Journal of Philosophical Investigations

نوع مقاله : مقاله علمی- پژوهشی

نویسنده

دانشیار گروه فلسفه علم و تکنولوژی، پژوهشگاه علوم انسانی و مطالعات فرهنگی، تهران، ایران.

10.22034/jpiut.2021.47985.2976

چکیده

با گذر از نیمه قرن بیستم میلادی وقایعی رخ داد و پدیده‌هایی برآمد که در مجموع آنها را «بحران پزشکی» خواندند. این بحران سبب شد فلسفه که از نیمۀ قرن نوزدهم از پزشکی منتزع شده بود مجالی برای حضور مجدد بیابد. فیلسوفان پزشکی، بحران را به فربه‌شدن وجوه علمی و تکنیکی و نحیف شدن جنبه‌های انسانی طبابت نسبت دادند. از همین رو، تأمل در باب اینکه پزشکی چیست و چگونه باید میان وجوه علمی-تکنیکی و انسانی آن توازن برقرار کرد به یکی از مسائل محوری فلسفۀ پزشکی بدل شد. سرشت پزشکی معمولاً در غالب دوگانۀ علم-هنر صورت‌بندی می‌شود. در این مقاله ابتدا این صورت‌بندی را تشریح می‌کنم و سپس نابسندگی آن را نشان خواهم داد. در پایان الگویی پیشنهاد می‌دهم که بتوان سرشت پزشکی را بیرون از دایرۀ دوگانۀ علم/هنر فهم کرد. در این الگو پزشکی پرکتیسی است علمی، مبتنی بر قضاوت، گفتگو، مفاهمه و استوار بر سامانی اجتماعی. این الگو با چالش‌های غایت‌شناختی، معرفت‌شناختی، علم‌شناختی، سیاست‌گذارانه و حرفه‌مندی روبروست که نیازمند تأملات جدی و پیوسته در سرشت پزشکی است.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

On the Nature of Medicine: Necessities, Approaches, and Challenges

نویسنده [English]

  • Alireza Monajemi

Associate Professor, Philosophy of Science and Technology Department, Institute for Humanities and Cultural Studies, Tehran, Iran.

چکیده [English]

After the middle of the twentieth century, symptoms gradually appeared which were collectively called the “crisis of medicine”. This crisis gave philosophy, which had been abstracted from medicine since the mid-nineteenth century, an opportunity to reflect. Medical philosophers attributed the crisis to the inflation of the scientific and technical aspects and, consequently, to the weakening of the human aspects of medicine. Therefore, reflection on the nature of medicine became one of the central issues of philosophy in medicine.
In this article, I will first highlight the need to study the nature of medicine, explain the various concpetions of the nature of modern medicine - based on the dichotomy- science vs. art , and show their inadequacy and inappropriatness. Finally, I will provide a model to the nature of medicine beyond the realm of science / art. In this model, medicine is a scientific practice, based on judgment, dialogue, communication and social order. This model faces teleological, epistemological, scientific, political, and professional challenges that require serious and continuous reflection on the nature of medicine.

کلیدواژه‌ها [English]

  • Nature of medicine"
  • Philosophy of medicine"
  • Art-Science dichotomy
  • practice"
  • "
  • Gadamer"
  • Bleakley A. (2015) Medical humanities and medical education: How the medical humanities can shape better doctors, New York: Routledge, pp 40-59.
  • Cole TR, Carlin NS, Carson RA. (2015) Medical humanities: An introduction, Cambridge University Press.
  • Elstein AS, Shulman LS, Sprafka SA. (1978) Medical Problem Solving: an Analysis of Clinical Reasoning. Cambridge, MA: Harvard University Press.
  • Engel GL. (1977) "The need for new medical model: a challenge for biomedicine". Science, 196:129-36.
  • Feinstein, A. (1967) Clinical Judgment, Baltimore: Williams and Wilkens.
  • Feinstein, A. R., & Horwitz, R. I. (1997) "Problems in the evidence of Evidence-Based Medicine", The American Journal of Medicine, 103, 529-535.Forstram, L. A.(1977) "The scientific autonomy of clinical medicine", Journal of Medicine and Philosophy, 2, 8—19.
  • Flexner, A. (1910) "Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching", Bulletin 4., New York City: The Carnegie Foundation for the Advancement of Teaching.
  • Foucault, M. (1392) The Birth of the Clininc, trans. Fatemeh Valiani, Tehran: Mahi Publication. [in Persain]
  • Gadamer,H.G.(1996) The Enigma of Health. Stanford: Stanford University Press.
  • Goldman, L., Dennis, A, Editors (2004) Cecil’s textbook of medicine, Approach to medicine, the patient and the medical profession: medicine as learned and humane profession. Saunders, 1-10.
  • Gruppen, L. D., Frohna, A. Z. (2002) "Clinical reasoning". In: Norman GR, Ven Der Vleuten CPM, Newble DI. International Handbook of Research in Medical Education. Great Britain: Kluwer Academic Publishers.
  • Higgs, J.; Jones, M. (1996) Clinical Reasoning in the Health Professions. Second edition.
  • Hofmann, B. (2003) "Medicine as Techne: A Perspective from Antiquity", Journal of Medicine and Philosophy, 28(4): 403–425.
  • Hojat, M. (2002) "Physicain empathy: definition, components, measurement, and relationship to gender and specialty". American Journal of Psychiatry, 159(9): 1563-1580.
  • Hojat, M. (2004) "An empirical study of decline in empathy in medical school". Medical Education, 38: 934-41.
  • Jenicek, M. (2012) A Primer on Clinical Experience in Medicine: Reasoning, Decision Making, and Communication in Health Sciences, Taylor & Francis.
  • Kemmis, S. (2012) "Phronesis, experience and the primacy of pracxis", E.A. Kinsella, A. Pitman (eds.), Phronesis as Professional Knowledge: Practical Wisdom in the Professions, 147–161.
  • Mant, D. (1999) "Can randomized trials inform clinical decisions about individual patients?" Lancet, 353, 743-746.
  • Marcum, J. A. (2008) An Introductory Philosophy of Medicine: Humanizing Modern Medicine. Dordrecht: Springer-Verlag.
  • Monajemi, A., Namazi, H. (2020) "Medical/Health Humanities: Critical analysis of theoretical and practical foundations of medicine". Philosophy of Science, 10(20): 225-249. doi: 10.30465/ps.2021.34161.1488 [in Persian]
  • Moseley, R. (1993) "Intuition in the art and science of medicine", in Corinna Delkeskamp-Hayes and Mary Ann Gardell Cutter (eds.), Science, Technology, and the Art of Medicine, Kluwer Academic Publisher 211-218.
  • Munson, R. (1981) "Why medicine cannot be a science". The Journal of Medicine and Philosophy, 6: 183–208.
  • Newton, N.(2001) "Rationalism and emprocosm in modern medicine", Law and Contemporary Problems, 64: 299-316.
  • Norman G. (2005) "Research in clinical reasoning: past history and current trends". Medical Education, 39: 418-27.
  • Panda, S. C. (2006) "Medicine: Science or Art?" Mend Sana Monograph, 4(1): 127-138.
  • Pellegrino E, Thomasma D. (1981) A Philosophical Basis of Medical Practice. New York: Oxford University Press.
  • Pellegrino, E. D. (1979) ‘Medicine, science, art: An old controversy revisited" Man Med, 4, 43–52.
  • Sadeghzadeh, K. (1980) "Toward metamedicine" Metamedicine 1, 3–10.
  • Sadeghzadeh, K. (2013) Handbook of Analytic Philosophy of Medicine, Dordrecht/ Holland: Springer.
  • Schaffner, K. F. (1993) Discovery and Explanation in Biology and Medicine. Chicago, IL: University of Chicago Press.
  • Schaffner, K. F., Engelhardt, H. T., Jr. (1998) "Medicine, philosophy of" Routledge Encyclopedia of Philosophy, Craig, E., ed. New York: Routledge, vol. 6: 264–269.
  • Schramme, Thomas & Edwards, Steven (eds.) (2017) Handbook of the Philosophy of Medicine. Springer.
  • Sober, E. (1979) "The art and science of clinical judgment: an informational approach". Evaluation and Explanation in the Biomedical Sciences, Engelhardt, H. T., Jr., Spicker, S. F., eds. Dordrecht, The Netherlands: Reidel, pp. 29–44.
  • Svenaeus, F. (2000) The Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a Philosophy of Medical Practice. Linkoping Studies in Arts and Sciences, Department of Health and Society, Linkoping University.
  • Toulmin, S. (1993) "Knowledge and art in the practice of medicine: clinical judgment and historical reconstruction", in Corinna Delkeskamp-Hayes and Mary Ann Gardell Cutter (eds.), Science, Technology, and the Art of Medicine, Kluwer Academic Publisher 231-249.
  • Wieland, W. (2002) "The character and mission of the practical sciences, as exemplified by medicine", Poiesis and Praxis, 1:123-134.
  • Wieland, W. (1993) "The concept of the art of medicine", in Corinna Delkeskamp-Hayes and Mary Ann Gardell Cutter (eds.), Science, Technology, and the Art of Medicine, 165-181.
  • Wolf, H. and Pederson, S. and Rosenberg, R. (1380) An Introduction to the. Philosophy of Medicine. Trans. Homayoun Moslehi. Tehran: New. Design. [in Persian]
  • Worrall, John (2002) "What Evidence in Evidence‐Based Medicine?" Philosophy of Science. 69.
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