Is There Room For Philosophy In Health Care?
Dean, Northwestern College of Chiropractic
I recently received an article entitled Philosophy and Evidence-Based Orthodontics, by Harvard dental professor Sheldon Peck, DDS, MScD. The flavor of this article can easily be discerned by the following passage:
“In orthodontics, we seem to be witnessing nothing less than a throwback to the proprietary era, when someone’s crafty philosophy or school of thought could masquerade as new science. That may have been an acceptable pitch 90 years ago, but now thankfully we have sounder choices. In this factual, evidence-based age that is ours, do we really want or need anyone’s belief system as a cornerstone of our diagnostic and treatment methods? Philosophy can be a wonderful guidepost for our personal lives and our spiritual fulfillment; yet, that does not qualify it as a scientific basis for delivering the best orthodontic care.”
The dialogue within the orthodontic profession sounds strikingly familiar to that of chiropractic. I am continually amazed how minds become closed tighter than steel traps when the mere mention of the word philosophy is uttered. Unfortunately, however, little acknowledgement is given, or allowed, for a dialogue on the rightful place for philosophy in science or health care. To draw upon an Aristotelian concept, philosophy and science are inseparable, for one is the driving force behind the other. Those who suggest that philosophy exists only for personal or spiritual fulfillment and has no role in science really do not understand the role of philosophy—be they Harvard professors or members of the chiropractic community.
One must first realize that our own views of what constitutes “science” and scientific method is merely a philosophy, an art derived from precepts and built on principles with the intention of describing one’s experiences. Philosophy contains five traditional branches: 1) Metaphysics, 2) Epistemology, 3) Ethics, 4) Politics and 5) Esthetics.
Metaphysics, the first branch of the study of philosophy, asks the question, “What is the nature of reality?” Inquiring minds have taken several approaches to this question. Is the whole equal to the sum of its parts, or is the whole greater than the sum of its parts? Each question presupposes a different metaphysical construct, the former is mechanistic and the latter is vitalistic. The metaphysical construct then sets the stage for the second branch of philosophy, Epistemology.
Epistemology is the theory of the method of knowledge, which asks the question, “How do we know?” Scientific methodology is epistemology. Do we use inductive reasoning, the cornerstone of mechanistic “scientific” approaches, or deductive reasoning, the cornerstone of vitalistic approaches? Perhaps, we can gain knowledge of either metaphysical construct using both inductive and deductive methods. What is true is that either approach is equally valid at addressing the metaphysical question, though the approaches differ in the way in which the subject is addressed.
Conventional Western scientific methodology applied from a mechanistic perspective represents one of many approaches for the acquisition of knowledge; knowledge that does not prove things to be true but rather identifies things to be false.
One cannot even begin to address the issues of Ethics and Politics without first developing a model based on the first two philosophical branches. When that is achieved then ethics, a code of values that directs your choices and actions, and politics, a system of ethics applied to social functions, can be developed and applied.
Esthetics, the final branch of philosophy, is the artistic representation of your philosophical view. In chiropractic Esthetics is technique, the adjustment and the intention behind it. Chiropractic philosophy without the adjustment is empty; the adjustment without philosophy is misguided.
My purpose is not to provide a lesson in philosophy but rather, to suggest that the metaphysical question of what constitutes a human being is at the heart of a health care delivery model, and the way in which we “scientifically” investigate it. Is a human being merely the sum of its parts, which can be altered, added to or taken away from? Or is a human more than the sum of its parts, and to see it as anything less is to not see the total person?
Is chiropractic merely the diagnosis of acute injury and the disease process, a therapeutic intervention for pain control? Or is chiropractic a unique way of looking at health that allows for adaptability and self-regulation based on the primacy of the nervous system? The answers to these philosophical questions will drive our scientific methods of inquiry, and with time will accumulate a body of evidence that will either support or refute our chiropractic models of health. Whether we acknowledge it or not, philosophy is at the very core of science! There is no denying it; there is no ignoring it. We must recognize it, embrace it, and discuss it as a profession!
Noted author Ayn Rand framed our philosophical choice well: “As a human being you have no choice about the fact that you need a philosophy. Your only choice is whether you define your philosophy by a conscious, rational, disciplined process of thought and scrupulously logical deliberation OR let your subconscious accumulate a junk heap of unwarranted conclusions, false generalizations, undefined wishes, doubts and fears, thrown together by chance, but integrated by your subconscious into a kind of mongrel philosophy and fused into a single solid weight: self doubt, like a ball and chain in the place where your mind’s wings should have grown.”
My hope is that one day our profession can move beyond the superficiality of philosophical slogans and embrace a dialogue about the truly amazing and liberating concepts that lie at our core. If we can, there will be no doubt as to chiropractic’s unique position in health care.
This article was reprinted from The Bulletin, Northwestern Health Sciences University’s chiropractic alumni publication, Winter 2004; Vol. 12, No. 1;March 2004; page 18.