INTRODUCTION TO MEDICAL PHILOSOPHY

1. INTRODUCTION TO MEDICAL PHILOSOPHY By: E.Suryadi & Trijoko H. Faculty of Medicine GMU

2. If the people in medicine have knowledge they stand in a position to carry out the applied aims of medicine with greater effectiveness. Medicine's unique connection with ethics heightens the importance of correct application of knowledge. Epistemology falls short of being an applied field, but can contribute to the goals of medicine and bioethics.

3. What is philosophy? • Greek: philosophia • Philein = love, philos = friendship • Sophia = wisdom • Wisdom love = true (based on) & good (the effect is) • Outlook on life • Characteristics of philosophy thinking: inclusive comprehensive, reflective, synoptic, speculative, radical, conceptual, systematic, freedom, responsible and implicative, not only factual

4. The role of philosophy • Philosophy as a attitude • Philosophy as a method • Philosophy as a problem cluster • Philosophy as a theory cluster • Philosophy as a logical analysis • Philosophy as an activity to acquire comprehensive view

5. Three problems of the philosophy notion • 1. Existential problems -Quantity: monism; dualism; pluralism -Quality : spiritualism; materialism -Process or changing: mechanism; teleology; vitalism; organism

6. 2. Knowledge problems -Pertain to a resource: rationalism; empirics; realism; criticism. -Pertain to an essential: idealism; empirics; positivism; pragmatism

7. 3.Values problems -Idealism ethic : moral/ spiritual -Deontologism ethic: obligation -Teleology ethic :production, outcome, result -Hedonism : pleasant, enjoyment, happiness -Utilitarism : goodness

8. Philosophy and science • Philosophy as mater scientiarum (ascience mother) • Philosophy as a basic of science development • The sciences preference in a specific aspect and philosophy endeavor for unity of sciences • Philosophy view comprehensive reality so that “a something” become consistent

9. Philosophy of health 1. Vitalism 2500 years ago in ancient Greece Hippocrates offered a healing theory based on the idea of the internal energy of healing the organism (called: physic) so that physician = doctor to protect the healing energy and to maintain its vital power and strength

10. 2. Atomism Democritus’ idea was that our organism is nothing but minor particles coming together and falling apart. Democritus couldn’t imagine the presence of the healing energy in the particles we consist of and tried to prove that its existence is impossible. In practice physicians are its master and instead of expecting a low natural process to eliminate a harmful substance from the body.

11. 3. Regeneration • Regeneration is a philosophy of regaining the balance among many organism energies that are sometimes opposed. • A natural energy of healing called physic (Hippocrates) or Chi (Chinese). • Every human has the right to be healthy and is bound to be healthy

12. Alternative medicine • Traditional Chinese Medicine does not only focus on the body but also focuses on the body and its environment. • Acupressure, Acupuncture, Exercise, Food Therapies, Herbal Medicine and Meditation are the modalities of treatment commonly associated with Traditional Chinese Medicine • These techniques are not only used as treatments but they also are performed to assist in the prevention of disease

13. Oriental Medicine Philosophy When the body is in balance between Yin and Yang health is predominant. When the Yin and Yang are imbalanced, diseases occurs.

14. Health is an expression of balance, Oriental medicine views disease as physical expressions of an imbalance within the body. Oriental Medicine Physicians look at the symptoms. along with other diagnostic methods, to identify patterns of disharmony. Each of the body organ systems must be in balance within itself as well as within its relationship to the other organ systems.

15. Philosophy of Medicine Plato emphasized virtue,and said that good medicine is that which attains good ends. This is now known as teleological ethics. From ancient times there was emphasis on codes, oaths and other formulations. The Hippocratic oath defined morally acceptable conduct towards patients, considered duties to patients and referred to priestly vows and sacred art.

16. The practice of medicine consisted of the arts of preserving health, prolonging life and curing diseases but also required a ‘habit of nice discernment’, knowledge of the world, an ability to deal with prejudice and a controlled temperament. The moral qualities of humanity and sympathy were to be combined with firmness of mind, good humour, candour, decorum and good communication with patients.

17. John Gregory (1724 –1773) was particularly concerned with Scottish Moral Sense Theory, which was based onmotivation and character not action and consequence. It stressed humanity leading to empathy, discretion, confidentiality and tolerance. He condemned commercial self-interest, argued that reason could not be the basis of morality and thought that instinct needed training and control.

18. Should physicians in particular study philosophy? With some important reservations, then we find ourselves lining up behind the great Roman philosopher and physician Galen, when he writes: "We must practice philosophy if we are true followers of Hippocrates. And, if we practice philosophy, there is nothing to prevent us, not only from reaching a similar attainment, but even from becoming better than him."

19. The title of the work from which this is taken is The Best Doctor is Also a Philosopher.

20. Although same object, same data, same knowledge same faith. but difference perception and difference response because difference philosophy!? Patient Doctor Management!?

21. In line with an element of Professor Caplan's definition of the philosophy of medicine, I will attempt to explicate the key concepts in philosophy in medicine of ‘uncertainty' and 'underdetermination.'

22. Two basic types of uncertainty • "The first results from incomplete or imperfect mastery of available knowledge," and, • “The second depends upon limitations in current medical knowledge“ • Uncertainty is inherent to medical knowledge

23. With 'underdetermination' substituted for 'uncertainty' we see that there can be no instance of the negative: there is never a case where the evidence does not underdetermine the theory. So, perhaps nothing is lost by removing this part of the premise • It is not a simple case of underdetermination because it is a conflict between methods and not theories.

24. A number of claims that must be attended by doctor: 1. The public wants certainty and clarity 2. Science can rarely provide (1) 3. The data are uncertain 4. Scientists are in disagreement

25. A number of claims that must be attended by doctor: 5. To deceive the public is unethical 6. To mask the reality of [presumably] (1) through (4) to avoid 'confusion' is unethical, because it is an instance of (5) 7. To misguide health policy is imprudent

26. A number of claims that must be attended by doctor: 8. To mask the reality of [presumably] (1) through (4) is imprudent because it is an instance of (7) 9. Patients, practitioners, and the public officials have the right to know when the facts are certain and when they are not.

27. A number of claims that must be attended by doctor: 10. Patients, practitioners, and the public officials have the right to know when the evidence underdetermines the theory and when it does not.

28. Imre Lakatos says: “Philosophy of science without history of science is empty, history of science without philosophy of science is blind” • Philosophy of medicine without history of medicine is empty, history of medicine without philosophy of medicine is blind. • If you want to become the best doctor you must learn about philosophy and history of medicine