’t explain it fully.

3. Ontological Commitments
o Physicalism/Materialism: The biomedical model believe everything
is physical matter.
 o Organicism: Humanistic model are committed to organicism,it views
patients as interconnected whole that focuses on the relationship
between parts rather than the part themselves.

Moving away from a purely biomedical model towards the more humanistic
approaches brings out the need for betterment not only in the technical aspects of
medicine but also in the quality of care and well-being of patients. Understanding
these various worldviews of medicine allows the practitioner to offer improved,
humane healthcare that balances scientific advancement with holistic, empathetic
treatment of body and mind.

Medical Causation and Realism

Medical causation and realism suggest that entities such as patients, diseases, and
bacteria are real, mind-independent objects within a medical worldview.There exist
a casual connection among them.Biomedical practitioners generally adhare to
scientific realism.They view medical entities like bacteria as tangible and directly
responsiblr for causing diseases.On the other hand,humanistic practioners tend
towards antirealism or a weaker form of realism. They view diseases and invisible
entities as more abstract.They believe that understanding illness involves looking
at various factors, including psychological and social ones. That realism-
antirealism philosophical debate underlines the difference in approaches that exists
between the biomedical model of medicine, with its concern with disease
causation, and the humanistic approach to the patient's overall experience of
illness.

Patient as Body or Person

Understanding the nature of the patient is crucial in shaping medical worldviews

and practices. Let's explore how different models perceive the patient.

Patient as Mechanical Body:

Biomedical Model: The biomedical model views the patient as a mechanical body
that consists of separate parts. The patient is reduced to body parts in this model,
whereby the broken part needs to be fixed or replaced without considering the
patient's lived context.
Mechanization: It is a body divided into parts, compared to a generic standard,
made visible through technology, and alienated from the patient's own experience .
Medical technology plays an important role in this mechanization, where the
patient becomes disembodied and treated as an anonymous part of a medical
machine-world.

Patient as Person:

Humanistic Model
In the humanistic model, the patient is not just a body; he is an integrated being
with a body and mind in an environmental context. The model views the patient as
a person with his experiences and stories.
Phenomenological Understanding
It considers the patient as an individual-a life that lived a world. It concentrated on
understanding the body of a patient and his experience within the context of
personal life.

Concept of Person by Cassell

Cassell views the patient in wholeness, a person with an illness story, values, and
what matters to him or her. The approach goes beyond the view of body parts,
which includes the moral and human aspects of patient care.

Concept of Self by Tauber

Tauber defines the self through the relations with others, and hence he emphasizes
the importance of moral and ethical responsibilities. He proposes a balance
between the individual's rights and responsibilities; thus, he considers the patient in
his social and relational world.

Disease or Illness and Health or Wellbeing

Disease or Illness

According to biomedical model disease is a physical condition that can be identiy

through scientific investigation .Health is considered the absence of disease. All
this generally leaves patient suffering and the existential experience of a patient
outside the box. The humanistic practitioners clearly point to the wholeness of a
patient's illness experience, suffering inclusive, and also to existential concerns. A
positive definition of health, in their thinking, also involves physical and mental
and sometimes spiritual well-being.

 Conceptions of Disease

o Ontological Conception: Disease is an entity separate from the person, such

as an infectious agent.
o Physiological Conception: Disease is a deviation from normal physiological
functions.
o Evolutionary Conception: Disease results from maladaptation of the body's
defenses.
o Genetic Conception: Disease is explained by genetic mutations or
abnormalities

Illness: Humanistic practitioners focues on illness as a concrete notion that

embraces the personal experience of a patient and his social background. The
disruption of a patient's lifeworld constitutes illness, which is instigated by
personal and social values.

Health or Wellbeing
While the biomedical model defines health negatively as the absence of disease,
often reducing it to a material state, humanistic models define health in positive
terms as well-being, incorporating physical, mental, and social dimensions.

 Conceptions of Wellbeing

o Normative Concept: Represents cultural norms and encompasses such

factors as cosmetic surgery to improve well-being.
o World Health Organization: Health is the state of complete physical, mental,
and social well-being and not just the absence of disease.
o Whitbeck: The capability to act and participate autonomously and
effectively in a variety of activities.
o Ryff and Singer: Positive health is the engagement in living and the
expression of a wide range of human potentialities.
o Nordenfelt's Welfare Theory: The ability to achieve vital goals necessary for
long-term happiness.
Diagnosis and Therapy

The key parts of diagnosis and treatment in medical practice show how diseases
are understood and treated. According to the biomedical model, a disease is a
physical condition caused by some mechanical reason. It relies on technology for
diagnosis and treatment. Often, an outside-in approach is used: clinical data are
gathered from medical interviews, physical exams, and lab tests. Vaccines,
antibiotics like penicillin, and gene therapy are some major breakthroughs in this
model. However, the biomedical model sometimes misses the patient's personal
experience and emotional needs.

On the other hand, the humanistic model looks at the patient's overall wellbeing
from the physical, emotional, and existential aspects of the illness. This model uses
an inside-out approach, focusing on the communication between the patient and
doctor to gather comprehensive information. Humanistic practitioners see the
doctor as a healer whose presence and empathy play an important role in recovery.
Humanistic medicine supports combining natural body healing with modern
technology.

Bringing together both models can hopefully create a more complete and caring
approach to patient care, addressing both the technological and personal aspects of
the patient's health and wellbeing.

Epistemology

Epistemology is the study of knowledge, including how we know things and how
we justify what we know. There are different types of knowledge:

1. Acquaintance Knowledge: Knowing something or someone, like knowing a

house plan or understanding your own thoughts.
2. Competence Knowledge: Knowing how to do something, like driving a car or
doing surgery.
3. Propositional Knowledge: Knowing facts that can be true or false, traditionally
defined as "justified true belief."
Medical Thinking

Medical thinking is the process by which physicians arrive at decisions about

patient care. Physicians use two approaches in medical thought: objective thinking,
which pertains to facts and data, and subjective thinking, which relates to the
patient's life experiences and personal values.

Objective Thinking

Objective thinking is based on evidence, logic, and proven facts. For example, the
rationalists, Plato believe that knowledge comes from reasoning and the empiricist
like Hume argues learning is experience-based. In medicine, the doctors follow
both the approach to diagnose the illness and suggest a treatment option.

Statistics in Medicine: Doctors often use statistics to drive their decisions. The
frequentist approach compares groups of patients when thinking about general
patterns and differences, while Bayesian statistics combines the accumulation of
past experiences together with current data to allow personalized prediction for
individual patients.

Subjective Thinking

Subjective thinking incorporates the personal side of health care, the patient's
feelings, values, and unique experiences. Humanistic doctors believe that an
understanding of these personal factors is essential to good care. Intuition—that is,
rapid, experience-based judgments—also supplements objective data

Values in Medicine:Values help the doctor understand what is most important to

the patient. These can be personal, cultural, or professional. These values
combined with the medical knowledge of the doctor will more often result in better
care and a better doctor-patient relationship.

Virtue Epistemology:This can be elaborated by the concept that the character of

the doctor is predominant, comprising honesty, empathy, and integrity. The good
doctor requires not only technical expertise but personal virtues to come to a
decision.
Narrative Reasoning:It means that narrative reasoning is to understand the story of
a patient and how his or her illness affects his or her life. In this way, it will
provide a full picture about the health condition of the patient. Combination of
scientific knowledge with that of the patient will also allow doctors to connect
deeper with their patients and treat them effectively and humanely.

A holistic approach to medical thinking integrates objective evidence and

subjective understanding into an effective mix of medical thinking. Combining fact
with the personal turns doctors into complete carers, which increases the quality of
treatment and respect for the patient's humanity.

Clinical Judging and Decision-making

Physicians are faced by uncertainty when diagnosing or treating their patients.

Objective and subjective reasoning help physicians make such decisions. Objective
reasoning depends on facts, data and evidence for its conclusion; one would use
charts or guidelines to find an answer. Objective reasoning involves measurable
results such as test outcomes and is pursued in a step by step manner. On the other
hand, subjective reasoning focuses on personal experience, feelings and values of
the patient. This approach is intuitive-empathetic, whereby the doctor looks at the
big picture and connects with the patients. In integrating these two ways of
thinking, he will be able to attend to both the medical problem and the uniqueness
of his patient.

On the other hand, decision-making involves a process of getting information,

testing ideas, and selecting the best option. Physicians may adhere to step-by-step
processes, such as decision trees, but most of the time, these are impracticable or
inapplicable. In those situations, subjective reasoning proves handy, especially
when one is trying to address the feelings or concerns of a patient. Blending
evidence with a human touch, the doctor will provide better care that suits the
situation of each patient. Not only does this build trust, but it also results in better
health outcomes.

The Role of Explanations in Medical Practice

Explanation in medicine is more than describing symptoms or naming diseases; it
is the "why" of such conditions. Causal explanations are about establishing the root
cause, including genetic, environmental, and physiological factors that bring about
mechanisms such as genetic mutations or pathogen interactions that enable
treatments. Complementary to these, biomedical explanations describe the disease
process and give scientific insight into how conditions arise and progress.

Equally important are the narrative explanations that go into the stories of the
patients, discussing their mental, social, and emotional contexts. In this way, such a
humanistic approach tempers the biomedical one, contemplating an integral patient
experience rather than one characterized by physical symptoms alone. Integration
of scientific explanation with the narrative one therefore yields a complete
understanding of the patient for personalized care that skillfully fuses precision
with compassion to the betterment of diagnosis, cure, and well-being.

Bridging Discursive and Narrative Approaches in Diagnostic Knowledge

The paradigmatic and narrative modes of cognitive functioning, as presented by

Jerome Bruner, are both ways of constructing the reality, and neither of these is
dispensable in diagnosis and therapy. The discursive diagnostic knowledge relies
logically on medical interviews, physical examinations, and tests with the purpose
of classification of diseases and symptoms on a quantitative basis. In this way, it is
accurate and valid but is prone to biases and medical fallacies. On the opposite, the
narrative diagnosis encompasses understanding of the patient's story, setting that
allows getting more meaningful, richer context for the symptoms. Such a narrative
approach may be justified by the believability and the centrality of plot in the
creation of meaning. The emphasis of the humanistic practitioners on integrating
the patient's narrative would form the basis for the development of the existential
concerns and quality care improvements. Medicine is narrative by nature. Medical
technology contributes, refines the diagnostic criteria, and enhances the accuracy
without the complete elimination of biases. This would, therefore, require a mix of
discursive and narrative approaches with technological advancement in bringing in
an all-rounded understanding of the patient's experience through a better diagnostic
outcome and improvement in patient care.

Integration of Philosophy into Medical Education

Medicine philosophy is also the decisive factor in setting and creating medical
education. Introduction to philosophical principles during training could develop
critical thinking among future doctors, their sensitive engagement, and the
approach toward ethical decisions. Thus, students will gain greater perception
about the very core-the patient's condition-by being familiar with some common
philosophical issues in understanding concepts of health, disease, and well-being.

A comprehensive medical curriculum encompasses both humanistic and

biomedical perspectives, insisting on the importance of consideration of patients as
a whole, rather than as carriers of symptoms. Teaching narrative reasoning together
with scientific knowledge empowers doctors-to-be with the communicative means
of building trust and rapport with their patients. Moreover, philosophical
discussions on cultural competence and implicit biases help the practitioner
navigate various values and beliefs of the patients and thus provide them with fair
and compassionate care.

Technological Advancements and Ethical Challenges

The rapid development of medical technologies, including AI, telemedicine, and

genetic engineering, opens new opportunities but also new ethical challenges
within healthcare. Philosophy of medicine provides a framework for addressing
these challenges and ensuring that technological progress serves human values.

For example, AI has reformed diagnosis and treatment planning but also raises
questions about patient autonomy, data privacy, and even the dehumanization of
care. It is at this juncture-that is, within debates regarding a philosophical
balancing between precision medicine and equal access-that interest in themes of
social justice and how technologies like CRISPR will be implemented emerges. At
the same time, telemedicine increases access despite ethical concerns about the
quality of virtual interactions and disparities in digital access.The appropriate
application of ethical principles and philosophical reasoning from healthcare
professionals should meet these challenges by guaranteeing that innovations
enhance and not undermine the humanity of the medical practice.

Cultural and Global Perspectives on Medicine

The philosophy of medicine stands at an interesting crossroad of cultural values
and global health inequalities, thus providing an imperative to understand the
diversity of perspectives. Cultural relativism reminds us that the definitions of
health and illness are never absolute but always a product of the societal norms and
beliefs. Recognition of diversity is the first step to culturally sensitive care.

The philosophical debates on global healthcare disparities address ethical questions

of resource allocation and access to care. For example, what is the just distribution
of scarce resources in the face of pandemics or resource-poor countries?
Integrating indigenous medicine with modern medicine raises questions of
epistemological validity and respect for tradition. These are issues that require
sensitivity to the interplay occurring between local and global health systems.

Feminist Philosophy and Medicine

Feminist philosophy brings important insights into health-related issues in terms of

structural injustices and gender biases within medical research and treatment.
Historically, the health concerns of women have been belittled or misunderstood,
leading to disparities in diagnosis and care. Conditions such as heart disease and
chronic pain are often underdiagnosed or dismissed in women because of the
gendered assumptions in the practice of medicine.

Feminist philosophers support the rights of reproductive health on grounds of

patient self-determination and informed consent. Another important aspect is the
idea of intersectionality in highlighting how such overlapping identities shape
patient experiences. Philosophy of medicine encourages more inclusive and
equitable healthcare systems by incorporating the feminist perspective.

Health Care Systems and Justice

Philosophical debates on justice and equity in health care address issues of
resource allocation and access to care. For instance, universal health care is an
ethical issue that takes into consideration the moral obligations of societies to
ensure equal opportunities for access to medical services.

Scarcity during crises, such as a pandemic, is real: how to allocate this, how to
distribute limited materials like ventilators, maybe vaccinations in particular, are
guided by frameworks on, for example, a utility-based philosophy, one aiming at
maximizing overall happiness versus deontology, laying claim to individual rights.
Thus, these debates express, again, the hope and need for transparent decision
processes in healthcare. Justice also includes efforts to correct systemic healthcare
inequities affecting vulnerable populations. Here, the philosophy of medicine
supplies the tools to critically think through these inequities and offer proposals
that favor fairness and inclusion.

The Future of the Philosophy in Medicine

The philosophy of medicine will continually make great contributions towards the
shape it is going to take in the future. As the technologies in medicine continue to
advance, there is the need for interaction among philosophers, scientists, and
practitioners in health since ethical questions are emerging from this field.
For example, neuroscientific progress and brain-computer interfaces challenge the
presumed views of consciousness, identity, and autonomy. It is in such debates that
the philosophy of medicine will be of essence to ensure that scientific steps do not
override human dignity and values.

Furthermore, infusion of the philosophical principles within the health systems will
facilitate an integrated health care approach through a balancing of scientific
precision against compassionate care. Philosophy of medicine will keep being
helpful in development and understanding of modern medicine, as it deals
explicitly with ethical dilemmas, enhances cultural competence, and advocates for
justice.

Death and the Philosophy of Medicine

The question of what constitutes death is one of the most profound and challenging
dilemmas both in philosophy and medicine. Philosophers have long debated
whether death should be strictly defined in biological terms, or whether it also
involves the cessation of personhood. Physicians have to balance these definitions
in the case of end-of-life care, such as determining whether a patient is "dead" or in
a persistent vegetative state. This issue also cuts across debates on euthanasia and
assisted suicide, where the principle of autonomy is weighed against the ethical
imperatives to preserve life. It is very relevant to have philosophical considerations
regarding the aspect of death among physicians in relation to ethical dilemmas
related to treatment and decisions to continue life and the right to die. These
discussions also emphasize having open and sensitive dialogues with patients and
families regarding realistic concerns with dying and the process of dying.

Conclusion

It is in this light that the philosophy of medicine, therefore, has a really important
role in shaping health care, tackling profound questions of health, illness, ethics,
and justice. It will help health professionals in critical thinking, empathy, and
making ethical decisions in complex situations. Philosophy advances the holistic
view of the patients by considering their experiences, values, and beliefs apart
from the symptoms. This brings forth better patient care and stronger doctor-
patient relationships. Philosophy is here to guide us through the responsible and
ethical use of new medical practices within the rapidly changing world. It offers
insight into how to balance progress with fairness, protect patients' autonomy, and
address global health inequalities. The philosophy of medicine brings up culturally
diverse approaches and methods to reduce inequality. Integrating philosophical
reflections within education and the practice of medicine will lead us toward a
healthcare system that moves with scientific progress, yet protects human dignity,
fairness, and compassion. Philosophy reminds us that the ultimate goal of medicine
is not just the curing of diseases but the care of people in a way that respects their
humanity and enhances their well-being.

References:
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2. Bynum, W. (2017). Medicine. In The Stanford Encyclopedia of Philosophy (E.

N. Zalta, Ed.). Stanford University. https://plato.stanford.edu/entries/medicine/

3. Wikipedia contributors. (n.d.). Philosophy of medicine. Wikipedia, The Free

Encyclopedia. Retrieved December 28, 2024, from
https://en.wikipedia.org/wiki/Philosophy_of_medicine