Medicine, philosophy of

The philosophy of medicine can be generally defined as encompassing those issues in epistemology, axiology, logic, methodology and metaphysics generated by or related to medicine. Issues have frequently focused on the nature of the practice of medicine, on concepts of health and disease, and on understanding the kind of knowledge that physicians employ in diagnosing and treating patients. The history of philosophical reflections concerning medicine reaches back to ancient Greece. Medical knowledge took a further step in the nineteenth century with the introduction of clinical pathological correlations, statistical methods, and systematic experimentation, out of which grew substantive literature exploring the character of medical reasoning and the framing of diagnoses. Debates also developed over contrasting physiological, ontological, nominalist and realist accounts of disease entities. Contemporary philosophy of medicine has been concerned with the nature of medicine in an increasingly scientific context, a concern that has generated several models of medicine, including George Engel’s biopsychosocial model, as well as analyses of the nature of the physician–patient interaction. The longstanding debate over the ontological status of health and disease has been recapitulated and extended by a number of authors, favouring an objective, statistically-based account, while others argue for an irreducible social and valuational element in these concepts. Several approaches to diagnostic logic, including Bayesian and computer-based analyses, have been developed, and sophisticated methods of determining disease causation and therapeutic efficacy, including analyses of the randomized clinical trial, have also been explored. Whether the philosophy of medicine is a distinct discipline or a branch of the philosophy of science has provoked vigorous arguments.