Disease and Diagnosis Value-Dependent Realism
The germs of the ideas in this book became implanted in me during my experience as a resident in clinical pathology at Boston University Medical Center. At the time, I had inklings that the test results churned out by our laboratories were more than scien
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Philosophy and Medicine VOLUME 63 Founding Co-Editor
S. F. Spieker Editor
H. Tristram Engelhardt, Jr., Centerfor Medical Ethics and Health Policy, Baylor College of Medicine and Philosophy Department, Rice University, Houston, Texas
Editorial Board
George 1. Agich, Department of Bioethics, The Cleveland Clinic Foundation, Cleveland, Ohio
Nicolas Capaldi, Philosophy Department, University ofTulsa, Tulsa, Oklahoma Edmund Erde, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey
Becky White, California State University, Chico, California
The titles published in this series are listed at the end ofthis volume.
DISEASE AND DIAGNOSIS VALUE-DEPENDENT REALISM
by
WILLIAME. STEMPSEY, S.l. College of the Holy Cross, Worcester, Massachusetts, U.S.A.
" ~.
SPRINGER SCIENCE+BUSINESS MEDIA, B.V.
A C.I.P Catalogue record for this book is available from the Library of Congress.
ISBN 978-0-7923-6322-4 ISBN 978-94-011-4160-4 (eBook) DOI 10.1007/978-94-011-4160-4
Material on pp. 28-32 is adapted from Robert M. Veatch and William E. Stempsey, S.l., "Incommensurability: Its Implications for the PatientlPhysician Relation." Journal of Medicine and Philosophy 20 (1995): 253-269. Copyright 1995, Kluwer Academic Publishers. Used with permission.
Printed on acid-free paper
All Rights Reserved
© 2000 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 2000 No part of this publication may be reproduced or utilized in any form or by any means, electronic, mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner.
To Mom and Dad
· ... Thou, my Friend! art one More deeply read in thy own thoughts; to thee Science appears but what in truth she is, Not as our glory and our absolute boast, But as a succedaneum, and a prop To our infirmity. No officious slave Art thou of that false secondary power By which we multiply distinctions, then Deem that our puny boundaries are things That we perceive, and not that we have made. William Wordsworth The Prelude
T ABLE OF CONTENTS PREFACE
xi
Chapter 1. INTRODUCTION
1
PART ONE. FACT AND VALUE
Chapter 2. SOCIAL CONSTRUCTIVISM VS. SCIENTIFIC REALISM Introduction Cognitive Significance of Concrete and Abstract Entities Social Constructivism Scientific Realism Towards a Value-Dependent Realism
9 10 16 25 31
Chapter 3. FACT VS. VALUE Introduction Facts Values The Fact-Value Distinction The Place of Values in Science The Meeting of Fact and Value in Medicine Conclusions
34 34 41 54 59 61 66
PART TWO. DISEASE
Chapter 4. THE CONCEPT OF DISEASE Introduction The Metaphysics of Disease The Normative Nature of Disease Conclusions
97
Chapter 5. THE CLASSIFICATION OF DISEASES Introduction
99
ix
69 70
81
x
TABLE OF CONTENTS
The Scope of Nosology The Construction of Classifications Examples of Nosologies Constructing Diseases from Facts and Values Conclusions
100 105 109 116
132
PART THREE. DIAGNOSIS
Chapter 6. THE ELEMENT
