The Philosophy of Medicine: Can We Trust It?

Many believe that medicine and philosophy are two unrelated disciplines. However, did you know that there's a philosophy of medicine?

Written and verified by the philosopher Maria Alejandra Morgado Cusati.

Last update: 17 February, 2023

Medicine seeks to heal, or at least to alleviate illnesses. Meanwhile, philosophy analyzes and systematizes very general notions, such as reality, knowledge, or the good. However, although it may not seem so, they have been liked since the time of Hippocrates (460 B.C. – 370 B.C.).

Although some authors have denied the existence of the philosophy of medicine as a distinct field of study, we now have dedicated journals, professional organizations, and considerable scholarly literature supporting the establishment of this philosophical branch. Therefore, in this article, we’re going to explain what it is and address some of the issues it deals with.

The philosophy of medicine: What is it?

The philosophy of medicine is a field of knowledge that examines fundamental issues in the theory, research, and practice of the health sciences. In particular, it considers metaphysical, epistemological, and ethical issues.

To better understand this definition, let us consider the areas of research that the discipline should cover, according to the philosopher James A. Marcum:

• The first is an ontology of medicine, which would address questions such as what is the nature of medicine and health institutions. For instance, what does it mean to be a doctor? What is the role and nature of the doctor-patient relationship?  Also, what kind of entities are diseases? (Among other things).
• The second is an epistemology of medicine, in which questions such as “What kind of knowledge is medical knowledge? How is it constructed and what kind of knowledge is the clinic, and how can one access knowledge of the disease and the body?” are raised, among others.
• And the third is the ethics of medicine, which involves inquiring into the regulation of the doctor-patient relationship. For instance, it seeks to answer questions such as these: What are the objectives, values, and goals that should guide medical practice? And hat has been the transition from medical ethics to bioethics? (Among others).

Debates within the philosophy of medicine

Some of the issues discussed within the philosophy of medicine are the following. We’ll tell you about them in detail.

How should health and disease be defined?

One of the fundamental and oldest debates in the philosophy of medicine is related to two basic concepts. The dividing line between disease and health is notoriously vague, especially given the wide range of variations in the human population and debates over whether many concepts of disease are socially constructed.

Addressing these distinctions remains important from an epistemological and moral standpoint, as these definitions influence when and where people seek medical treatment – as well as whether or not society considers someone to be “ill.”

Thus, defining illness, health, and their related concepts is not a matter of mere philosophical or theoretical interest, but is critical for ethical reasons. Above all, it’s important to ensure that medicine contributes to the well-being of people.

Evidence-based medicine (EBM)

EBM refers to a movement started in the early 1990s by a group of epidemiologists at McMaster University in Hamilton, Canada. They reacted against what was perceived as an over-reliance on clinical judgment and expertise in making decisions about patients.

In this sense, it’s an approach to medical practice aimed at optimizing care, emphasizing the use of evidence and research based on the scientific method. Advocates of EBM have developed hierarchies of evidence, which categorize different research methods with respect to their purported quality.

While there’s no universally accepted hierarchy, proposals prioritize randomized controlled trials and reviews of randomized controlled trials. Non-analytic studies (such as case reports) and expert opinions are among the least reliable.

In this regard, many philosophers have questioned the legitimacy of these hierarchies. So, questions have also been raised about the unreliability of medical research.

Clinical judgment and the role of expertise

The hierarchies of evidence in EBM place expert opinion in the last positions. The epidemiologists who initiated the movement had good reason to be skeptical about this issue. There are flaws in subject treatments to systematic testing when tradition and expert opinion are a factor.

Now, misjudgments about the efficacy of treatments for purely epistemic reasons are not the only concern one might have about expert opinions. In this case, physicians’ personal interests may influence their judgments and create biases in their practice.

For example, many physicians have connections to the pharmaceutical industry in one way or another. In fact, according to one study, 94% of U.S. physicians receive financial benefits from drug companies.

Therefore, it’s valid to assume that the market will influence treatment recommendations. Hence the importance of relying on the EBM principle so decisions can be based on the best available evidence. In this case, the key is systematic research.

When expert judgment becomes more valuable

However, the issue becomes more complicated when many systematic, population-level studies produce results that are not directly applicable to specific individuals. A fairly common example is the side effects of treatment.

In this case, the results of clinical trials may indicate that a particular drug is effective in treating a condition, but possible side effects are overlooked.

There are several reasons why clinical studies may not show evidence of adverse effects. It may be because they didn’t adequately follow those examined in the trial. For instance, perhaps they found side effects but didn’t report them. Or maybe the adverse effects were not statistically significant.

This demonstrates that the efficacy of a treatment in relieving the symptoms of a disease is not the only consideration in making a treatment decision. In these cases, the clinical judgment of the expert plays an extremely important role.

The validity of the philosophy of medicine

Philosophical reflection on medical issues is extremely important for the development of theories and practices that procure health and well-being for people. We should bear in mind that debates within this field have contributed to the development of medicine and its methods.