Ashley Kennedy

Scientific information plays an important role in shaping policies and recommendations for behaviors that are meant to improve the overall health and well-being of the public. However, a subset of the population does not trust information from scientific authorities, and even for those that do trust it, information alone is often not enough to motivate action. Feelings of shame can be motivational, and thus some recent public policies have attempted to leverage shame to motivate the public to act in accordance with science-based recommendations. We argue that because these shame policies are employed in non-communal contexts, they are both practically ineffective and morally problematic: shame is unlikely to be effective at motivating the public to behave in accordance with science-based policy, and shaming citizens is an unethical way to get them to comply. We argue that shame-based policies are likely to contribute to further distrust in scientific authority.

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research.

Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM.

Evidence‐based medicine (EBM) proponents have argued that mechanistic evidence concerning medical treatments should be considered secondary to evidence derived from randomized controlled trials (RCTs). One common criticism of RCTs is that they often do not yield results that are generalizable to clinical practice, and that for clinical practice application, mechanistic evidence is needed. However, proponents of EBM have argued that mechanistic reasoning is often unreliable and thus not very useful. Here we suggest an important role of mechanistic explanation that has been left out of this discussion entirely, namely, its importance in a patient’s decision of whether or not to take certain drugs. We argue that in certain cases, knowing how a treatment works is just as important for the patient as knowing whether it does. In this paper, we explore how and why giving patients mechanistic information can be an important factor in obtaining informed consent for medical treatment, focusing on the example case of hormonal contraceptives.

Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine. Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including the nature of clinical reasoning and the question of whether it can be standardized; the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; evidence synthesis ; and the nature and ethics of placebo controls. Philosophical analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice.

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as clinical research (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains.

Because they contain idealizations, scientific models are often considered to be misrepresentations of their target systems. An important question is therefore how models can explain the behaviours of these systems. Most of the answers to this question are representationalist in nature. Proponents of this view are generally committed to the claim that models are explanatory if they represent their target systems to some degree of accuracy; in other words, they try to determine the conditions under which idealizations can be made without jeopardizing the representational function of models. In this article, we first outline several forms of this representationalist view. We then argue that this view, in each of these forms, omits an important role of idealizations: that of facilitating the identification of the explanatory components within a model. Via examination of a case study from contemporary astrophysics, we show that one way in which idealizations can do this is by creating a comparison case that s...

Placebos are much discussed in both the medical and philosophy of medicine literatures. Once narrowly defined as inert “sugar pills,”, they now are now most often taken to be “treatments that appear similar to experimental treatments, but that lack their characteristic components”. In addition to their use in the control groups of many clinical trials, placebos are also now widely recognized by medical practitioners to be powerful therapies in themselves, often outperforming conventional drug therapies in these studies.Given this, I find Haller’s book, which is divided into six chapters, “Evidence Based Medicine,” “Postmodernist Medicine,” “The Powerful Placebo,” “Politics of...

In this paper I argue that ethics and evidence are intricately intertwined within the clinical practice of differential diagnosis. Too often, when a disease is difficult to diagnose, a physician will dismiss it as being “not real” or “all in the patient’s head.” This is both an ethical and an evidential problem. In the paper my aim is two-fold. First, via the examination of two case studies (late-stage Lyme disease and Addison’s disease), I try to elucidate why this kind of dismissal takes place. Then, I propose a potential solution to the problem. I argue that instead of dismissing a patient’s illness as “not real,” physicians ought to exercise a compassionate suspension of judgment when a diagnosis cannot be immediately made. I argue that suspending judgment has methodological, epistemic, and ethical virtues and therefore should always be preferred to patient dismissal in the clinical setting

Luc Bovens, in his 2006 article, argues that it can be shown that the ‘rhythm' method of birth control results in a larger number of embryonic deaths than the IUD, the morning after pill or the combination oral contraceptive pill, just so long as one accepts his three ‘plausible’ assumptions. In this brief response I will argue that Boven's third assumption is not plausible when one takes into account a basic knowledge of human reproductive biology. Thus, his argument, in both of its possible reconstructions, fails