Two further philosophical inputs to values based practice

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Two further philosophical inputs to values based
practice

• Dr Tim Thornton
• Lecturer in Philosophy
• Division of Medical Education

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My past philosophical research

• PhD in the History and Philosophy of Science
  Faculty, University of Cambridge
• More recently range of issues in philosophy of
  psychiatry
• The later Ludwig Wittgensteins Philosophical
  Investigations
• The contemporary philosopher John McDowell

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The application of philosophy to values based
practice

• We are most familiar with philosophical inputs to
  medical ethics philosophical theories / sets of
  principles which can be bolted onto more
  legitimate judgements.
• But as a BMA advisor recently said practical
  medical ethics is damaged by doctors mechanical
  application of principles.
• And philosophical resources suggest different
  more fruitful views of the relation of value and
  empirical judgements.

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Wittgenstein
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Wittgenstein and the tacit aspect of clinical
judgement 1

• Background There is an increasing emphasis on
  codification of expertise
• Much recent history of science suggests some role
  for tacit knowledge (eg Kuhn, Polanyi, Collins).
• But that leaves open the issue of whether the
  tacit dimension might be overcome through
  sufficiently thorough codification.
• That is a philosophical question.

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Wittgenstein and the tacit aspect of clinical
judgement 2

• Source Wittgensteins discussion of rules and
  understanding Investigations 139-239
• Whatever can be made explicit about judgement and
  expertise through codifications, an important
  tacit dimension necessarily remains.
• Even explicit ruled governed and conceptual
  judgement rests on practical know-how.

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Wittgenstein and the tacit aspect of clinical
judgement 3

• One cannot factor out a substantial conception of
  the subject who makes judgements and their whirl
  or organism (Cavell).
• Even conceptual / empirical judgement rests on a
  practical turn.

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McDowell
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McDowell and nature of values and values
expertise 1

• Background the (implicit or explicit) view of
  values taken affects the picture of values in
  medical ethics.
• An influential view combines two claims
• 1) values are a a non-natural, subjective add
  on to legitimate world-involving judgement.
• 2) values are codifiable in a set of principles.

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McDowell and nature of values and values
expertise 2

• Drawing on an Aristotelian view of values
  McDowell argues that
• 1) Values cannot in general be codified.
• 2) Value judgements depend on subjectivity, on
  subjects conceptions of life.
• 3) But there is no reason to doubt that they
  answer to moral features of the world
  subjectivism together with worldliness.

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McDowell and nature of values and values
expertise 3

• So a McDowellian view of morals, combined with a
  Wittgensteinian view of rules, suggests that both
  the empirical aspects of clinical judgement and
  value aspects (including medical ethics) are not
  contrasted.
• Both involve uncodified but no less disciplined
  practice suggesting a composite notion of good
  judgement.