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Theory

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Title: Theory


1
Theory Ethics in MedicineARTH02055, 2 CP
  • Andres Soosaar
  • Department of Public Health
  • http//biomedicum.ut.ee/andress

2
General goals of the course 1
  • 1.Overview of theoretical basis of medicine
    Medicine as science, practice, and art. The
    evidence-based medicine.
  • 2. Basic issues of human nature and general
    worldview.
  • 3. Philosophical questions of scientific
    knowledge in biology and medicine.

3
A very general goal
  • To put medicine into broader context and
    philosophical context is actually broad enough.

4
General approach
  • Philosophical and/or interdisciplinary approach.
  • Level of account is rather introductory and
    offering contexts, not transmission of final
    truths.

5
What is philosophy?
  • Gr philosophia Love of Wisdom
  • By Jenicek ja Hitchcock (2005) philosphy is the
    study of fundamental questions, that is,
    questions about concepts and principles.
  • Main branches of philosophy are metaphysics and
    ontology (being and reality) epistemology
    (knowledge) logic (inference) and ethics
    (values).

6
What is science?
  • 3 a knowledge or a system of knowledge covering
    general truths or the operation of general laws
    especially as obtained and tested through
    scientific method b such knowledge or such a
    system of knowledge concerned with the physical
    world and its phenomena NATURAL
    SCIENCEMerriam-Webster Online Dictionary
  • The issue of knowledge is important in both
    science and philosophy. A measure of quality of
    knowledge is truth.

7
Truth
  • There are several ways to understand truth, but
    the most popular approach is probably the
    correspondence theory of truth which means that
    proposition is true in case when it corresponds
    to the reality.
  • Absolute and relative truths. Science seems to
    move toward absolute truth, because theories are
    becoming more and more exact and fitting better
    with reality during scientific research.

8
Aristotle (384322 bc) on truth
  • To say of what is that it is not, or of what is
    not that it is, is false, while to say of what is
    that it is, and of what is not that it is not, is
    true
  • (Metaphysics 1011b25)

9
Philosophy and Science
  • Until Modern Times philosophy and science were
    focused almost on the same issues. It was
    tenacious hope to understand general principles
    of world only with reason without empirical
    support. Immanuel Kant gave an influential
    criticism of so called pure reason.
  • Nowadays they are rather different but still
    overlapping fields, e.g. philosophy of physics
    and theoretical physics.
  • Empirical approach is in sciences much more
    important as this in philosophy. In sciences is
    the format to get or produce new knowledge
    clearly more collective as it happens in
    philosophy.

10
Philosophy and Science
  • By John Searle (1999) philosophy has 3 different
    features
  • Philosophy is in large part concerned with
    questions that we have not found a satisfactory
    and systematic way to answer
  • Philosophical questions tend to be what I
    (Searle) will call framework questions.
  • Philosophical questions are ofted questions
    about our concepts and relationship between our
    concepts and the world they represent.

11
Some features of modern philosophy
  • There is more applied philosophies, i.e.
    philosophies which are focused on certain field
    of science, e.g. Philosophy of physics, biology
    or medicine.
  • Philosophy seems to take over the central
    cognitive format of sciences the peer-reviewed
    publication.
  • 2 first items together are showing that
    philosophy is more and more socially driven.
  • Philosophical writings have usually 1 author and
    its commentators, in sciences there usually
    dominates collective authorship. At the same time
    philosophical schools and traditions are still
    very influential. One possible role of philosophy
    is to offer for human environment potential but
    still coherent set of ideas.

12
System of sciences
  • There are several divisions on different basis
  • Popular division is natural and social sciences
    and humanities, also fundamental and applied
    sciences.
  • The basis for different sciences comes from their
    object and research methods.
  • Nowadays the is a tendency to combine sciences in
    several ways, we are speaking about
    interdisciplinarity, e.g. Neurosciences.

13
Philosophy of medicine
  • H. Tristram Engelhardt Jr defines the issue in
    Routledge Encyclopedia of Philosophy as follows
  • The philosophy of medicine can be generally
    defined as encompassing those issues in
    epistemology, axiology, logic, methodology and
    metaphysics generated by or related to medicine

14
Interpretations (4) of the philosophy of medicine
  • Speculative medicine as the attempt to discover
    the basic philosophical principles that lie
    behind the practice of medicine.
  • Logic of medicine brings togeteher attempts to
    clarify the character of scientific reasoning in
    medicine.
  • Philosophy of medicine as a subspeciality of
    philosophy of science.
  • Other explorations of philosophical issues that
    have special salience in medicine, e.g. bioethics
    stands in this division
  • Tr Engelhardt JR, KWM Wildes. Encyclopedia of
    Bioethics, 3rd ed, 3 vol. Pp. 1738-9.

15
What is medicine?
  • There are different opinions on that issue
  • Scientific medicine and alternative medicine
  • The central situation in medicine is the
    physician-patient relationship or therapeutic
    relationship which goals in improvement of
    patient condition.

16
  • medicine
  • Online Medical Dictionary http//cancerweb.ncl.ac.
    uk/
  • A scientifically-based discipline dedicated to
    the prevention and treatment of disease and
    injury.
  • MedlinePlus Medical Dictionary
  • http//www.nlm.nih.gov/medlineplus/mplusdictionary
    .html
  • 2 a the science and art dealing with the
    maintenance of health and the prevention,
    alleviation, or cure of disease

17
Central concepts of medicine
  • Health-disease distinction.
  • Basic principles are (i) existence of some norms
    and (ii) possibility to modify abnormal
    situations. Here is a lot of issues from natural
    sciences and psychology.
  • The therapeutic relationship.
  • Ideal situation would be that human relations are
    symmetrical but disease makes them clearly
    asymmetrical. Here is a lot of issues from
    psychology and social sciences.

18
  • Health a state of optimal physical, mental, and
    social wellbeing, and not merely the absence of
    disease and infirmity
  • Dorlands Illustrated Medical Dictionary, 28th
    ed., p. 736

19
  • disease any deviation from or interruption of
    the normal structure or functions of any part,
    organ, or system (or combination of thereof) of
    the body that is manifested by a characteristic
    set of symptoms and signs and whose etiology,
    pathology, and prognosis may be known or unknown.
  • Dorlands Illustrated Medical Dictionary, 28th
    ed., p. 478.

20
Health-disease distinction
  • The central goal of medicine is to support
    wellbeing (sic! Rather moral or psychological
    concept) of human beings.
  • Health and disease are qualitatively different
    conditions.
  • There are 1 health and many diseases
  • Health-disease distinction needs certain norm(s)
  • Health-disease distinction is complex but seem to
    be reduced on psychological (emotional) status of
    wellbeing indeed (or subjectivity).

21
Connections between health and disease
  • It doesnt seem to be a law constant amount of
    health and disease

Health
Disease
?
?
22
Connections between health and disease
  • Is this like a jump from one zone to another?

Disease
Disease
23
Development of the concept of disease
  • The concept of disease has been varied during
    history, but the central questions of the issue
    have been the cause and nature of disease.
  • Human nature has biological, psychological, and
    social dimension and therefore there is no wonder
    that there are biological, anthropological,
    sociological, philosophical etc explanations of
    diseases.
  • In medical practice is the key issue the process
    of disease, its nature, signs and possibilities
    for correction (therapy) and prevention.

24
Scientific and alternative medicine
  • The scientific (conventional) medicine is
    grounded on scientific knowledge and methods. The
    health care systems in the developed countries
    are build up on the basis of the scientific
    medicine and it is accepted and cultivated in
    medical faculties.
  • Alternative medicine is a vague term which covers
    numerous isolated practicies, e.g. Homeopathy,
    anthroposophical medicine, yoga etc.
  • NB! Our course is about scientific medicine.

25
  • Alternative medicine broadly describes methods
    and practices used in place of, or in addition
    to, conventional medical treatments. The precise
    scope of alternative medicine is a matter of some
    debate and depends to a great extent on the
    definition of "conventional medicine." Positions
    on the distinction between the two include those
    who reject the safety and efficacy of the other,
    and a number of positions in between.
  • The debate on alternative medicine is complicated
    further by the diversity of treatments that are
    categorized as "alternative." These include
    practices that incorporate spiritual,
    metaphysical, or religious underpinnings
    non-European medical traditions newly developed
    approaches to healing and a number of others.
    Proponents of one class of alternative medicine
    may reject others.
  • http//en.wikipedia.org/wiki/Alternative_medicine

26
  • The National Center for Complementary and
    Alternative Medicine defines complementary and
    alternative medicine as "a group of diverse
    medical and health care systems, practices, and
    products that are not presently considered to be
    part of conventional medicine". One distinction
    that the NCCAM makes is that complementary
    medicine is used in conjunction with conventional
    medicine whereas alternative medicine is used in
    place of conventional medicine. The NCCAM also
    defines integrative medicine as the combination
    of "mainstream medical therapies and CAM
    therapies for which there is some high-quality
    scientific evidence of safety and effectiveness".
  • http//en.wikipedia.org/wiki/Alternative_medicine

27
A conference on general issues of medicine
  • Eesti Arstide Liit, Tartu Ülikooli Kliinikumi
    Eetikakomitee, Tartu Ülikooli Eetikakeskus ja
    Eesti Bioeetika Nõukogu tähistavad rahvusvahelist
    arstieetikapäeva konverentsigaKas
    alternatiivmeditsiin pakub tõenduspõhisele ravile
    konkurentsi?
  • Has alternative medicine any chance to compete
    with evidence-based medicine?
  • 16.septembril 2005. a. algusega kell 11 Tartu
    Ülikooli raamatukogus

28
Birth of medicine as field and profession
  • Since very old times an ill person has needed
    help of others both to survive that condition and
    get some treatment or therapy to reject that
    disease. This basic situation has had long
    history and interesting course of development,
    see the course on history of medicine.
  • An important aspect of that development was
    increased ability of some members of community to
    help ill person in that difficult condition.

29
The physician-patient relationship
30
  • human being and human being
  • therapeutic relationship
  • Doctor and Patient
  • Medical man and Patient
  • Medical men and Patient
  • Service provider and client

31
  • The doctor-patient relationship has medical,
    psychological, social, legal, moral and other
    aspects, therefore it is possible to study this
    relationship within different sciences and
    methods.
  • A big problem with such approach is a problem
    that people mainly deal with the specific aspect
    of their interest and they may loose human being
    as whole.

32
SOCIETY
  • Patient Healer

diagnostics
therapy
Self Family Doctor with medical staff
Witch computer or robot time
NATURE
33
4 types of the professional-patient relationship
(Entralgo, 2003)
  • Spontaneus or instinctive relationship
  • Empirical relationship
  • Magico-religious realtionship
  • Scientific relationship
  • All types are presented almost at all times. The
    professional-patient relationship has both
    diagnostic and curative aspect or side.

34
Main features of the scientific
professional-patient relationship
  • Continuous secularization
  • 2 main aspects ethical one (comes still very
    much from Christianity)and technical one (comes
    biological sciences, currently evidence-based
    medicine).
  • Permanent dilemma Patient as person (ethics)
    versus patient as a set of tissues and organs.
  • Modern scientific medicine is very powerful, it
    is able penetrate deeply into many aspects of
    human existence.
  • Resources for medicine are limited in every
    society and it raises the issue of justice in
    allocation of them.

35
People in medicine as professionals
  • Medical professionals have obtained accept and
    authorization for their professional activities
    from society, they also have got responsibility
    for those activities.
  • Those people necessarily got better access to
    medical information and it started to cumulate
    into their hands.

36
Features of a profession (Greenwood, 1957)
  • Systematic body of theory
  • Authority to define problems and their treatment
  • Community sanctions to admit and train its
    members
  • Ethical codes that stress an ideal of service of
    others
  • A culture that includes the institutions
    necessary to carry out all of its functions.
  • NB! Nowadays society has intrude into several
    activities above.

37
Medicine as a teamwork
  • Permanent deepening of specialization adds new
    specialities into medical environment which
    necessarily increases the number of specialists
    which have their own role in treatment of every
    case.
  • If activities in team are badly coordinated, it
    produces confusions and negative emotions in
    patient mind.
  • Medical institutions have traditionally had
    strong hierarchical organization.

38
Medical terminology
  • An important tool in medicine both to communicate
    with each other and to do research is medical
    terminology and system of terms.
  • The ability to know and use that terminology is
    absolutely necessary for every doctor but is at
    the same time a big source of confusions outside
    of professional circle.

39
Medical terminology
  • Big number of basic medical terms comes from old
    Greek and Latin languages.
  • New terminology comes mostly from English and is
    often directly taken into different languages.
  • Countries have special boards which task is to
    develop medical terminology.

40
Online sources of medical terminology
  • Online Medical Dictionary http//cancerweb.ncl.ac.
    uk/
  • MedlinePlus Medical Dictionary
  • http//www.nlm.nih.gov/medlineplus/mplusdictionary
    .html

41
ICD-10
  • World Health Organization (WHO) has released the
    10th version of International Classification of
    Diseases (ICD) in 1992. http//www.who.int/classif
    ications/icd/en/
  • ICD is an extremely important agreement in
    medicine

42
General philosophical worldview concepts which
matter in medicine
  • Realism
  • Mind-Body Problem
  • Causality
  • Norm and normativity
  • Life and death

43
References
  • Jenicek M, Hitchcock DL. Evidence-based practice
    logic and critical thinking in medicine. AMA
    Press, 2005.
  • Searle JR. The future of philosophy. Phil.
    Trans.R.Soc.Lond. B, 1999, 354,2069-2080.
  • Several articels from Encyclopedia of Bioethics,
    3rd ed, 2003.

44
  • Prof Dietrich von Engelhardt (Lübeck University)
    will give the lecture Principles and Values in
    Medical Humanities on Tuesday, September at
    16.00 in Linkberg lecture hall (Hospital main
    building, 8 Puusepa St).
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