An Introductory Philosophy of Medicine

Part I. Metaphysics

Metaphysics, as a distinct subject within the western intellectual tradition, has its origins in Aristotle (384-322 BC). Although he did not coin the term, ancient editors of his works did and his treatise by that title is one of the first systematic explorations of the subject. For Aristotle (2001), metaphysics, which literally means "after or beyond physics," is actually prior logically to physics or the natural sciences. In contemporary philosophy, metaphysics deals "with questions that in some ways lie deeper than physics and most other branches of human enquiry: questions concerning the fundamental assumptions and theoretical foundations of these other inquiries" (Horner and Westacott, 2000, p. 1).

As western philosophy developed metaphysicians became concerned with the nature of objects that make up the world, whether natural or social, real or constructed. The topics covered in contemporary metaphysics range from the notion of God to that of time and space (Crane and Farkas, 2004). For example, what constitutes a person or the self is a vibrant area of metaphysical inquiry. Metaphysics is also concerned with the fundamental or universal properties or features of objects or, more technically, with ontology. Finally it is involved with the relationship among these properties, especially in terms of causation.

In this part, the metaphysical boundaries of the biomedical and humanistic or humane models of modern medicine are examined through an analysis of the larger cultural and scientific worldviews in which they are embedded. For our distinct views of the social and natural worlds shape the biomedical and humanistic or humane models. These worldviews often allow practitioners of the biomedical and humanistic models to practice in different worlds. In an initial chapter, I investigate the medical worldviews of the biomedical and humane models in terms of their metaphysical positions or stances, metaphysical presuppositions or assumptions, and ontological commitments. In the next chapter, the notions of causation and realism are examined, especially as they relate to medical knowledge and practice. Then I finally explore in the remaining chapters the specific metaphysical and ontological issues of the biomedical and humane models, including the nature of the patient, disease and health, illness and wellbeing, and diagnosis and therapeutics.

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