Philosophy of medicine has been defined as “a systematic set of ways for articulating, clarifying, and addressing the philosophical issues in medicine.”1 This burgeoning field has featured in several recent issues of CMAJ, most notably in Jonathan Fuller’s latest article, “The new medical model: a renewed challenge for biomedicine.”2 In this article, Fuller shows the value of philosophy in clarifying and describing “the new medical model,” and articulates the metaphysical, epistemological and ethical ideas that form the core of contemporary medical thought. In so doing, Fuller brings to light problems inherent to the new medical model, which in turn create challenges in clinical practice.
One such challenge raised by Fuller relates to the metaphysical/conceptual question, What is a disease?, which is a central and long-standing debate in the philosophy of medicine. Biomedicine and the new medical model equate disease with organic dysfunction, but often adopt an unsophisticated and limited understanding of function/dysfunction that fails to take into account the inherent evaluative and contextual features of these concepts.3 As Fuller aptly points out, biomedicine’s reductionist view of disease engenders a disease-centred ethic that can lead to fractured care, in particular, when faced with chronic disease.
Other philosophical approaches might help to overcome this problem. For example, adopting a phenomenological approach that focuses on an individual’s experience of illness and the impact of disease on a life world may help move us toward a more person-centred ethic.4 In these ways, philosophy can have a tangible impact on physician–patient interactions and delivery of care, as well as in the training of health care professionals.
Fuller’s article underscores several more challenges facing medicine today — from our understanding of comorbidity/multimorbidity to our application of population-level studies to guide individual patient care. By highlighting how many of medicine’s problems are indeed philosophical problems arising from a historically contingent medical model, Fuller makes a strong argument for why medicine needs philosophy.
Footnotes
Competing interests: None declared.
References
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