Healy Paul
Faculty of Health, Arts, and Design, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia.
Med Health Care Philos. 2019 Jun;22(2):287-295. doi: 10.1007/s11019-018-9875-5.
Although typically implicit, clinicians face an inherent conflict between their roles as medical healers and as providers of technical biomedicine (Scott et al. in Philos Ethics Humanit Med 4:11, 2009). This conflict arises from the tension between the physicalist model which still predominates in medical training and practice and the extra-physicalist dimensions of medical practice as epitomised in the concept of patient-centred care. More specifically, the problem is that, as grounded in a "borrowed" physicalist philosophy, the dominant "applied scientist" model exhibits a number of limitations which severely restrict its ability to underwrite the effective practice of care. Moreover, being structural in character, these problems cannot be resolved by piecemeal modifications of the existing model, nor by an appeal to evidence-based medicine (Miles in J Eval Clin Pract 15(6):887-890, 2009; Miles in Folia Med 55(1):5-24, 2013; Miles et al. in J Eval Clin Pract 14(5):621-649, 2008). Hence, the need for medical theorists to "partner with experts in the humanities to build a sui generis philosophy of medicine" (Whatley in J Eval Clin Pract 20(6):961-964, 2014, p. 961). In response, the present paper seeks to vindicate the merits of hermeneutically-informed template in providing the requisite grounding. While capable of correcting for the limitations of the applied scientist model, a hermeneutically-informed template is a "both/and" approach, which seeks to complement rather than exclude the physicalist dimension, and thereby aspires to reconcile technical mastery with patient-centred care, rather than eschew one in favour of the other. As such, it can provide a cogent philosophical template for current best practice, which does justice to the art as well as the science of medical care.
尽管通常是隐含的，但临床医生在其作为医学治疗者和技术生物医学提供者的角色之间面临着内在冲突（斯科特等人，《哲学、伦理与人文医学》4:11，2009年）。这种冲突源于在医学培训和实践中仍然占主导地位的物理主义模型与以患者为中心的护理概念所体现的医学实践的超物理主义维度之间的紧张关系。更具体地说，问题在于，作为基于一种“借来的”物理主义哲学，占主导地位的“应用科学家”模型存在一些局限性，这些局限性严重限制了其为有效护理实践提供支持的能力。此外，由于这些问题具有结构性，无法通过对现有模型的零碎修改来解决，也无法通过诉诸循证医学来解决（迈尔斯，《临床实践评估杂志》15(6):887 - 890，2009年；迈尔斯，《医学文献》55(1):5 - 24，2013年；迈尔斯等人，《临床实践评估杂志》14(5):621 - 649，2008年）。因此，医学理论家需要“与人文领域的专家合作，构建一种独特的医学哲学”（惠特利，《临床实践评估杂志》20(6):961 - 964，2014年，第961页）。作为回应，本文旨在证明在提供必要基础方面，具有诠释学依据的模板的优点。虽然能够纠正应用科学家模型的局限性，但具有诠释学依据的模板是一种“既……又……”的方法，它寻求补充而非排除物理主义维度，从而渴望将技术掌握与以患者为中心的护理相协调，而不是舍弃一方而青睐另一方。因此，它可以为当前的最佳实践提供一个有说服力的哲学模板，该模板既公正地对待了医疗护理的艺术，也公正地对待了其科学。
