An Introductory Philosophy of Medicine

Philosophy and/in/of Medicine

In a round-table discussion held at the first trans-disciplinary symposium on philosophy and medicine in 1974, Jerome Shaffer questioned the validity of any relationship or interface between medicine and philosophy. "I am inclined to think," claimed Shaffer, "that there are medical problems and there are philosophical problems, with no overlap or borderline area between them, no field which could be called medicophilosophy or philosopho-medicine on the analogy with bio-chemistry or astro-physics" (1975, pp. 215-216). Although he acknowledged that a field such as philosophy of medicine might exist, problems and issues arising from medical knowledge and practice are best addressed by philosophers of mind and philosophers of science as well as by moral philosophers. Hence, concluded Shaffer, "there is nothing left for Philosophy of Medicine to do" (1975, p. 218).

Edmund Pellegrino took issue with Shaffer, claiming that Shaffer in an effort to deny a relationship or interface between philosophy and medicine has "philosophized about medicine" (1975, p. 231). Pellegrino also made a distinction between a philosophy in medicine and a philosophy of medicine. The first relationship between philosophy and medicine, philosophy in medicine, is unproblematic and involves using philosophical methods to address philosophical problems such as causality in medical knowledge and practice. The second relationship, philosophy of medicine, Pellegrino admitted is problematic because of the nature of medicine. However, according to Pellegrino medicine is, contra Shaffer, more than simply the sum of the sciences that constitute it. Philosophy of medicine involves defining the nature of medicine per se or in terms of its essence. A few years later, Pellegrino (1976) added a third relationship between the two disciplines, philosophy and medicine, in a lead article to the first issue of a new journal entitled The Journal of Medicine and Philosophy. This relationship involves problems that overlap between the two disciplines.

Gerlof Verwey (1987) claimed in a critical commentary on Pellegrino and David Thomasma's A Philosophical Basis of Medical Practice that the nascent field of contemporary philosophy of medicine produced its first fruits.'Pellegrino and Thomasma rehearsed and further developed the three relationships between philosophy and medicine first proposed by Pellegrino.' "Philosophy and medicine," Pellegrino and Thomasma contended, "comprises the mutual considerations by medicine and philosophy of problems common to both" (1981a, p. 29). Problems common to both include consciousness, mind-body, perception, and language. The relationship is a collaborative affair, in which the two disciplines retain their individual identities. Although separate, each discipline may draw on the conceptual resources of the other for addressing a problem at hand. The result of such interaction is often the synthesis of a new idea concerning health or illness, especially through a dialogical method (Pellegrino, 1998).

"Philosophy in medicine," according to Pellegrino and Thomasma, "refers to the application of the traditional tools of philosophy-critical reflection, dialectical reasoning, uncovering of value and purpose, or asking first-order questions-to some medically defined problem" (1981a, p. 29). The problems may involve logical or epistemological issues, but the majority and most popular concern ethical issues. In this relationship, philosophers "function in medicine-that is, in the medical setting as educator and trained thinker exhibiting the way philosophy can illuminate and examine critically what physicians do in their everyday activity" (Pellegrino and Thomasma, 1981 a, p. 30). Pellegrino (1998) later points to the use of existentialism and phenomenology as examples of fertile philosophies for analyzing medicine.

Pellegrino and Thomasma admitted that philosophy of medicine is the most problematic of the three relationships and needs careful explication. In philosophy of medicine, genuine philosophical issues concerning medical knowledge and practice are examined.' According to Pellegrino and Thomasma, this relationship is defined as "a systematic set of ways for articulating, clarifying, and addressing the philosophical issues in medicine" (1981a, p. 28). The philosopher's role vis-n-vis medicine is to apply a critical and dialectical methodology to address philosophical issues in medicine, especially the clinical encounter. The aim of the philosophy of medicine is to account for "the whole domain of the clinical moment" (Pellegrino and Thomasma, 1981a, p. 28).

Importantly for Pellegrino and Thomasma, philosophy of medicine functions both descriptively and normatively: "The philosophy of medicine seeks explanations for what medicine is and ought to be, in terms of the axiomatic assumptions upon which it is based" (1981a, p. 30). It is this spirit that a philosophy of medicine is developed herein, especially in terms of metaphysics, epistemology, and ethics of medical knowledge and practice. The driving question for this approach involves the nature of medicine itself. However, before addressing that subject the question of whether philosophy of medicine exists must be entertained first.



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