Interactions between persons—knowledge, decision making, and the co‐production of practice

There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as “ethical add-ons” but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that “sits within the minds” of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to 'integrate' different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focusing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts

Steven Shapin. The Scientific Life: A Moral History of a Late Modern Vocation

In The Scientific Life, Steven Shapin argues that people and their virtues matter in late modern science. While scientists struggle to remain objective and impersonal, it is the personal, familiar, and charismatic—the traits once swept aside as vices by the scientifically virtuous—that have come to embody the “truth-speakers” of late modernity. With an enormous and sometimes daunting wealth of primary sources (from technical commentaries to his own sociological fieldwork), Steven Shapin breathes life back into these quotidian virtues. The Scientific Life is as much a disjointed genealogy of scientific virtue as a reminder that trust still matters at the cutting-edge of scientific “future-making.” Shapin’s mastery of historical narrative is clear; anyone interested in the American scientific persona and how it has transformed in the twentieth century would do well to wade patiently through this thick and rewarding text. But hang up your expectations of historical linearity (and, sometimes, thematic coherence) as you weave through motley professionals, theorists, and critics drawn from over a century of science commentators. Perhaps this work is best described as textured: rich in detail, woven intricately, but hardly smooth to the touch

Medical Explanations in Evolutionary Medicine, Network Medicine, and Medically Unexplained Physical Symptoms

This dissertation is a philosophical exploration of the limits of medical explanations. I examine three case studies to explore these limits: evolutionary medicine, network medicine, and the medically unexplained. Evolutionary medicine and network medicine exemplify modern attempts to develop new explanatory strategies in clinical research and practice. They are burgeoning, nascent fields that challenge our conventional understanding of health and disease. I am critical of the former and optimistic about the latter. I argue that the ultimate explanations posed by evolutionary medicine are pragmatically and epistemically inadequate as medical explanations. Explanations that appeal to our ancestral past are speculative, often based on adaptationist assumptions, and empirically suspect—we cannot rely on them to develop medical interventions. Network medicine aims to map the connections between the causes of disease and pathophenotypes. It has the potential to reconceptualize diseases as emergent topologies of these networks. I discuss the role of mechanisms in these models and how multi-level, context-sensitive networks aim to be empirically robust. Medically unexplained syndromes, in contrast, are an obscure class of illnesses that cannot be explained by somatic biomedicine. Like complex chronic diseases, these syndromes are a thorn in the overwhelming success of medical progress. Patients with unexplained syndromes are often diagnosed with psychiatric illnesses, and I argue that it is an epistemic injustice to pathologize such gaps in medical knowledge. Rather than diagnosis these conditions by exclusion, we need to embrace epistemic humility when confronted with such medical uncertainty. This dissertation adds to the literature on medical explanations, exploring their unique virtues and clinical implications.Ph.D

In Search of Transdisciplinarity: A Review of Two Workshops Supported by Situating Science

Disciplines have a way of imprisoning their creations. Entrenched in an incommensurable discourse, ideas grow stagnant. Whether ideas transcend this imprisonment is a matter of adapting, flexing, and mobilizing knowledge. This is the aim of Situating Science: Cluster for the Humanistic and Social Studies of Science. Promoting transdisciplinarity among researchers, stakeholders, and the public, the Cluster brings diverse groups of scholars to sit around a common table and discuss a common theme. My aim in this short review is to capture some of the central themes and discussions of two such workshops, one on empathy, the other evidence-based medicine. Both workshops provided a fascinating multidisciplinary perspective on topics that easily transcend disciplinary boundaries. Yet the divisions between participants were clear, leaving some discouraged about producing collaborative work. As both workshops boasted a broad range of speakers and participants, my challenge has been to identify common themes without diminishing or disregarding this multiplicity of perspectives. I have only sought to highlight some of the most thought-provoking ideas

Inked: Graduate Writing Groups as Writing Centre Pedagogy

In the post-pandemic era, Canadian writing centres are ideally positioned to organise and support graduate writing groups. At the University of Toronto’s Health Sciences Writing Centre, we have begun offering a weekly, multidisciplinary graduate writing group for students in the health sciences. Inked: the Health Sciences Writing Collective aims to bridge the gap between high-commitment co-working groups and low-commitment accountability groups. We outline how the group emerged, how it addresses graduate challenges, and how it builds self-efficacy and community among members. We argue that this move to group-centred, indirect instruction presents an exciting direction for writing centre pedagogy in Canada

Interactions between persons—Knowledge, decision making, and the co-production of practice

There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as “ethical add-ons” but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that “sits within the minds” of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to ‘integrate’ different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Ethics & Philosophy of Technolog

The causal explanatory functions of medical diagnoses

Diagnoses in medicine are often taken to serve as explanations of patients’ symptoms and signs. This article examines how they do so. I begin by arguing that although some instances of diagnostic explanation can be formulated as covering law arguments, they are explanatory neither in virtue of their argumentative structures nor in virtue of general regularities between diagnoses and clinical presentations. I then consider the theory that medical diagnoses explain symptoms and signs by identifying their actual causes in particular cases. While I take this to be largely correct, I argue that for a diagnosis to function as a satisfactory causal explanation of a patient’s symptoms and signs, it also needs to be supplemented by understanding the mechanisms by which the identified cause produces the symptoms and signs. This mechanistic understanding comes not from the diagnosis itself, but rather from the theoretical framework within which the physician operates