Editorials Medical philosophy? Smart thinking for doctors

The world is weirder than we is the analysis of concepts. Philosophy is ADDRESS FOR CORRESPONDENCE not a rarefied pursuit requiring the pose of thought David Misselbrook 1 None of us can grasp our world. There are Rodin’s thinker, it is more like a box of tools Faculty of the History and Philosophy of Medicine, over 1011 stars in our galaxy, and about 1079 that may come in handy for any reflective Society of Apothecaries, Black Friars Lane, London, protons in the universe. Any consideration worker. Tools to analyse concepts may EC4V 6EJ, UK. of such totalities is impossible for the well be handy for a complex and confusing E-mail: [email protected] mind to grasp, even though, by a strange job like general practice. Let me list three coincidence, your brain contains 1011 obvious areas where philosophy may help. coming to your own conclusions. neurones. I cannot grasp the reality of For Aristotle one goal of studying the billions of subatomic particles in the Language philosophy was to develop ‘phronesis’ coffee mug in front of me. I can only grasp First, philosophy challenges us to be more or good judgement. This month’s BJGP my staggeringly simplified model of it as critical with how we use language. If I see carries the first in a series of short articles, a ‘solid’ object. I can only cope with this lung cancer as an illness I reckon that’s An A–Z of Medical Philosophy. I hope they simple object by ignoring most of the facts fair enough. Is hypertension an illness? Is will give you something to think about, I know about it and identifying only its task- personality disorder an illness? Analysing and perhaps bring the odd smile to your related characteristics: it holds my drink. the way we use words such as health and face. Maybe they will even help your own The genius of the mind is to create a model illness may help us to be much clearer phronesis. of the world which is both useful and that, about what we think we are doing. Facts until it is examined more closely, deceives are often less clear than simplistic models David Misselbrook, us that it is itself the world. suggest. GP, Emeritus Dean RSM, Course Director of the There will always be a gap between the Diploma in the Philosophy of Medicine of the world itself and our grasp of it. Each one Values Society of Apothecaries and BJGP Senior Ethics of us has to create models of the world Second, how can we set medicine’s goals? Advisor, London. to fit our needs. We all understand how Good medicine relates not only to facts (for important it is to stand back and take a example, I am breathing) but also to values Competing interests critical view of research articles. Perhaps (for example, it’s good to be alive). And it is David Misselbrook is Course Director of the we need to take this a step further and here that science has a problem because Diploma in the Philosophy of Medicine of the Society of Apothecaries. reflect more critically on other areas of our one cannot treat values in the same way knowledge, and indeed our lives. as material objects. It was David Hume Kant teaches us that observations who first pointed out that values cannot Provenance Commissioned; not externally peer reviewed. without theories to explain them are be derived from facts.3 As McNaughton blind or meaningless.2 Kant’s view is that puts it ‘values are not determined by the our understanding of all sense data is way the world is, because value is not to DOI: 10.3399/bjgp13X660625 mediated via the theories that we hold be found in the world’.4 Medicine depends about the context of the data. All conscious completely on judgements such as ‘state experiencing is subjective: we have no A is preferable to state B’, but such a God’s eye view. So if as doctors we want to statement requires values and can never use reliable knowledge to help real patients be derived solely from scientific facts. The then we face a number of hurdles. As one of role of facts is to define and understand my friends always says, ‘facts change’, and states A and B. We require values to choose they seem to change at an alarming pace between them. these days. Any tools that can help us to examine what we think of as facts about the Ethics world must surely help us, both as doctors Third and perhaps most obviously there and simply as human beings. is the subset of acts and values that we refer to as medical ethics. The relationship We need all the help we can get between ethics and moral philosophy is One definition of philosophy is just that, it much disputed. But it’s worth diving in and REFERENCES 1. Misselbrook D. Thinking about patients. Newbury: Petroc (now Radcliffe Press), 2001. 2. Kant I. Critique of pure reason. 1781. London: “Any tools that can help us to examine what we think Everyman, 1993: Part II, Section 1. 3. Hume D. Enquiry concerning the principles of of as facts about the world must surely help us, both morals. Oxford: Oxford Philosophical Texts, 1998. as doctors and simply as human beings.” 4. McNaughton D. Moral Vision. Oxford: Blackwell, 1988.

8 British Journal of General Practice, January 2013