Title: Theory
1 Theory Ethics in MedicineARTH02055, 2 CP
- Andres Soosaar
- Department of Public Health
- http//biomedicum.ut.ee/andress
2General 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.
3A very general goal
- To put medicine into broader context and
philosophical context is actually broad enough.
4General approach
- Philosophical and/or interdisciplinary approach.
- Level of account is rather introductory and
offering contexts, not transmission of final
truths.
5What 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).
6What 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.
7Truth
- 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.
8Aristotle (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)
9Philosophy 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.
10Philosophy 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.
11Some 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.
12System 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.
13Philosophy 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.
15What 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
17Central 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. -
20Health-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).
21Connections between health and disease
- It doesnt seem to be a law constant amount of
health and disease
Health
Disease
?
?
22Connections between health and disease
- Is this like a jump from one zone to another?
Disease
Disease
23Development 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.
24Scientific 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
27A 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
28Birth 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.
29The 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.
32SOCIETY
diagnostics
therapy
Self Family Doctor with medical staff
Witch computer or robot time
NATURE
334 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.
34Main 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.
35People 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.
36Features 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.
37Medicine 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.
38Medical 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.
39Medical 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.
40Online sources of medical terminology
- Online Medical Dictionary http//cancerweb.ncl.ac.
uk/ - MedlinePlus Medical Dictionary
- http//www.nlm.nih.gov/medlineplus/mplusdictionary
.html
41ICD-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
42General philosophical worldview concepts which
matter in medicine
- Realism
- Mind-Body Problem
- Causality
- Norm and normativity
- Life and death
43References
- 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).