Veatch R M, Stempsey W E
Kennedy Institute of Ethics, Georgetown University, Washington, DC 20057, USA.
J Med Philos. 1995 Jun;20(3):253-69. doi: 10.1093/jmp/20.3.253.
Scientific authority and physician authority are both challenged by Thomas Kuhn's concept of incommensurability. If competing "paradigms" or "world views" cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local or partial incommensurability might provide a framework for understanding the implication of contemporary philosophy of science for medicine. We distinguish four steps in the process of translating medical science into clinical decisions: the doing of the science, the appropriation of the scientific findings by the clinician, the transfer of the findings from the clinician to the patient, and the choice of a treatment regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Clinicians who must use the results of scientific research will inevitably interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicated to the patient. Finally, clinician and patient values must come into play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relativism; some scientific accounts are better than others. However, the challenge of the incommensurabilists shows that further analysis is needed to establish how particular accounts are better or worse.
托马斯·库恩的不可通约性概念对科学权威和医生权威都构成了挑战。如果相互竞争的“范式”或“世界观”无法进行合理比较，那么我们就没有办法判断任何特定观点的真实性。然而，局部或部分不可通约性的概念可能为理解当代科学哲学对医学的影响提供一个框架。我们将医学科学转化为临床决策的过程分为四个步骤：科学研究的开展、临床医生对科学发现的运用、临床医生向患者传达研究结果以及治疗方案的选择。不可通约性在每个阶段都可能发挥作用。科学中至少存在一些依赖于构建科学理论者世界观的理论和价值负载。必须运用科学研究结果的临床医生不可避免地会从自身世界观的角度来解读研究。当这些数据传达给患者时，可能会存在进一步的不可通约性。最后，在任何关于治疗方案选择的决策中，临床医生和患者的价值观都必须发挥作用。医学研究或实践的任何阶段都不是价值中立的。这一立场并不意味着相对主义；有些科学解释比其他的更好。然而，不可通约论者提出的挑战表明，需要进一步分析以确定特定解释是如何更好或更差的。
