Epistemology of the Clinic

In the dominant collective imaginary, there is a sharp asymmetry between what a patient knows and what a doctor knows. The patient knows their own bodily experience. They know, in the terminology used to describe such situations, what their symptoms are. The doctor has all the rest of the knowledge: of the significance of these symptoms, and ultimately after tests only they know when to order and how to interpret, of the cause of the symptoms (usually referred to as “diagnosis”), the course the illness is likely to take (the “prognosis”) and the most appropriate treatment plan. We have, therefore, a highly asymmetrical situation where the patient and the doctor know strictly different things: just like the patient doesn’t have the knowledge required to accurately identify a cause, course, or treatment for their symptoms, the doctor doesn’t have independent knowledge of what the symptoms and, more broadly, lived experienced of the disease are. This conception of the knowledge dynamics a...

One of the central debates in the field of philosophy of medicine concerns the nature of disease. There are many different positions with interesting and subtle differences, but they are usually divided into two types: naturalist views which separate disease from health on the basis of purely natural, biological facts , and normativist views, which distinguish disease from health at least partly by appeal to value , of what is good and what is bad for the person involved.  The paradigm naturalist view is that of Christopher Boorse (1977). According to him, what makes a body diseased is that it is not functioning properly, as compared against bodies of the same age and sex. So, for instance, a person with tuberculosis is diseased, in virtue of the fact that their lungs are no longer able to perform their proper function, as measured by, for instance, reduced oxygen extraction compared to the average person.  And the most prominent normativist view is that o...