Yun-Ying Kuo

Patient-centered care (PCC) is widely endorsed in contemporary medicine, yet philosophical analyses often approach it through concept-first approaches that define patienthood in advance—typically in terms of autonomy, holistic personhood, or rational agency—and then assess clinical practice by reference to these ideals. This paper argues that such an approach can obscure how patienthood is configured in practice. We develop a tool-first approach that treats cognitive, communicative, and material tools as analytically primary for understanding how patients are individuated in clinical reasoning. The argument is grounded in an ethnographic case study conducted in a specialized cancer hospital, focusing on outpatient clinics in medical oncology, colorectal surgery, and palliative care. Rather than treating ethnography as descriptive background, we use it to identify tools-in-use that structure what becomes salient, actionable, and patient-relevant in situated encounters. Across these settings, distinct configurations of tools generate systematically different modes of patienthood. In oncology, staging systems and expectation management configure patients as therapeutic trajectories oriented toward uncertain futures. In surgery, anatomical diagrams and probabilistic framings individuate patients as operative bodies embedded in structured decision spaces. In palliative care, symptom scales, narrative practices, and informational scaffolding configure patients as experiential subjects and epistemic agents. We analyze these differences as instances of structural plurality: patterned, tool-mediated modes of patient individuation that are internally coherent yet irreducible to a single model. On this account, ethical ideals commonly associated with PCC—such as autonomy, shared decision-making, and informed consent—can be understood less as prior normative standards applied to practice, and more as contingent achievements that depend on how tools structure salience, understanding, and possibilities for agency in clinical contexts.

This paper distinguishes the drug-centered view of psychedelics (DCP) and the drug-assisted view of psychedelics (DAP). While these approaches differ conceptually, both rely on the methodology of evidence-based medicine, using randomized controlled trials to validate therapeutic efficacy. Using MDMA-assisted psychotherapy as a case study of DAP, we reconstruct the causal reasoning underlying its proposed therapeutic effects, identify two key causal assumptions, and critically examine them. Our analysis shows that the DAP community’s reliance on evidence-based medicine is not merely methodological, but also reflects questionable epistemological assumptions inherited from the empirically supported therapy tradition. We conclude by proposing value-based practice as a complementary methodology better suited to the relational and value-laden dimensions of DAP.