Click here to download

Epistemic Uncertainty in Medical Practice. From Ethics to Organization
Journal Title: RIVISTA TRIMESTRALE DI SCIENZA DELL’AMMINISTRAZIONE 
Author/s: Pier paolo Dal Monte 
Year:  2015 Issue: 4 Language: Italian 
Pages:  44 Pg. 63-106 FullText PDF:  336 KB
DOI:  10.3280/SA2015-004003
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


Even if it is a modern habit to discuss ethics and bioethics profusely, we think that the relationship between ethics and epistemology is not always adequately considered. The connection between the "science of proper doing" and the "science of proper knowing" is a crucial aspect of the therapeutic interaction. Since the purpose of medical practice has always been defined as pursuit of the good of the patient, the focal interest of epistemology in this context must be to assess the right method to achieve the appropriate knowledge for this purpose. Medicine is not a hard science and it is always necessary to encourage the "epistemic doubt", and to persistently enquire about "correct knowing", not only because a flaw or a lack of knowledge may be harmful to patients (thus ethically deplorable), but, more importantly, because flawed methodology could undermine the very basis of knowledge. This essay tries to stimulate the epistemic doubt about methodology per se. We start with an etymological assessment of the terms "epistemology" and "ethics" in order to establish their proper use, then we expound the investigation of the epistemic tools we use to know the world around us and, in the last paragraphs we try to assess the methods of knowledge specifically adopted in the medical field.
Keywords: Epistemology, ethics, medicine, medical practice, evidence based medicine

  1. Agamben G. (2005). Homo sacer. Torino: Einaudi.
  2. Agazzi E. (1991), The Problem of Reductionism in Science. Dordrecht: Springer Science., DOI: 10.1007/978-94-011-3492-7
  3. Agostino d’Ippona, De trinitate. Disponibile all’indirizzo web: www.documentacatholica momnia.eu (3/10/2015).
  4. Agostino d’Ippona. De Trinitate. Diponibile all’indirizzo web: http://www.augustinus.it/ latino/trinita/index.htm (29/11/2015).
  5. Antiseri, D., Federspil, G. Scandellari, C. (2003). Epistemologia, clinica medica e la “questione” delle medicine “eretiche”. Soveria Mannelli: Rubbettino.
  6. Arendt, H. (1987). La vita della mente. Bologna: Il Mulino.
  7. Arendt, H. (2003). Vita Activa. La condizione umana. Milano: Bompiani.
  8. Aristotele (1983). Etica nicomachea. Bari: Laterza.
  9. Aristotele (2001). Politica. Milano: RCSLibri.
  10. Aristotele (2009). Fisica. Milano: Mimesis.
  11. Bagnai A. (2011). Crisi finanziaria e governo dell’economia. Disponibile all’indirizzo web: http://www.costituzionalismo.it/docs/Bagnai.pdf (29/11/2015).
  12. Battaglia S. (1972). Grande dizionario della lingua italiana. Torino: UTET.
  13. Becker G. (1993). Human Capital: a theoretical and empirical analysis, with special reference to education. Chicago: The University of Chicago Press., DOI: 10.7208/chicago/9780226041223.001.0001
  14. Beekes R., Beek L. (2010). Etymological Dictionary of Greek. Leiden-Boston: Brill.
  15. Benveniste E. (2002). Il vocabolario delle istituzioni indoeuropee. Torino: Einaudi.
  16. Bertalanffy von L. (1972). General System Theory. Foundations, Development, Applications. New York: Gorge Braziller.
  17. Bibbia (2008): La Sacra Bibbia della CEI. Bologna: Edizioni Devoniane.
  18. Black D. (1998). Limitations of evidence. Journal of the Royal College of Physicians of London, 32: 23.
  19. Blau J.N. (1997). Evidence-based medicine. Journal of Evaluation in Clinical Practice, 3: 149., DOI: 10.1046/j.1365-2753.1997.00070.x
  20. Bohm D. (1980). Wholeness and the Implicate Order. London: Routledge.
  21. Bohm D. (1987). Causality and Chance in Modern Physics. Philadelphia: University of Pennsylvania Press.
  22. Bohm D. (1993). “Last words of a quantum heretic”. Interview with John Morgan. New Scientist, 137: 27.
  23. Bohr N. (1934). Atomic Theory and the Description of Nature. Cambridge: Cambridge University Press.
  24. Bohr, N. (1935). Can quantum mechanical description of physical reality be considered complete? Physical Review, 48: 696-702., DOI: 10.1103/PhysRev.48.696
  25. Bohr N. (1958). Atomic Physics and Human Knowledge. Nerw Tork: Wiley.
  26. Bohr N. (1963). Essays 1958/1962 on Atomic Physics and Human Knowledge. New York: Wiley.
  27. Boulding K.E., Khalil L., a cura di (1996). Evolution, Order and Complexity. London: Routledge.
  28. Caland W., a cura di (1931). Pancavimsa Brahmana. Calcutta: Asian society of Bengal.
  29. Cassirer E. (2006). Linguaggio e mito. Milano: SE.
  30. Chandogya Upanishad, with the commentary of S’ankaracarya (1942). Poona: Poona Oriental Book Agency.
  31. Chantraine P. (1968). Dictionnaire ètimologique de la langue greque. Paris: Édition Klincksieck.
  32. Cho M.K., Bero L.A. (1996). The quality of drug studies published in symposium proceedings. Annals of Internal Medicine, 124: 485., DOI: 10.7326/0003-4819-124-5-199603010-00004
  33. Corbin H. (1986). Corpo Spirituale e terra celeste. Milano: Adelphi.
  34. Couto J.S. (1998). Evidence-based medicine: a Kuhnian perspective of a transvestite non-theory. Journal of Evaluation in Clinical Practice, 4: 267., DOI: 10.1111/j.1365-2753.1998.tb00085.x
  35. Culpepper L., Gilbert T.T. (1999). Evidence and ethics. Lancet. 353: 829., DOI: 10.1016/S0140-6736(98)09101-6
  36. Dal Monte P.P. (2013a). La dissoluzione dell’etica nell’età della tecnica. In: Maggiore D., a cura di, Argomenti di bioetica chirurgica. Acireale: Bonanno.
  37. Dal Monte P.P. (2013b). La medicina: arte, scienza, tecnocrazia o burocrazia. Advanced Therapies, II, 2: 27.
  38. Dal Monte P.P. (2013c). L’allucinazione della modernità. Roma: Editori Riuniti/University Press.
  39. Daniélou A. (1992). Mythes et Dieux de L’Inde. Paris: Flammarion.
  40. Dante Alighieri (1967). Commedia. Milano: Mondadori.
  41. De Vaan M. (2008). Etymological Dictionary of Latin and the other Italic Languages. Leiden-Boston: Brill.
  42. Ellul J. (2009). Il sistema tecnico. Milano: Jaca Book.
  43. Ermete Trismegisto (2005). Corpus Hermeticum. Milano: Bompiani.
  44. Evidence-Based Medicine Working Group (1992). Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA, 268: 2420., DOI: 10.1001/jama.1992.03490170092032
  45. Feyerabend P. (1993). Against Method. London: Verso.
  46. Flack L. (1979). The Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press.
  47. Funtowicz S.O., Ravetz J.R. (1992). Three types of risk assessment and the emergence of post-normal science. In: Krimsky S., Golding D. a cura di, Social Theories of Risk. Westport: Praeger.
  48. Funtowicz S.O., Ravetz J.R. (1994). Emergent complex systems. Futures, 26: 568., DOI: 10.1016/0016-3287(94)90029-9
  49. Gabbay J., le May A. (2004). Evidence based guidelines or collectively constructed “mindlines”? British Medical Journal, 329: 1013., DOI: 10.1136/bmj.329.7473.1013
  50. Galilei G. (1970). Dialogo sopra i due massimi sistemi. Torino: Einaudi.
  51. Ganguli K.M. (1883-1896). The Mahabharata of Krishna-Dwaipayana Vyasa Translated into English Prose. Calcutta: Bharata Press. Disponibile all’indirizzo web: http://www.holybooks.com/wp-content/uploads/MahabharataOfVyasa-EnglishTranslationByKMGanguli.pdf (29/11/2015).
  52. Gell-Man M. (1994). The Quark and the Jaguar. Freeman: New York.
  53. Giampietro M. (2004). Multi-scale integrated analysis of agroecosystems. Boca Raton: CRC Press.
  54. Gilbody S.M., Song F. (2000). Publication bias and the integrity of psychiatry research. Psychological Medicine. 30: 253.
  55. Goodman K.E. (2003). Ethics and Evidence-Based Medicine. Cambridge: Cambridge University Press.
  56. Grassano C. (2010). “L’epistemologia della lunga arte”, studio e riflessioni sull’epistemologia della medicina. Relazione al Master di formazione pratico-teorico: Valutazione psicologica e psicodiagnostica. Processi di decisione clinica. Centro studi di psicologia e psico terapia relazionale, Pulsano (TA).
  57. Griffith T.H. (1896). The Hymns of the Rig Veda. Benares: E.J. Lazarus and Co.
  58. Gupta M. (2003). A critical appraisal of evidence-based medicine: some ethical considerations. Journal of Evaluation in Clinical Practice. 9, 2: 111., DOI: 10.1046/j.1365-2753.2003.00382.x
  59. Guyatt G., Rennie D., a cura di (2002). Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press.
  60. Habermas J. (1972). Knowledge and human interest. Boston: Beacon Press.
  61. Hardwig J. (1985). Epistemic dependence. The Journal of Philosophy. 82: 335., DOI: 10.2307/2026523
  62. Hardwig J. (1991). The role of trust in knowledge. The Journal of Philosophy. 88, 12: 693., DOI: 10.2307/2027007
  63. Haynes R.B. (2002). What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to? BMC Health Services Research, 2: 3., DOI: 10.1186/1472-6963-2-3
  64. Heidegger M. (2004). L’abbandono. Genova: Il Nuovo Melangolo.
  65. Heisenberg W. (1958). The representation of Nature in contemporary physics. Daedalus, 87 (summer): 95.
  66. Heisenberg W. (1990). Physics and Philosophy. London: Penguin Books.
  67. Henry S.G., Zaner R.M., Dittus R.S. (2007). Viewpoint: Moving Beyond Evidence-Based Medicine. Academic Medicine, 82, 3: 292., DOI: 10.1097/ACM.0b013e3180307f6d
  68. Hillman J. (2002). Anima mundi, Il ritorno dell’anima nel mondo. In: L’anima del mondo e il pensiero del cuore. Milano: Adelphi.
  69. Hillman J. (2004). Il potere. Milano: Rizzoli.
  70. Holling C.S. (2001). Understanding the Complexity of Economic, Ecological, and Social Systems. Ecosystems, 4: 390., DOI: 10.1007/s10021-00-0101-5
  71. Jonas H. (2011). Frontiere della vita, frontiere della tecnica. Bologna: Il Mulino.
  72. Jung C.G. (1977). Gli archetipi dell’inconscio collettivo. Torino: Bollati Boringhieri.
  73. Kampis G. (1991). Self-Modifying Systems in Biology and Cognitive Science: A New Framework for Dynamics, Information, and Complexity. Oxford: Pergamon Press.
  74. Kneale W., Kneale M. (1962). The Development of Logic. Oxford: Clarendon Press.
  75. Kuhn T.S. (1970). The Structure of Scientific Revolutions. Chicago: Chicago University Press.
  76. Lao Tzu (1977). Tao Tē Ching, raccolto in Testi Taoisti. Torino: Utet.
  77. Leeder S.R., Rychetnik S. (2001). Ethics and evidence-based medicine. Medical Journal of Australia, 175: 161.
  78. Leibniz G.W. (1896). New essays concerning human understanding. London: Mc Millan.
  79. Lotka A.J. (1925). Elements of Physical Biology. Baltimore: Williams & Wilkins Company.
  80. Maturana H., Varela F.J. (1998). De maquinas y seres vivos. Autopoiesis, la organisaciòn de lo vivo. Santiago de Chile: Editorial Universitaria S.A.
  81. Monier-Williams M. (1964). A Sanskrit-English Dictionary. Oxford: Clarendon Press.
  82. Mumford, L. (2005). Tecnica e cultura. Milano: Il Saggiatore.
  83. Murri A. (1924). Pensieri e precetti. Bologna: Zanichelli.
  84. Ockham W. (1495). Quaestiones et decisiones in quattuor libros Sententiarum Petri Lombardi. Lyon: Johannes Trechsel.
  85. Odum H.T. (2007). Environment, Power and Society. New York: Columbia University Press.
  86. Padoux A. (1990). Vāc, the concept of the word in selected Hindu Tantras. Albany: State University of New York Press.
  87. Panikkar R. (2002). Il dharma dell’induismo. Milano: Rizzoli.
  88. Perozziello F.E. (2009). Prospettive epistemologiche della Medicina moderna: tra Tecnologia e necessità di un nuovo Umanesimo. Intervento al convegno Counseling Bioetico: strumenti, prospettive, abilità. Torino, 19 settembre 2009.
  89. Platone (1980a). Gorgia. In: Platone. Opere complete. Bari: Laterza.
  90. Platone (1980b). Timeo. In: Platone. Opere complete. Bari: Laterza.
  91. Platone (1980c). La Repubblica. In: Platone. Opere complete. Bari: Laterza.
  92. Platone (1980d). Alcibiade minore. In: Platone. Opere complete. Bari: Laterza.
  93. Platone (1980e). Teeteto. In: Platone, Opere complete, Bari: Laterza.
  94. Platone (1980f). Fedro. In: Platone. Opere complete. Bari: Laterza.
  95. Platone (1980g). Fedone. In: Platone. Opere complete. Bari: Laterza.
  96. Pokorny J. (2007). Proto-Indo-European Etymological Dictionary. A Revised Edition of Julius Pokorny’s Indogermanisches Etymologisches Worterbuch. Indo-European Language Revival Association. Disponibile all’indirizzo web: https://marciorenato.files. wordpress.com/2012/01/pokorny-julius-proto-indo-european-etymological-dictionary.pdf (29/11/2015).
  97. Prigogine I. (1978). From Being to Becoming. San Francisco: W.H. Freeman and Co.
  98. Prigogine I. Stengers I. (1984). Order out of Chaos. New York: Bantam Books.
  99. Quine W.V.O. (1963). From a logical point of view. New York: Harper & Row.
  100. Rosen R. (1977). Complexity as a system property. International Journal of General Systems, 3, 4: 227.
  101. Rosen R. (1985). Anticipatory Systems: Philosophical, Mathematical and Methodological Foundations. New York: Pergamon Press.
  102. Rosen R. (1991). Life Itself: A Comprehensive Inquiry into the Nature, Origin and Fabrication of Life. New York: Columbia University Press.
  103. Rosen R. (2000). Essays on Life Itself. New York: Columbia University Press.
  104. Sackett D.L., Rosenberg W.M., Gray J.A., Haynes R.B., Richardson W.S. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312 (7023): 71., DOI: 10.1136/bmj.312.7023.71
  105. Sackett D.L., Straus S.E., Richardson W.S., Rosenberg W.M., Haynes R.B. (2000). Evidence-Based Medicine: How to Practice and Teach EBM. Edimburgh: Churchill Livingstone.
  106. Schrödinger E. (1944). What is life. Cambridge: Cambridge University Press.
  107. Shakespeare W. (2005). Troilus and Cressida. San Diego: ICON Group International.
  108. Shakespeare W. (2006). The Tragedy of Hamlet, Prince of Denmark. New York: Chamberlain Bros.
  109. Smith A. (2007). An Inquiry into the Nature and Causes of The Wealth of Nations. Petersfield: Harriman House.
  110. Snodgrass A (2005). Architettura, tempo, eternità. Milano: Giorgio Mondadori.
  111. Stapp H.P. (2007). Mindful Universe, Quantum Mechanics and the Participating Observer. Berlin: Springer-Verlag.
  112. Stapp H.P. (2009) Mind, Matter And Quantum Mechanics. Berlin: Springer-Verlag.
  113. Thatcher M. (1987). Interview for Woman’s own. Disponibile all’indirizzo web: http://www.margareththatcher. org/document/106689 (29/11/2015).
  114. Tommaso d’Aquino (2009). Summa teologica. A cura di Centi T.P, Belloni A.Z. Testo disponibile al sito: http://www.documentacatholicaomnia.eu, consultato il 20 aprile 2015.
  115. Tonelli M.R. (1998). The Philosophical limits of Evidence-Based Medicine. Academic Medicine, 73, 12: 1234.
  116. Tucci G. (2005). Storia della filosofia indiana. Bari: Laterza.
  117. Walach H., Schmidt S. (2005). Repairing Plato’s Life Boat with Ockham’s Razor The Important Function of Research in Anomalies for Consciousness Studies. Journal of Consciousness Studies, 12, 2: 52.
  118. Walach H., Falkenberg T., Fønnebø V., Lewith G., Jonas W.B. (2006). Circular instead of hierarchical: methodological principles for the evaluation of complex interventions. BMC Medical Research Methodology, 6: 29., DOI: 10.1186/1471-2288-6-29
  119. World Health Organization (1948). Constitution of The World Health Organization. Disponibile all’indirizzo web: http://www.who.int/governance/eb/who_constitution_en.pdf (29/11/2015).
  120. Wulf C. (2005). From the Subject of Desire to the Object of Seduction: Image-Imagination-Imaginary. International Journal of Baudrillard Studies, 2, 2, disponibile all’indirizzo web: http://www2.ubishops.ca/baudrillardstudies/vol2_2/wulf.htm (29/11/2015).
  121. Yates F.A. (2007). L’arte della memoria. Torino: Einaudi.
  122. Zimmer H. (1952). Philosophies of India. London: Routledge & Kegan Paul.
  123. Zolla E. (1988). Archetipi. Venezia: Marsilio.
  124. Zolla E. (1990). Verità segrete esposte in evidenza. Venezia: Marsilio.
  125. Zolla E. (2003). Mistici dell’Occidente. Milano: Adelphi.
  126. Zuang-zi (1982). Zuang-zi (Chuang tzu). Milano: Adelphi

Pier paolo Dal Monte, Epistemic Uncertainty in Medical Practice. From Ethics to Organization in "RIVISTA TRIMESTRALE DI SCIENZA DELL’AMMINISTRAZIONE" 4/2015, pp. 63-106, DOI:10.3280/SA2015-004003

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content