Establishing Medical Reality

Medicine raises numerous philosophical issues. Most discussed have been debates in bioethics. Yet contemporary medicine is also a rich source of controversies and examples that raise important issues in philosophy of science, philosophy of biology, and metaphysics. This volume approaches the philosophy of medicine from the broad naturalist perspective that holds that philosophy must be continuous with, constrained by, and relevant to empirical results of the natural and social sciences and that believes that the history, sociology, politics, and ethics of science provide relevant information for philosophical analysis. One traditional topic covered by several of the contributions is the nature of disease, but the approach is largely from the philosophy of science rather than traditional linguistic analysis. The complex interplay of epistemological and sociological factors in producing evidence in medicine is discussed by chapters on collective medical discussion making, experimental medicine, " genetic" diseases, mental illness, and race and gender categories. The upshot is a volume that ties medicine to contemporary issues in philosophy of science and metaphysics like no other.

'...An excellent collection of essays in the philosophy of medicine. Whereas most philosophical work about medicine has been concerned with medical ethics, this volume focuses more on key questions in epistemology and metaphysics, although many of these are also relevant to ethical issues. Some of the chapters are among the best I have read in the philosophy of medicine on their respective topics.'

Professor Paul Thagard, Philosophy Department, University of Waterloo, Ontario, Canada

Résumé
Medicine has been a very fruitful source of significant issues for philosophy over the last 30 years. The vast majority of the issues discussed have been normative they have been problems in morality and political philosophy that now make up the field called bioethics. However, biomedical science presents many other philosophical questions that have gotten relatively little attention, particularly topics in metaphysics, epistemology and philosophy of science. This volume focuses on problems in these areas as they surface in biomedical science. Important changes in philosophy make biomedical science an especially int- esting area of inquiry. Contemporary philosophy is largely naturalistic in approach it takes philosophy to be constrained by the results of the natural sciences and able to contribute to the natural sciences as well. Exactly what those constraints and contributions should be is a matter of controversy. What is not controversial is that important questions in philosophy of science and metaphysics are raised by the practice of science. Physics, biology, and economics have all drawn extensive phi- sophical analysis, so much so that philosophical study of these areas have become specialized subdisciplines within philosophy of science. Philosophy of medicine approached from the perspective of philosophy of science with important exc- tions (Schaffner, 1993; Thagard, 2000) has been relatively undeveloped. Nonetheless, medicine should have a central place in epistemological and metaphysical debates over science.

Contenu
Normality, Disease and Enhancement.- Holistic Theories of Health as Applicable to Non-Human Living Beings.- Disease and the Concept of Supervenience.- Decision and Discovery in Defining 'Disease'.- Race and Scientific Reduction.- Towards an Adequate Account of Genetic Disease.- Why Disease Persists: An Evolutionary Nosology.- Creating Mental Illness in Non-Disordered Community Populations.- Gender Identity Disorder.- Clinical Trials as Nomological Machines: Implications for Evidence-Based Medicine.- The Social Epistemology of NIH Consensus Conferences.- Maternal Agency and the Immunological Paradox of Pregnancy.- Violence and Public Health: Exploring the Relationship Between Biological Perspectives on Violent Behavior and Public Health Approaches to Violence Prevention.- Taking Equipoise Seriously: The Failure of Clinical or Community Equipoise to Resolve the Ethical Dilemmas in Randomized Clinical Trials.