An Introductory Philosophy of Medicine

Part II. Epistemology

Epistemology is the philosophical discipline concerned with the nature of knowledge, including its sources, acquisition, and justification. Philosophers recognize several types of knowledge (Pojman, 1998). One type is acquaintance knowledge, in which someone is familiar with an object or idea such as a house plan, an organism's anatomy, or even one's own thoughts. The next type is competence knowledge, which "involves an ability to perform a skill and can be done consciously or unconsciously" (Pojman, 1998, p. 130). Driving a car or performing a surgical procedure would be an example of such know-how or practical knowledge. Finally, there is propositional knowledge. This type of knowledge has truth value, and its traditional definition, since the time of the Greeks, is "justified true belief." Although an individual person is the subject who thinks and acts in terms of such knowledge, a community of professionals or lay people is also important for sanctioning it.

In Part II, I examine the epistemological issues associated with the humanization of the biomedical model. To that end, in Chapter 6 I discuss medical thinking, in terms of objective or impersonal and subjective or personal ways of knowing or reasoning. Biomedical practitioners often base medical knowledge on objective means of reasoning or knowing, while humanistic or humane practitioners generally include subjective ways. In the next chapter, clinical judging and decision making are investigated both in terms of the biomedical and the humanistic models. In Chapter 8, I examine the epistemological issue of explanation, especially with respect to how biomedical and humane practitioners account for disease and illness. In the next chapter, the establishment of diagnostic knowledge is discussed in terms of the patient's story of disease and illness through the technical means utilized by biomedical practitioners and through the narrative means utilized by humane practitioners. In the final chapter, I explore the role of medical research and its associated technology in discovering and justifying therapeutic knowledge, with respect to clinical trails. I conclude with a discussion of narrative therapeutics.

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