Rani Lill Anjum (Norwegian University of Life Sciences)

Abstract

Contemporary debates in philosophy and medicine raise a number of concerns about the existing medical paradigm. For the most part, these are addressed within separate debates, for instance about methods (the evidence hierarchy, external validity), values (empathy, autonomy), practice (evidence-based, person centred) or concepts (causation, probability). Some of the discussions are internal to philosophy, but the majority of the debates seems to touch upon more interdisciplinary issues related to philosophy of medicine, philosophy of science or practical ethics. Thomas Kuhn thought it was a sign of crisis in a paradigm when its members start participating in philosophical discussions, and perhaps this is now the case in medicine. By looking at these debates in unison, we can identify some more fundamental concerns underlying current medical thinking, which seem ontological in nature. While the methods and practice of evidence-based medicine seem to have a solid ontological basis in Hume’s philosophy, person centred healthcare emphasises very different features and values, which are more consistent with the neo-Aristotelian ontology of causal dispositionalism. This ontology gives philosophical priority to causal complexity over mono-causality, propensities over frequencies, holism over reductionism, interaction over composition, heterogeneity over homogeneity and medical uniqueness over statistical correlations. In this talk, I argue that it matters which of these frameworks we choose for understanding health and illness.