Abstract
After considering two of Pellegrino’s papers that address the relation between philosophy of medicine and medical ethics, I identify several overarching problems in his account that revolve around his self-described essentialism and the lack of a systematic attempt to relate clinical medicine to biomedicine and public health. I address these from the critical realist position of Bernard Lonergan, who grounds both metaphysics and ethics on the normative structure of human inquiry and seeks to understand historical development, such as we are witnessing in health science and health care, in terms of the dynamic structure of the human good. I conclude that Lonergan’s generalized empirical method and hierarchical account of world order provide a potentially dynamic framework on which to build a more comprehensive philosophy of medicine than one whose foundations rest primarily on a phenomenology of the clinical encounter and the telos of medicine.
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Notes
In a work that Pellegrino and Thomasma cite, Dewey says, “Because of this sense of the evanescence and uncertainty of what used to be called ends … [they] are now called values” [6, p. 396].
As I discuss below, Lonergan does not subscribe to essentialist positions in philosophy, but he does draw on Hildebrand’s phenomenological account of feeling with respect to value, which Pellegrino does not discuss.
In his earlier paper, Pellegrino designates these three phenomena as the fact of illness, the act of profession, and the act of medicine [2, pp. 207‒212].
In this way, Lonergan introduces history formally into the realist tradition of Aristotelian-Thomistic philosophy.
See [13] for a full account of clinical reasoning in terms of the structure of cognition and deliberation that I outline here.
GEM is generalized with respect to the common core of operations underlying all human praxis and the data to which investigators attend, which encompass data of consciousness as well as data of sense; it is empirical in that judgments are to be verified in reference to experiential data. By method Lonergan means “a normative pattern of related and recurrent operations that yield ongoing and cumulative results” [16, pp. 135‒139].
Niebuhr [19, p. 56] contrasts the faculty psychology and associationist psychology of the past with the more recent psychology of interaction.
See also [20, pp. 26‒106].
Intentional refers to the orientation of a conscious subject toward an object, not simply to purposeful action.
Organismic (holistic) refers to the functioning of whole organisms; suborganismic refers to part functioning within individual organisms.
From this standpoint, clinical epidemiology as Alvan Feinstein [23] conceived it mediates between clinical medicine and public health.
Psychology, in the present scheme, concerns what goes well and what goes awry at the level of intrapersonal psychic operation. Since individual psychic development and operation fundamentally involves a context of social interaction and formation, mental health science and practice, more broadly conceived, must also take into account the vertical integration that unfolds historically in people’s lives across intrapersonal and interpersonal levels of operation.
References
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Daly, P. Grounding medical ethics in philosophy of medicine: problematic and potential. Theor Med Bioeth 40, 169–182 (2019). https://doi.org/10.1007/s11017-019-09491-y
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DOI: https://doi.org/10.1007/s11017-019-09491-y