Maya J. Goldenberg

This paper examines the conclusions that one must draw from the finding that there are values in science. The value-ladenness of scientific claims puts the nature and role of empirical evidence into question, as seen in recent discussions in the philosophy of medicine regarding evidence-based medicine and feminist science studies, which maintains the normativity of its feminist claims. Within the critical literature and debates surrounding evidence-based medicine (EBM), one finds a championing of the lessons learned from post-positivist science studies: the evidence-based effort to ground medical decision-making in the most rigorous sources of scientific evidence obscures the social values that necessarily enter into all decision-making contexts, the complex social context of clinical practice being no exception. The critics of EBM claim that to try to derive a formal methodology governed by pre-established rules, guidelines, and hierarchies of information misplaces the contextual and social features of biomedical knowledge and practice, thereby obscuring the power interests that so problematically dictate large factions of biomedical research and practice. Yet possible relativist implications follow from this finding, and we find that the EBM critics amply criticize EBM’s tacit theory of evidence, but then fail to formulate a constructive alternative theory of evidence within this fact-value interplay. After overviewing some such criticisms of evidence-based medicine, I turn to contemporary critical science studies, especially the feminist empiricism of Lynn Hankinson Nelson and Helen Longino, for workable alternative theories of evidence within a framework of normative scientific claims. I will suggest these theories fail to guide medical decision-making because of some undesirable consequences of Quinean fact-value holism: the denial that our values have logical content and are therefore not empirically examinable relativises even these nuanced conceptions of evidence. A naturalized look at how facts and values actually interact in medical decision-making suggests that this fact/value holism is not realistic. I provide an illustrative example of a physician devising a treatment recommendation for a patient to demonstrate that in practice, facts and values intermingle in the decision-making process without indeterminacy and subsequent appeals to moral and political frameworks, as feminist empiricism suggests. In the end, value-laden evidence can retain its adjudicative force and normativity.

The once animated efforts in medical phenomenology to integrate the art and science of medicine (or to humanize scientific medicine) have fallen out of philosophical fashion. Yet the current competing medical discourses of evidencebased medicine and patient-centered care suggest that this theoretical endeavor requires renewed attention. In this paper, I attempt to enliven the debate by discussing theoretical weaknesses in the way the “lived body” has operated in the medical phenomenology literature—the problem of the absent body—and highlight how evidence-based medicine has refigured medical phenomenology’s historical nemesis, “biomedicine.” What we now need is a phenomenology of the embodied subject in the age of evidence-based medicine.

The public rejection of scientific claims is widely recognized by scientific and governmental institutions to be threatening to modern democratic societies. Intense conflict between science and the public over diverse health and environmental issues have invited speculation by concerned officials regarding both the source of and the solution to the problem of public resistance towards scientific and policy positions on such hot-button issues as global warming, genetically modified crops, environmental toxins, and nuclear waste disposal. The London Royal Society’s influential report “Public Understanding of Science”, which spearheaded the now-thriving area of science...

With twentieth- and twenty-first-century philosophy of science’s unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that non-epistemic values can be rationally evaluated and that standpoint epistemology’s universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding, I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. I further argue that my recommended empiricist methodology is preferable to Psillos’s search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science.