In the final year of CauseHealth, we have been working on a new book written specifically for clinicians and other healthcare professionals. The book is meant as a resource for those interested in the relationship between their daily practice and the philosophical assumptions that motivate this practice.
The working title of the book is Dispositions and the Clinical Encounter and it is edited by Rani Lill Anjum, Samantha Copeland and Elena Rocca. The first part, Philosophy, consists in 5 chapters that outline the philosophical framework of CauseHealth, with particular focus on what is relevant for the clinic. The second part, Practice, is written by some of our CauseHealth clinicians and a patient, who demonstrate how dispositionalism can translate into practice.
Here is the list of contents (note that some of the titles might change):
Introduction: What is the CauseHealth Handbook? by Anjum, Copeland and Rocca
Part I Philosophy
Chapter 1: Dispositions and the Single Patient, by Anjum
Chapter 2: Probability for the Clinic, by Rocca
Chapter 3: When a Cause Cannot be Found, by Anjum and Rocca
Chapter 4: Reductionism and the Biomedical Model, by Anjum and Rocca
Chapter 5: What Then with Guidelines?, by Copeland
Part II Practice
Chapter 6: Above and Beyond Statistical Evidence. Why Stories Matter for Clinical Decisions and Shared Decision Making, by Matthew Low
Chapter 7: The Complexity of Persistent Pain – A Patient’s Perspective, by Christine Price
Chapter 8: Causality and Dispositionality for Diagnosis in Medical Practice, by Ivor Ralph Edwards
Chapter 9: Lessons from a Clinic for Patients with Severe Obesity, by Kai Brynjar Hagen
Chapter 10: Reflections on the Clinician’s Role in the Clinical Encounter, by Karin Mohn Engebretsen
Chapter 11: Psychotherapy in a Conditional World – A Plea for Causal Dispositionalism, by Tobias Gustum Lindstad
Chapter 12: Evidence-Based Healthcare and dispositionalism, by Roger Kerry
Chapter 13: The Practice of Whole Person Centred Healthcare, by Brian Broom
Chapter 14: A Broken Child, a Diseased Woman, by Anna Luise Kirkengen
Conclusion: Eight Dispositionalist Recommendations for Making Causal Evidence Clinically Relevant and Informed, by Anjum, Copeland and Rocca
From the introduction:
Why a CauseHealth handbook?
Medicine shows us that no practice takes place in a philosophical vacuum. Only by becoming aware of the philosophical assumptions, will one be able to understand how they enable, restrict or shape the practice. What, for instance, does it actually mean when we say that clinical practice should be based on evidence? Although the scientific evidence is itself largely empirical, the norm of evidence-based practice is not. In this sense, not only medicine, but all sciences contain some non-empirical elements. Being able to identify the non-empirical foundation of scientific norms and practices is a first and necessary step for critically evaluating them.
This handbook is intended as an intellectual resource for clinicians and medical professionals who are interested in digging deeper into the philosophical foundations of their daily practice. It is a tool for understanding some of the philosophical motivations and rationality behind the way medicine is studied, evaluated and practiced, at the interface of science and the humanities. In particular, this book illustrates the impact that our thinking about causation, both philosophically and conceptually, has on the clinical encounter.
There are four organizing themes that each chapter will touch on, not necessarily in the same order: ontology, methods, practice, and norms. Ontology is the study of reality, its entities and their organisation, and is therefore the most fundamental level of our analysis. Different people, or different schools of thought, might adopt different assumptions about the nature of reality, also called ontological assumptions. One famous example of an ontological assumption is Descartes’ mind-body divide, the claim that everything that exists in the world is either a cognitive being or a material being. It is important to notice that there is no way to empirically demonstrate such a claim: one can just provide conceptual arguments for it, which could in turn be countered. This is why we call it an ‘assumption’. Like any other ontological assumption, Descartes’ dualism influences how we relate to the world, which is why we think ontology must be at the centre of any discussion of why we choose to study the world in a particular way, that is, our choice of method.
During the course of the book we will try to show how an ontology can motivate particular norms, methods and practices, and how competing practices might require different methods, norms and ontology:
ONTOLOGY → NORM → METHOD → PRACTICE
This direction of scientific production, from ontological assumptions to practice, is the main and most fundamental idea of CauseHealth, and the one we want to communicate to practitioners in this book. We should clarify that this is a controversial claim that we are supporting here, as not all philosophers would agree with us on this. Some, for instance, would tend to think the contrary: scientific practice should dictate the way we think about the world. Some others would not give any space to ontological assumptions in scientific practice, and would only talk about the study of knowledge, or epistemology.
We disagree with both these takes, and in the course of this book we will instead support that, if we want to see a genuine and permanent change in the way medicine is practiced, we cannot leave the ontological foundation on which it is based untouched. For instance, we might want a healthcare system that acknowledges the patient as an integrative whole, where the medical issues must be understood not only on the physiological level, but also within a biographical, social and cultural context. However, if the methodological foundation of medicine is premised on the fragmentation and isolation of different causal factors, then no such integration can be achieved. No genuine and permanent change would happen in methodology unless this was motivated by different ontology and norms of science.
During the four years of the CauseHealth project, we found increasing support for this basic idea among medical professionals. We found with surprise that, what costed us lengthy and tedious arguments within the philosophical academic circles, was enthusiastically supported by those on the ground in the medical profession, either in research or in care. In the words of the late Stephen Tyreman, osteopath and valuable collaborator during the CauseHealth years:
…progress and development is not simply a matter of making new discoveries. It is a complex, multi-faceted process that involves good science, yes, but in the context of prevailing socio-cultural ideas and, most importantly, of an individual’s world-view. (Tyreman 2018).
This handbook offers a guide to these more foundational assumptions, or world-views, within medicine. Our idea is to show how a change in the ontological foundation could motivate a paradigmatic change in scientific methodology and clinical practice towards a more person centred approach, focusing on the whole person. The aim of the book is to engage and empower healthcare professionals to take part in changing and defining the premises for their own practice.