Philisophy Of Health Flashcards
What are values?
are values really just preferences or can we have a real theory of values?
Judgements can sometimes be disguised as fact in this way. e.g. “abortion is cruel”
Most medical decisions involve values used to manage facts.
Aristotle argues that “virtue makes us sum at the right mark, and practical wisdom makes us take the right means”.
Clinicians are expected to be up to date on their knowledge, perhaps they need to continue updating their values too.
WHO definition of health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
What is the iatrogenesis of defining health (Illich - Medical Nemesis 1978)
The medical profession has become a major threat to health. Clinical iatrogenesis, but also social and structural.
For example living death on dialysis, hospitals bastions of ‘narcissistic scientism”.
Ask turns anxious well into sick. Mood is medicated, comments on the US mental health medical industry.
Foucault and the medical gaze
Dehumanising medical separation the patient’s body from the patient’s person (identity). The material and intellectual structures that made possible the analysis of the body were mixed with power interests: in entering the field of knowledge, the human body also entered the field of power, becoming a possible target for manipulation.
Foucault also argued that the French and American revolutions that spawned modernity also created a ‘meta-narrative’ of scientific discourse that held scientists, specifically medical doctors, as sages who wold in time abolish sickness and so solve all of humanity’s problems.
For the 19th century moderns, medical doctors replaces the discredited medieval clergy;physicians save bodies, not souls. This myth was part of the greater discourse of the humanist and Enlightenment schools of thought that believed the human body to be the sum of a person: biological reductionism that became a powerful tool of the new sages: through thorough examination (gazing) of a body, a doctor deduces symptoms, illness, and cause, therefore achieving unparalleled understanding of the patient - hence, the doctor’s medical gaze was believed to penetrate surface illusions, in near-mystical discovery of hidden truth.
In simple terms, the psycho-social model is ignored in favour of the biomedical. Bedside medicine aims at health, hospital medicine aims at normality - they differ!
Boarse’s biostatistical model of health
Species X
Statistically typical set of functions observed within Species X
Organism Y exists within species X, as it can perform all functions belonging to species X
Organism Z displays inferior function - is it part of the species? is ‘inferior’ a value judgement?
eg compare a sprinter, a normal person, and one with a broken ankle - huge difference in running ability. do statistics account for this?
Normal vs Natural
Normative: standard model or organism X against which e ca compare variants - normative model values certain functional states above others
Naturalistic model: particular traits confer survival benefit in certain scenarios.
Maslow’s Hierarchy of Needs
- physical survival needs (e.g. food and shelter)
- safety and security needs (e.g. physical safety, economic security)
- social needs (e.g. belonging, love, affection)
- need for self-esteem (e.g. prestige and status)
- self actualisation (e.g. opportunity for creativity)
Where does healthcare fit?
Misselbrook’s criticisms of the biomedical model
- biomedical model sufficient: “Dr, Jon fell and his leg is bent at a funny angle and he’s screaming with pain’
- biomedical model insufficient: “Dr, Jon is back at school now on crutches, but is finding it difficult on Monday he said his leg was hurting again”
- biomedical model inappropriate: “Jon is out of his plaster now and walking fine, but he lost his place in the school athletics team. he says he doesn’t want to go to school and last night i heard him crying in his room”
Aristotle on the philosophy of health
“THE GOAL OF THE MEDICAL ART IS HEALTH”
most people have needs too complex for the biomedical model
Bonhoffer: health is the ‘strength to be’ e.g. courage to rewrite self-narrative if required
health - ability to adapt and self manage in the face of social, physical and emotional challenges (Huber et al)
Pleasure and pain are not the highest goods, healthcare should allow people to better understand their own life narrative (Toon)
Human flourishing requires use of values to bring meaning to facts (Fullford)
Summary of the main models of health
WHO model - physical, mental, social well being - unusable!!
Naturalistic or Biomedical model - absence or cure biomedical abnormalities. a default model for modern medical practice
Functional model - flourishing, freedom from/ability to overcome obstacles in the narrative of life. derived from the normative model - function rather than physiological wellness.
What are Misselbrook’s models for healthcare
Model 1: healthcare’s role is to maintain biomedical parameters within normal range. This involves controlling factors that threaten those measurements and health surveillance for risk factors.
Model 2: healthcare exists to enable people olive the lives that they choose, as much as possible unhindered nay illness or disability. treatment benefits must be balanced against treatment burdens. elements of model 1 can be consistent with model 2.
What does Misselbrook say the role of a doctor/clinician is?
BIOMEDICAL TECHNICIAN: fixers who understand the scope and limits of medicine
SHAMAN: parental figure who sanctions changes in patients social role during illness, society’s accredited moral agents
SICKNESS GUIDE: advisor who facilitates access to healthcare or enables coping with illness, a translator between patients world and medical world
WITNESS: a listening ear and witness to the darkness in people’s lives, the naturalists of society, understanding and description, helping people to understand their narratives
