© 2019 Sergei SHEVCHENKO
2019 – № 2 (18)
Sergei Yurievich Shevchenko is Cand. Sc. in Philosophy; Research Fellow at the Department of Humanitarian Expertise and Bioethics at the Institute of Philosophy, Russian Academy of Sciences; teacher at the Department of Bioethics of the Russian National Medical Research University (Moscow).
Keywords: integration, medical systems, nomological machines, transdisciplinarity, transacademicism, transinstitutionality
Abstract. The article denotes philosophical and theoretical-methodological problems linked to the integration of medical systems. They are reviewed based on the achievements of members of Stanford School for the philosophy of science. Using the optics of this group, the author concludes that the main field for the integration of medical systems could be not the spheres of recognized and well-established medical knowledge but its problematic points. The possibilities for medical systems integration are reviewed in three dimensions: transdisciplinarity, transacademicism and transinstitutionality.
Many patients tend to address representatives of various medical systems for the same issue. However, these systems may understand this problematic issue in contrary ways; accordingly, the patients receive contradictory recommendations. As a result, they are forced to choose one of the approaches even if they think that the whole non-consistent complex of practices existent in various medical systems. An important starting point in solving the integration problem is acknowledging that the person’s “lifeworld” is the space where the different medical systems interact. From this point of view, regulating the methodological and epistemological relations between the systems looks like an important goal.
A good starting point for clarifying methodological and epistemological relations between medical systems could be the works of the so-called Stanford School of the philosophy of science. Among other reasons, because the research of a variety of scientific approaches and practices is what unites the mentioned philosophers in a school.
One of the key representatives of Stanford School, John Dupre, suggested the definition of “scientific imperialism” as an important supplement to criticism of reductionism undertaken by his colleagues. According to Dupre, reductionism can be viewed as a “vertical” subordination of disciplines. “Imperialism”, however, is a “horizontal” phenomenon (Dupre 1995: 374–381). E. g., economical approaches are perceived by sociologists but the boundaries of the disciplines do not change: the works by sociologists are still published in the professional magazines they control. The medical systems that are different from conventional medicine may be under reductionist pressure, as well as the pressure from “methodological imperialism” – e. g., through an attempt to reproduce in their frameworks the statistical apparatus of the evidence-based medicine.
One of the strategies for overcoming imperialism in the context of medical systems integration could be to mutually reject claims for a realistic character of consistencies stated by each system. This being said, the reality of study objects and each system’s impact, as well as the reality of the features of these objects can still be mutually recognized.
Thanks to this methodological swing, the main field for integrating medical systems could be not the spheres of well-substantiated knowledge but problematic points of medical knowledge and, most importantly, medical practices. Such an interaction does not require establishing a comprehensive translation system between biomedical facts and the facts of complementary medicine; it would be enough to admit the reality of phenomena important for the patient’s lifeworld – e. g., reducing the intensity of pain. In this sense, such an integration will be not only a path to transdisciplinarity but also, and more importantly, a path to transacademism and transinstitutionality. As transdisciplinarity, in this case, we can understand the formation of a common field of knowledge. While transacademism implies research by representatives of various medical practices into diagnosticizing and treating each other. This sort of knowledge exchange is only possible in the frameworks of interaction between institutions of various medical systems, i. e. transinstitutionality.
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