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PubMed1999

The procedure of new drug application and the philosophy of critical rationalism or the limits of quality assurance with good clinical practice.

K.R. Popper's philosophy of critical rationalism is concerned with the detection and removal of error. Fundamental contradictions exist between Popper's theory of knowledge and the present-day practice of the clinical investigation of new drugs. Currently, the public authorities concerned with the licensing of drugs pass judgment on trials, which are closely linked by the one-sponsor problem: the assertions made by the sponsor are not independently confirmed. This lack leads to excessive documentation and to costly monitoring and auditing, which are intended to ensure the credibility of results. In Popper's view, confirmatory trials, independent of the sponsor and supervised by the regulatory bodies, would be a better way to achieve reliable knowledge. The consequence would, among other things, be a reorganization of phase III of the clinical investigation of new drugs by dividing it into independent parts, one under the control of the sponsor and one under the control of the public authority. The implementation of this suggestion would lead to a more scientific manner of dealing with new drugs and to savings in terms of unproductive measures during the application process.

Clinical Trials, Phase III as Topic↗
PubMed2000

Technology in medicine: ontology, epistemology, ethics and social philosophy at the crossroads.

In reference to the different approaches in philosophy (of medicine) of the nature of (medical) technology, this article introduces the topic of this special issue of Theoretical Medicine and Bioethics, that is, the way the different forms of medical technology function in everyday medical practice. The authors elaborate on the active role technology plays in shaping our views on disease, illness, and the body, whence in shaping our world.

Biomedical Technology↗
PubMed1999

Moral perception and the pursuit of medical philosophy.

This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the 'moral perception' required to appreciate this moral dimension. I will argue that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon.

Decision Making↗
PubMed1999

Bakhtin's philosophy and medical practice--toward a semiotic theory of doctor-patient interaction.

Doctor-patient interaction has gained increasing attention among sociologists and linguists during the last few decades. The problem with the studies performed so far, however, has been a lack of a theoretical framework which could bring together the various phenomena observed within medical consultations. Mikhail Bakhtin's philosophy of language offers us tools for studying medical practice as socio-cultural semiotic phenomenon. Applying Bakhtin's ideas of polyphonic, context-dependent and open-ended nature of human communication opens the possibilities to develop prevailing theoretical and empirical approaches to the study of medical consultations.

Communication↗
PubMed2001

The 'medical body' as philosophy's arena.

Medicine, as Byron Good argues, reconstitutes the human body of our daily experience as a "medical body," unfamiliar outside medicine. This reconstitution can be seen in two ways: (i) as a salutary reminder of the extent to which the reality even of the human body is constructed; and (ii) as an arena for what Stephen Toulmin distinguishes as the "intersection" of natural science and history, in which many of philosophy's traditional (and traditionally abstract) questions are given concrete and urgent form. This paper begins by examining a number of dualities between the medical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine as combining both universal and existential knowledge is then considered. Their expression, in terms of attention, respectively, to natural science and to personal history, is explored through the epistemological contrasts between the medical body and the familiar body, noting the traditional philosophical questions which they in turn illustrate.

Consciousness↗
PubMed2001

Ethical boundary work: geneticization, philosophy and the social sciences.

This paper is a response to Henk ten Have's "Genetics and Culture: The Geneticization thesis". In it, I refute Ten Have's suggestion that geneticization is not the sort of process that can be measured and commented on in terms of empirical evidence, even if he is correct in suggesting that it should be seen as part of 'philosophical discourse'. At the end, I relate this discussion to broader debates within bioethics between the social science and philosophy, and suggest the need for philosophical approaches to take the social sciences seriously.

Bioethics↗
PubMed2002

Recent philosophy of biology: a review.

Academia is subdivided into separate disciplines, most of which are quite discrete. In this review I trace the interactions between two of these disciplines: biology and philosophy of biology. I concentrate on those topics that have the most extensive biological content: function, species, systematics, selection, reduction and development. In the final section of this paper I touch briefly on those issues that biologists and philosophers have addressed that do not have much in the way of biological content.

Animals↗
PubMed2003

Assessing overmedication: biology, philosophy and common sense.

Overmedication is nowadays a serious problem in health care due to influences from the pharmaceutical industry and agencies responsible for regulation. The situation has indeed become appalling in psychiatry, where both theories and treatments have deteriorated under the impact of the industry. The overmedication problem is associated with biased biology in medicine. Adequate biological approaches would indicate that drug therapies must yield to diet therapies, particularly treatments involving omega-3 fatty acids, in many cases. To the extent that philosophy of science adapts to mainstream medicine in analyses of the current situation, it may reinforce the existing bias. To redress imbalances in health care, we ultimately have to rely on common sense.

Antacids↗
PubMed2004

The sartorial self: William James's philosophy of dress.

William James placed great importance on clothing, and this emphasis on apparel is reflected in his writings on psychology, in his letters, and in his own style of dress. his perspective on dress was influenced by a passage on the "philosophy of clothing" in Hermann Lotze's Microcosmus. James believed clothing to be an essential part of the material self; in this article it is argued that it is important to the spiritual and social selves as well. James's interest in the self-expressive aspects of clothing was reflected in his attire, his descriptions of colleagues" clothing, his account book, and his chairmanship of Harvard's Committee on Academic Dress.

Clothing↗
PubMed1996

Implementation of a hermeneutic inquiry in nursing: philosophy, rigour and representation.

The thesis of this paper is that researchers working in interpretive traditions need to address three central issues: philosophy, rigour and representation. This paper discusses the process of an hermeneutic inquiry as a research methodology used in seeking to understand the experiences of older patients admitted to an acute hospital. The methodology includes the philosophical framework and assumptions underpinning the research. Philosophical hermeneutics guides the inquiry as a reflection of the research process. Three issues concerning legitimation of the hermeneutic research process arise: the philosophical underpinnings of the methodology, representation, or the participation of the researcher in making data, and rigour, or the way in which trustworthiness of hermeneutic research can be established. I recommend that Gadamer's primacy of application to the understanding of texts can also be applied to understanding of health environments. I conclude that Gadamer's post-modern sensibility regarding text and the framework of Guba & Lincoln's fourth generation evaluation are compatible within a hermeneutic inquiry.

Acute Disease↗
PubMed1997

Project 2000: perceptions of the philosophy and practice of nursing: shifting perceptions--a new practitioner?

This is the first of two papers which address aspects of the findings of a large scale study commissioned by the English National Board which set out to examine the impact of Project 2000 on perceptions of the philosophy and practice of nursing. The findings presented here suggest that there have been fundamental shifts in perceptions of the nature and discipline of nursing. Students and diplomates of the course perceive themselves as knowledgeable doers, with their practice well grounded in theory and research. They value the interpersonal skills teaching and place the patient firmly at the centre of care delivery, viewing the patient holistically and being prepared to be fierce patient advocates where necessary. It is difficult to determine the extent to which these shifts can be attributed to the Project 2000 course, although the Project 2000 approach to education appears to be an important factor.

Attitude of Health Personnel↗
PubMed1997

Project 2000. Perception of the philosophy and practice of nursing: preparation for practice.

As part of a comprehensive study of perceptions of the philosophy and practice of nursing Project 2000 students and newly qualified diplomates were asked to reflect on their Project 2000 course as a preparation for professional practice. Data were collected from both students and diplomates through self-completion questionnaires and a small number of interviews with diplomates in two study centres, one in the north and the other in the south of England. Nurse managers and G grade practitioners were invited in focus group interviews to discuss the Project 2000 preparation and assess the diplomates 'fitness for purpose'. Findings suggest that the majority of students and diplomates acknowledged that the course had prepared them well. They acknowledged the importance of the inter-personal skills component of the course, together with the life sciences input. The diplomates particularly valued the theoretical aspect of the course, being well versed in research and keen to continue their learning. Perceived limitations of the course were the management preparation and course organization. Practical skill deficits were perceived as initial skills deficits only. Managers and practitioners were keen to employ the diplomates, whilst acknowledging their need for support and preceptorship. Three important issues for nursing and nurse education are discussed, including the balance of the Project 2000 course, preceptorship and support, and preparation for a role in the community.

Attitude of Health Personnel↗
PubMed1999

Primary nursing: a mode of care or a philosophy of nursing?

An examination of the literature surrounding primary nursing has shown that the term 'primary nursing' is used to mean different things by different authors. This results in a confusing situation where 'primary nursing' is considered by some to mean both a mode of organizing care delivery and a philosophy of nursing. In this paper I argue for a clear separation between the terms which refer to the set of ideas underpinning nursing and descriptions of modes of care. A case is made for using the term 'human centred nursing' to refer to nursing beliefs and 'primary nursing' to refer to the mode of nursing care delivery.

Delivery of Health Care↗
PubMed2002

Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice.

Psychiatric intensive care units (PICUs) were first developed in the UK in the early 1970s and have become an integral part of inpatient services. This paper reviews all aspects of PICU provision from its origins to the most recent studies of intensive care treatment and philosophy. A search of CINAHL, MEDLINE and British Nursing Index databases revealed ample research and discussion papers from the past 30 years to permit a thorough review of the available literature. This divides roughly into discussion and descriptive research on topics related to: (a) the infrastructure of PICUs, including bed numbers, staffing levels, admission criteria and aspects of the physical environment; and (b) the treatment provided to patients on the PICU, both pharmacological and psychosocial, plus a limited amount of evaluative research on the efficacy of PICU care. This paper provides a summary and overview of these issues based upon currently available literature. It concludes that there is strong evidence for wide variation in the provision and nature of PICU care, reflecting idiosyncratic and localized development of services. Moreover, there is an almost complete lack of evidence on the efficacy of PICU care for particular types of patients and problems, leaving a paucity of research upon which PICU infrastructure, policy and therapeutic approach can be based.

Ethics, Clinical↗
PubMed2001

Whose evidence? Lessons from the philosophy of science and the epistemology of medicine.

OBJECTIVE: To demonstrate the inadequacies of empiricism as a scientific foundation for evidence-based approaches to psychiatry. METHOD: The principles of empiricism are reviewed in the light of developments in the philosophy of science and phenomenology. Case studies are selected from the history of physical sciences, biological science and clinical sciences (pathology, neuroscience, psychosocial science and psychopathology), paying particular attention to the role of observation in theory construction. RESULTS: The principles of empiricism, particularly its view of the nature of observation as the basis of evidence do not reflect the historical reality of scientific theorizing and practice. Science has constructed alternative models of its own activity that do justice to the complexities of its subject matter, including the world of human experience and mental illness. CONCLUSIONS: A failure to recognize both the limitations of empiricism in science and the conceptual richness of alternative formulations that accord more closely with the complexity of psychiatry's domain will result in a naïve model of science and inadequate understanding of the limitations of 'evidence' that guide the training, clinical practice and research in our profession. The consequences will be the intellectual, clinical and ethical impoverishment of psychiatry.

Evidence-Based Medicine↗
PubMed1998

Truth, virtue and beauty: midwifery and philosophy.

In this paper, we outline three moments in the history of Western philosophy--Classical Greek, Modernity, Postmodernity--and the ways in which issues of truth, virtue and beauty have been understood within these philosophical formations. In particular, we investigate the ways in which notions of truth, virtue and beauty influenced the orthodoxy of birthing practices at these different moments. Finally, we examine current, critical reflections on the role of the intellectual in postmodern society and use these reflections as a heuristic for understanding the role of the contemporary midwife. We suggest that midwifery must reconcile two divergent demands. The first is to mobilise the positive, instrumental benefits of Western medical science to improve mortality and morbidity outcomes. The second is to remain sensitive to the cultural and social meanings attached to traditional birthing practices and to understand the roles these play in the well-being of mother and child.

Adult↗
PubMed2002

[Holistic thinking in medicine--do we need a medical philosophy? Current efforts to think beyond the limits of school medicine, needs for systematic standardization].

The increasing debate dealing with topics of medicine and with medicine itself necessitates a scientific and systematic approach to the reality of medicine as a whole. This can be accomplished by the philosophy of medicine. For the purpose of reorientation of this discipline a division into notices of medicine, aesthetics of medicine and ethics of medicine is proposed.

Austria↗