Philosophy for Medicine: Applications in a Clinical Context

Although clinical medicine bristles with philosophical questions, in the moral decisions of everyday medical practice we do not always contemplate them very deeply, but rather make our judgments fairly intuitively. However, as Philosophy for Medicine emphasises, our intuitive moral thinking is by no means disconnected from philosophical theory.

Eds Martyn Evans, Pekka Louhiala, Raimo Puustinen

Radcliffe Medical Press, £21.95, pp 168 ISBN 1 85775 943 5

Rating:

The book is very easy to understand. It starts with an introductory section that frees the reader from any fear that “philosophical things” are difficult to grasp. It defines “philosophy” in this context by asking us not to take for granted the things we normally take for granted. Doctors are encouraged to recognise and reflect on the philosophical questions arising during clinical practice.

The authors emphasise the clinical encounter as the core of medicine: “The medical consultation establishes the conditions and framework within which scientific work with patients proceeds.” During a medical consultation doctors are repeatedly confronted with a variety of human phenomena that cannot be approached or solved by the methods of biological sciences alone.

However, without ignoring the efficacy and strength of biomedicine the authors question the relation between the concept of evidence and the concept of truth. From a philosophical point of view, “There is fairly widespread agreement that no satisfactory theory of truth exists at present.” The authors conclude that the discussion about evidence based medicine is superficial. The book does, however, discuss the most common theories of truth in the context of medicine.

Regarding aesthetics of clinical practice, the book reminds us that the separation of science from art has been a relatively recent phenomenon in Western medicine. In addition to biomedical scientific facts, doctors are called on to take into account their patients' emotions and cultural backgrounds; clinicians have a responsibility to be sensitive to the quality of service they deliver.

Doubt and uncertainty are acknowledged as being daily elements of a doctor's work. The authors discuss different types of uncertainty in the context of clinical work. Even if “the power of the randomized controlled trial is considerable,” we cannot always be absolutely sure whether conclusions can be extrapolated to the individual patient we are treating.

“We can never be absolutely sure of what we do, but we have to accept our personal responsibility to do our best in the absence of final truths.” This simple but profound message—together with the reminder that the primary aim of medical endeavour is to take care of sick patients—is what makes Philosophy for Medicine valuable reading for all clinicians.