Medical Metaphysics
The origin and nature of ontology and its basic question are discussed. Seven meanings of "is", and two meanings of "exists" are identified. To do justice to common sense, an existence predicate in terms of causal entrenchment is introduced. The main ontological positions are briefly outlined: nominalism, Platonism, tropism, ontological realism and anti-realism. After distinguishing between pure, applied, and formal ontology, a first attempt is made toward a fuzzy ontology, which enables us to talk about partial being. To this end, the existence predicate is fuzzified to introduce grades of being. Thus, the boundaries between being and nothingness become continuous. This approach seems to open up promising and novel ontological perspectives and may eventually lead to a general theory of the relativity of existence. Finally, vague, non-existent, and fictional entities are briefly considered with the latter being the reason for distinguishing between ontology de re and ontology de dicto. This interesting and useful method may allow us to settle many ontological debates in medicine which appear to be unresolvable in traditional ways.
The concept of ontological commitment is explained. It is shown that the analysis of the ontological commitments of medical knowledge represents an ideal method of medical-ontological research. The ontology of nosology in general, and of mental and psychosomatic disorders in particular, are discussed. It is argued that nosological nominalism and tropism may be defendable, on the one hand; and compatible with social constructivism, on the other. An emergentist theory of mind is advocated according to which the psychogenesis of mental and psychosomatic disorders cannot exist. Their sociogenesis is advocated instead. The recent, so-called biomedical ontology engineering is demonstrated to deal primarily with medical vocabularies and thesauri, but not with medical ontology. It is thus a de dicto ontology, and as such, merely a medical-linguistic enterprise. Our dichotomy of ontology into de re versus de dicto ontology is applied to diseases to show how the ontology of nosology may benefit from this distinction. In addition, a fuzzy approach to formal ontology is outlined by taking the first steps toward fuzzy mereology.
Regarding truth in medicine, it is shown that medical knowledge does not contain much truth because it mainly consists of hypotheses and deontic rules. The truth values of the former are unknown. The latter have no truth values. Likewise, in clinical practice true diagnoses and prognoses are not always attainable for different reasons that are thoroughly discussed. So, misdiagnoses will remain unavoidable forever, although their frequency may be reduced by improving the techniques of clinical judgment. Since medical theories are artifactual structures and medical languages are artifactual systems, the truth of diagnoses and prognoses based upon them is made in medicine.
Like any other entity, medicine has numerous properties. Characterizing it by limiting its ‘nature’ to only one of these properties, is prone to dogmatism. Our analysis of this issue reveals that clinical research is a practical science, while biomedical-experimental disciplines represent theoretical sciences. By virtue of its practicality, clinical research belongs to the discipline of normative ethics, for it seeks and establishes deontic-clinical rules of action usually called clinical-practical knowledge. The execution of these ought-to-do rules in clinical practice turns this practice into a moral activity. The good old medicine, characterized as practiced morality and normative ethics, is currently in transition to an engineering discipline. Medical knowledge, therapeutica, clinical decisions, organs, tissues, cells, genes, molecules, and even health are being engineered today to the effect that medicine is on the way toward anthropotechnology as a branch of biotechnology.
This completes Part VII consisting of 4 chapters and 107 pages.