Abstract
This paper considers the view that medicine is both “science” and “art.” It is argued that on this view certain clinical knowledge – of patients’ histories, values, and preferences, and how to integrate them in decision-making – cannot be scientific knowledge. However, by drawing on recent work in philosophy of science it is argued that progress in gaining such knowledge has been achieved by the accumulation of what should be understood as “scientific” knowledge. I claim there are varying degrees of objectivity pertaining to various aspects of clinical medicine. Hence, what is often understood as constituting the “art” of medicine is amenable to objective methods of inquiry, and so, may be understood as “science”. As a result, I conclude that rather than endorse the popular philosophical distinction between the art and science of medicine, in the future a unified, multifaceted epistemology of medicine should be developed to replace it.
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Notes
- 1.
I wish to thank Philippe Huneman for helpful comments on a draft of this paper.
- 2.
- 3.
As an aside, this claim warrants comment. It is not clear that ethical non-naturalists need be troubled by Gorovitz and MacIntyre’s assertion here. They need only deny that factual information is sufficient for informing claims about what is good, not that it can play a (non-sufficient) warranted role in justifying inferences about what is good for a patient or other agent in the health care system.
- 4.
Indeed, for example, the issue of generality in explanation has been with us since the Ancients. Ancient Greek thinkers also distinguished between episteme and techne, a distinction based in part on the claim that the best explanations are those that are timeless and apply with broad generality. However, though early Greek thinkers also distinguish between these forms of knowing, as discussed below (n. 8), these distinctions do not match the contemporary distinction between art and science well as it is described here. See Parry (2009) for a detailed review of the diversity of Ancient Greek views on this topic and the many ways they relate to current epistemology.
- 5.
In his The Wounded Storyteller, Arthur Frank (1995) develops an account of illness as subjective experience and disease as the objective description of that subjective experience in biomedical terms. It is in this sense that I use terms such as “illness” and “disease.”
- 6.
In contrast to Cassell’s assertion, Hasok Chang’s (2004) work on the science of thermometry shows that the standardization of the activity of measuring “temperature” over hundreds of years is what makes this example appear as an innocuous instance of the elucidation of a objective fact about a patient. However, Chang’s account of the evolution of the concept of temperature shows that such facts require literally centuries of research and debate in order for the idiosyncrasies of experimentation to be codified into a broadly accepted physical theory of temperature measurement.
- 7.
Another context in philosophy of medicine where the relationship between objective and subjective knowledge figures largely is debates over the meaning of the concepts, health, disease, and illness. Beginning with Boorse’s account (1977, 1997), some argue that health has meaning by contrast with disease, which is best described in objective, “biostatistical” terms, or in terms of species typical functioning. Yet, others argue that these foundational medical concepts are thoroughly subjective due to the normative, evaluational aspects of medical reasoning and nosology (e.g., Nordenfelt 1987). And, yet others contend that concepts like health and disease are normative and objective, proposing a hybrid account of sorts (Lennox 1995; Schaffner 1999). Finally, others argue that understanding these concepts philosophically is a quixotic pursuit, with no bearing on medical practice (Hesslow 1993). Taking a stance on this literature lies beyond the scope of this inquiry.
- 8.
This too is a problem that extends historically to the Ancients. As noted (n. 4), Ancient Greek philosophers distinguished between different ways of knowing, including episteme and techne. However, different thinkers interpreted these terms quite differently. For example, in the Nicomachean Ethics (especially Book VI), Aristotle describes these two types of knowledge as more general, in contrast to a third type of knowledge of how to act rightly in particular contexts, known as practical wisdom or phronesis (Aristotle 2000). It is fascinating that Ancient Greek thinkers took medicine, along with navigation, as an exemplar of practices where all types of knowledge were required (Jaeger 1957). Although these discussions are clearly relevant to modern debates about the epistemology of medicine, contemporary scholars are in agreement that the Ancient Greek conceptions of knowledge do not mirror our own understanding of art as a craft and science as objective facts (Hofmann 2003; Evans 2006).
- 9.
The same might be said for empirical work in applied ethics, however, for the sake of brevity that point will not be made here.
- 10.
- 11.
For a lively, careful discussion of the philosophical implications of team-based care, see the contributions to King et al. 1988.
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Cunningham, T.V. (2015). Objectivity, Scientificity, and the Dualist Epistemology of Medicine. In: Huneman, P., Lambert, G., Silberstein, M. (eds) Classification, Disease and Evidence. History, Philosophy and Theory of the Life Sciences, vol 7. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8887-8_1
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