PHNOM PENH, Cambodia (AP) — Cambodia's ailing former king Norodom Sihanouk has changed his mind and asked that he be cremated after he dies.
The 89-year-old Sihanouk revised an earlier request for a burial, saying he would now prefer to be cremated. The message was posted on his website Saturday.
He asked that his ashes be put in an urn, preferably made of gold, and …
LONDON (AP) — Thierry Henry says Major League Soccer will not attract players from Europe while they are at the peak of their careers as long as teams are forced to operate under a salary cap.
The former France striker joined New York Red Bulls last year from Barcelona but, like David Beckham, only switched to the United States when he was well into his 30s as a so-called Designated Player.
Clubs can sign three DPs on top of the salary cap, a situation the former Arsenal and Barcelona player said puts MLS sides at a disadvantage.
Henry said the imposition on MLS franchises is akin to telling European champion Barcelona that it would have to sell one of its Spanish World …
Openly transgender Los Angeles Times sportswriter Mike Penner, who blogged on latimes.com about his transition to female as Christine Daniels, has reverted to being male and is again going to work as Penner, according to LAObserved.com.
Sports Editor Randy Harvey told the Web site: "We're looking forward to Mike's byline appearing in the paper and on the Web site with increased frequency. He continues to be a valued member of our sports staff."
Penner/Daniels did not return …
The University of Notre Dame has honored actor and activist Martin Sheen with its Laetare Medal for his humanitarian work.
The 67-year-old Sheen received the award Sunday during the school's commencement. The award is Notre Dame's top honor and is given annually to a Catholic "whose genius has ennobled the arts and sciences, illustrated the ideals of the church, and enriched the heritage of humanity."
"While acting is what I do for a living, activism is what I do to stay alive," Sheen told the crowd during commencement Sunday at Notre Dame.
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A replica of a cross honoring America's war dead that drew the attention of the U.S. Supreme Court before it was stolen this month mysteriously appeared Thursday in a Mojave Desert federal park, but officials said it was illegal and took it down.
A maintenance worker discovered the cross bolted to a concrete pad on Sunrise Rock, Mojave National Preserve spokeswoman Linda Slater said.
The cross apparently was put up during the night and nobody has claimed responsibility, Slater said.
The stolen cross had been the subject of a legal dispute for about a decade after a former park service employee sued on grounds that the Christian religious symbol …
The Maccabees still dominate the Hanukkah story, but the risingstar of the holiday for some Jews is Judith.
Feminists point to the heroic, devout Hebrew woman as a primereason to unlock half of Jewish tradition and history - the mostlyuntold story of women.
Religious art experts say Judith is the only female figure toadorn a serious, classical Jewish religious symbol. Her imageoccasionally appears on a menorah - or ritual candelabrum - duringthe eight-day celebration of Hanukkah.
"Women are largely responsible for the observance of Hanukkah,it being more of a home celebration than a synagogue holiday," saidLinda Shepherd, cantor at Emanuel Congregation, …
JAKARTA, Indonesia (AP) — An Indonesian man was arrested on suspicion that he used rat poison to kill at least four men in recent months, police said Wednesday.
Mujianto alias Genthong was arrested Monday in the East Java district of Nganjuk following an investigation into the bodies found in recent weeks, said local police chief Lt. Col. Anggoro Sukartono.
He said three dead victims were discovered in January while the fourth was found early this month. Two men who were poisoned last week survived and were receiving hospital treatment.
Local police chief Lt. Col. Anggoro Sukartono said the man was believed to have had a sexual relationship with many of the victims, all …
AC Milan needs to bounce back from a three-game winless streak and is hoping newly signed midfielder Amantino Mancini can help despite club president and Italian Premier Silvio Berlusconi questioning the acquisition.
Milan takes on Bologna on Saturday, and Berlusconi isn't happy at signing Mancini from city rival and Serie A leader Inter Milan.
"He's been inactive for two years and he's another playmaker," Berlusconi said of the Brazilian. "We need someone who scores goals, a finisher."
Told about Berlusconi's comments, Mancini responded: "I know. I've got to get back in form. When you don't play for a long time you tend …
Gandria is probably the best filly nobody's heard of, and she'sbeen facing the best colts in Canada.
If there is any threat to Silverbulletday at Saratoga, she'sprobably it breaking from the wall with the best pattern. The …
VIENNA (AP) — World slalom champion Marlies Schild will not start in next week's season-opening World Cup giant slalom at the Rettenbach glacier in Soelden, the same course where she broke her left lower leg in a training crash three years ago.
Schild says she is "not willing to fight this slope again. I am just not feeling ready for …
Turkey's state-run news agency says Kurdish rebels have killed six Turkish soldiers in a raid on a military outpost in the country's southeast.
The Anatolia news agency says Tuesday that the overnight attack also left some soldiers wounded at the remote outpost near the Iraqi border and close to the town of Cukurca in …
PITTSBURGH -- It felt like home.
His first cast sailed down a seawall steps from an officebuilding. Within minutes, we drifted past the first piece of urbantrash, a sunken shopping cart. (Are rivers magnets for waywardshopping carts?)
Been there, done that on the Chicago River. Watching Rick Clunnfish Pittsburgh's three rivers -- the Allegheny, Monongahela andOhio -- last Wednesday was like deja vu.
You either love or hate fishing urban rivers. I love it.
That's why I went to see the 2005 CITGO Bassmaster Classic.
One, I wanted to see if I could pick tidbits for fishing theCalumet and Chicago systems. Two, I wanted to see if BASS …
ON October 1, Mrs Evadokia ''Dusha'' Stafford completed 55 yearsas sole licensee of The Beehive public house in Pencader. Is this arecord? Is there anyone in Carmarthenshire , or beyond, stillworking as licensee after more than 55 years? Mrs Stafford would bepleased to know.
Janet Dube Pencader Carmarthenshire
KARACHI, Pakistan - Thousands of Benazir Bhutto supporters surged toward Karachi on Wednesday, the eve of the former premier's return from exile, as she declared any Islamic militant assassin targeting her would "burn in hell."
Meanwhile, Pakistan's top court heard challenges to the legality of Gen. Pervez Musharraf's re-election as president.
Police were readying bomb disposal squads and sealing roads ahead of Bhutto's planned return to this chaotic city of 15 million people on Thursday, where she hopes 1 million people will greet the end of her eight-year exile.
Negotiations with Musharraf that could see the archrivals team up in a U.S.-friendly alliance to fight al-Qaida and the Taliban have already produced an amnesty covering the corruption cases that made her leave Pakistan in 1999. Bhutto hopes to secure a third term as prime minister after January elections.
"My return heralds for the people of Pakistan the turn of the wheel from dictatorship to democracy," Bhutto said at a news conference in Dubai, flanked by her husband and two daughters.
Bhutto recently courted controversy in Pakistan by saying that she would cooperate with the American military in targeting Osama bin Laden, and authorities here warned that militants could launch suicide attacks and roadside bombings against her.
Asked about such threats, Bhutto said Islam forbids suicide bombings and attacks on her. "Muslims know if they attack a woman they will burn in hell," she said.
The government of Sindh province, of which Karachi is the capital, appealed to Bhutto to abandon plans for a snail-paced 10-mile grand procession into Karachi, saying it would leave her vulnerable.
It said the main threat was from Taliban and al-Qaida.
With Bhutto's Pakistan People's Party already mobilizing rallies and convoys of supporters expected to arrive from its strongholds across Sindh by late Wednesday, many observers believe more than 100,000 will turn out. The PPP is predicting there will be more than 1 million.
Vast billboards proclaiming the two-time prime minister as the country's savior festooned the route from the airport. Thousands of her supporters had already arrived from the city of Multan in neighboring Punjab province and from Pakistan's part of divided Kashmir, said Waqar Mehdi, a party spokesman.
A shipping container fortified with bulletproof glass is being readied to convey Bhutto through Karachi, and some 3,500 police and paramilitary troops and 5,000 party volunteers will guard the streets, officials say.
"We have taken precautions against suicide bombers and the police are ensuring there are no implanted explosives on the route," said PPP security adviser, retired general Ahsan Ullah.
Overnight, police used shipping containers to block three access roads on the highway leading from the airport that Bhutto will travel, and seven bomb disposal squads would start sweeping the route by late Wednesday, said Mazhar Shahab, a senior city police official.
The provincial education department announced all schools in Karachi would be closed Thursday.
However, fears of a repeat of political clashes that left more than 40 dead in the city in May eased when Karachi's most powerful party - the pro-Musharraf Mutahida Qaumi Movement - said it would not obstruct Bhutto when she arrives on a commercial flight from Dubai on Thursday afternoon.
"We hope her arrival will decrease the present political polarization in the country," MQM provincial lawmaker Faisal Sabzwai said.
Musharraf, who seized power in a 1999 coup, has seen his popularity plunge since a failed attempt to oust Pakistan's top judge in the spring. The deal with Bhutto appears aimed at boosting his political base as he vies to extend his rule.
He easily won a new five-year term in an Oct. 6 vote by lawmakers that was boycotted by opposition parties.
Musharraf's opponents have petitioned the Supreme Court, claiming that he was ineligible to contest the vote because he has retained his post as army chief. Government officials insist the election was held legally.
The Supreme Court has emerged as the main threat to Musharraf's hold on power since his botched attempt to fire the independent-minded Chief Justice Iftikhar Mohammed Chaudhry.
At a hearing Wednesday, opposition lawyers requested that all of the court's 17 justices decide whether Musharraf should be disqualified. But Chaudhry declined to get involved and instructed an 11-member panel hearing the case to continue, court spokesman Arshad Muneer said.
If he wins, Musharraf has promised to step down as army chief and restore civilian rule. The government says a caretaker government will hold the elections in January.
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Associated Press writer Afzal Nadeem in Karachi and Sadaqat Jan and Zarar Khan in Islamabad contributed to this report.
Organizers for Chicago's bid to host the 2016 Olympics have reached an agreement to buy a former hospital campus they intend to transform into an Olympic Village.
Chicago 2016 officials say they'll acquire the Michael Reese Hospital property on the near South Side from an affiliate of Medline Industries for $86 million.
Under the agreement, Medline will provide a donation of up to $32.5 million that can be used to pay for demolition and site remediation. The deal had hit a snag a few months ago over those costs.
In a release issued Monday, Chicago 2016 Chairman Patrick Ryan says he appreciates Medline's willingness to restructure the deal.
Chicago is competing against Madrid, Tokyo and Rio de Janeiro for the 2016 Summer Games.
North Korea test-fired several short-range missiles off its western coast Friday, a news report said.
Yonhap news agency reported that the launches happened around 10:30 a.m. (9:30 EDT Monday), citing an unidentified government official.
South Korea's Joint Chiefs of Staff and the Defense Ministry said they were checking on the report.
Yonhap said the North had showed signs of preparations earlier this week for testing short-range missiles as part of routine training, declaring a no-sailing zone off the coastal city of Nampo and placing a military boat equipped with anti-ship missiles on standby there.
But the North appeared to have dropped the plan, after it did not fire a missile at that time, Yonhap said.
The reported launches come a day after South Korea withdrew officials from a joint industrial zone with North Korea on Pyongyang's request.
The move was sparked by the North's anger over the tougher policy stance taken by new South Korean President Lee Myung-bak on the communist nation, a contrast from a decade of liberal Seoul governments.
The North regularly test fires missiles, and its long-range models are believed able to possibly reach the western coast of the United States. The country also conducted its first-and-only nuclear bomb test in October 2006, but it is not known to have a weapon design able to fit inside a missile warhead.
Donald G. Ogilvie will retire as president and CEO of the American Bankers Association at the end of April 2005. The ABA said that its board of directors has named Edward L. Yingling, currently executive vice president, to succeed Ogilvie.
Ogilvie joined the ABA staff in 1985 from the Celanese Corp., where he was a corporate vice president for five years. Prior to that, he was associate dean of the Yale School of Management and served in the Office of Management and Budget and the Department of Defense.
"Under Don's leadership, ABA has strengthened its position as the leading trade association for the financial services industry and is well positioned to maintain this leadership role as we go forward," said ABA Chairman Ken Fergeson, who is also chairman of NBanC, Alois, OkIa.
Yingling also joined the ABA in 1985 and currently oversees all government relations activities. he has spent his career working on bank regulation and legislation and is consistently named one of the top lobbyists in Washington.
"Ed and I have been partners for almost 20 years in creating the ABA as we know it today - an association focused on providing world class representation of and service to the banking industry," said Ogilvie. "Ed will be a first-rate CEO."
The international Red Cross has made its first visit to Afghan prisoners held by the Taliban in the northwest of the country, the organization said Tuesday.
The International Committee of the Red Cross said it visited three members of the Afghan security forces detained by the Taliban in Badghis province. The two visits took place last month, it said.
"This is the first time since the beginning of the current conflict that the ICRC has visited people detained by the armed opposition," said Reto Stocker, the head of the ICRC's delegation in Kabul. He called the visits a breakthrough.
ICRC spokeswoman Carla Haddad Mardini declined to comment on the conditions of the three prisoners visited by the agency.
"We did assess the conditions of detention and treatment and made recommendations when we felt necessary," she told reporters.
The neutral agency does not publish the findings of its visits, but issues confidential reports to the detaining authorities or groups.
Haddad Mardini said she was unable to say how many other people were being held by the Taliban in Afghanistan. The access to the three prisoners has been the result of years of work, she said. "We hope we will be able to repeat that visit and to extend such visits to other regions in the country."
The ICRC, which is the guardian of the Geneva Conventions on the conduct of warfare, regularly visits prisoners of war around the world to check how they are being held and treated. It also helps prisoners keep in touch with their families.
The agency said it has visited 136 places of detention in Afghanistan and has registered more than 16,000 prisoners since the U.S. invasion in 2001.
Stocker said he hopes the ICRC will also be able to visit people held by "other armed opposition groups," in Afghanistan.
The Chicago School Finance Authority on Thursday rejected theBoard of Education's claim that its budget is balanced even thoughGov. Edgar hasn't released $43.7 million in state aid.
"It is abundantly clear that there are no guarantees that thosemonies are forthcoming," said finance Chairman Martin Koldyke at ameeting of the five-member authority.
Review of the board's revenue estimates by attorneys andadvisers from Peat Marwick is the first step in the oversight panel'sinspection of the $2.6 billion budget. The authority will vote onthe budget Wednesday.
Koldyke said later that several elements in the board's revenueestimates are not dependable, including the board's contention thatthe teachers will end up with a 2.6 percent increase instead of the 7percent promised.
Board President Florence Cox defended the budget, saying boardmembers felt it was balanced because of ambiguous statements Edgarmade when he vetoed the speedup in state aid.
Edgar said he could still grant Chicago's September payment inAugust. Cox said that prompted board members to include the futurerevenue in the budget. But two days later he refused to use hisdiscretion, saying Chicago had to get its "fiscal house in order."
The governor also said he wanted to see how the conflict betweenthe board and the Chicago Teachers Union over salary issues playedout.
Again on Thursday, Edgar sent a double-sided message to theboard:
"If and when the school system brings spending under control . .. the Governor certainly will be willing to consider accelerating theschool aid payment," said Mike Lawrence, the governor's presssecretary.
But even as Koldyke sent board members back to the drawing boardto fill the gap, he acknowledged that the increasingly tight visesqueezing Chicago schools was put there by a lack of state funding.
"Any cynic that would suggest that we are going to be able tocut our way out of this dilemma is living in a fool's paradise,"Koldyke said. "It is fiscally mandatory that we've got to increasestate support."
Cox called on not only Edgar, but also the finance authority torelease reserve money to plug the budget hole.
"We cannot do it without some help," Cox said. "If we cannotuse (the money) I think it is time now for other key actors in thescenario to step up and start carrying this ball. There is no placeelse to go."
Former board President Clinton Bristow Jr., who weathered thesame storm last year, said nothing is going to be spared when boardmembers make the next round of cuts.
"You have to basically open up every possibility. Before wetried to deal solely with central administration to get all of thedollars. Now we have to put everything on the table," he said.
"We all hope that the speedup will be forthcoming," Koldykesaid. "But the big hole that really has to be negotiated is theteachers' salaries. And the sooner we get to that, the better."
Liverpool defender Fabio Aurelio is leaving the Premier League club after rejecting a pay-as-you-play deal.
The Brazilian's four-year career at Liverpool has been blighted by injuries and this season ended prematurely in February with a thigh problem. Because of his fitness record, the club offered the 30-year-old Aurelio a flexible contract based on the matches he played.
Liverpool manager Rafa Benitez said Tuesday that "we had been trying to work something out with regards an extension but it was a pity that we couldn't."
Benitez added that "the one problem we had with Fabio was that he suffered too many injuries and it was such a pity because he has great quality."
Easter is fast approaching. As a former rabbit owner, I wouldlike to say to the many people who are considering it: Do NOT buyyour children a live rabbit for Easter!
Rabbits, particularly bunnies, are adorable and irresistible.Most people, however, have no idea that rabbits live a long time(ours was 13 years old when we were forced to euthanize him). Andwhile he brought joy to our lives daily, he also left our familyroom with a half-dozen "potholes" in our carpeting, and every powercord that he could access had numerous spots with exposed wiringbecause he chewed off the insulation. A rabbit's sole recreationalactivity is chewing, and most people quickly find that they cannotkeep those cute little bunnies they bought only a few months earlierbecause of their destructive nature.
Unfortunately, many of these same people find the easiest thingto do is to turn the poor creatures loose (abandon them) in thewild, which is a sure death sentence. Domestic rabbits are notequipped to fend for themselves or
defend themselves against predators, and will die from exposurein regions with severely cold weather.
In the past 18 months, I have had to rescue two abandoneddomestic rabbits who wandered onto our property. The second rabbitwould have soon died because shortly after catching her, a bittercold snap occurred that lasted more than two weeks. So if you wantto buy your child a rabbit, make it a stuffed toy or milk chocolateone, and do some bunny -- and yourselves -- a favor.
Patrick Ryan,
Northlake
WASHINGTON - The Commerce Department has lost more than 1,100 laptop computers since 2001, most of them assigned to the Census Bureau, officials said Thursday night.
The Census Bureau, the main collector of information about Americans, lost 672 computers. Of those, 246 contained some personal data, the department said in a statement. However, no data from any missing computer has been known to have been improperly used, the department said.
WHANGAREI, New Zealand (AP) — Tonga has made four player changes in the side to meet Japan on Wednesday from the team that lost the Rugby World Cup opener against New Zealand.
Winger Fetu'u Vainikolo, outside center Alipate Fatafehi, blindside flanker Sione Vaiomo'unga and lock Tukulua Lokotui were selected Monday to replace Viliame Iongi, Andrew Ma'ilei, Finau Maka and Joe Tu'ineau for the Pool A match at Northland Events Centre.
The Tongans lost 41-10 to the All Blacks at Eden Park and then made 12 changes for Canada in Whangarei last Wednesday, going down 25-20 to almost end their bid to make the quarterfinals.
Halves Taniela Moa and Kurt Morath and center Siale Piutau are set to become the only Tonga players to have started all three matches.
Japan was beaten 47-21 by France in its opener before selecting a second-string team that lost 83-7 to the All Blacks.
"I was very impressed with the way they played France," coach Isitolo Maka said. "I knew that was the team they would play against us. I knew they would play their second team against the All Blacks. So you can't read much into the All Blacks game.
Of backrower and captain Finau Maka, his brother, Isitolo Maka said: "He's got a problem with his ribs, so hopefully he will be right for France. He injured his ribs in the last 15 minutes against Canada. He would have come off but we had used our substitutions, so he had to carry on."
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Tonga: Vungakoto Lilo, Fetu'u Vainikolo, Siale Piutau, Alipate Fatafehi, Sukanaivalu Hufanga, Kurt Morath, Taniela Moa; Viliami Ma'afu, Sione Vaiomo'unga, Sione Kalamafoni, Paino Hehea, Tukulua Lokotui, Taufa'ao Filise, Aleki Lutui (captain), Soane Tonga'uiha. Reserves: Aloisio Ma'asi, Alisona Taumalolo, Halani Aulika, Joseph Tu'ineau, Samiu Vahafolau, Samisoni Fisilau, Andrew Ma'ilei.
With a crash of cymbals and a blast of horns, Meredith Willson's nostalgia-drenched musical, The Music Man, marches into the Nampa Civic Center for four more performances. This Music Theatre of Idaho production offers a fast-paced visit to River City, Iowa, where they not only "got trouble," but also plenty of laughs, gorgeous costumes and memorable music, such as "Seventy-six Trombones," "The Wells Fargo Wagon" and the beautiful "My White Knight."
Nampa's Allen Ellis plays the title role (Harold Hill) with incredible energy, an engaging personality and a bigger-than-life swagger and grin. Ellis, a music teacher at Timberline High School, comes from a musical family, several of whom are in the show. His mother, Cammi Ellis, is adorable as a giddy gossip in a wig that looks as though it came from the court of Marie Antoinette. His wife, Debra Ellis, shows off her lyrical voice as his main antagonist and love interest, the tart and sharp Marian the Librarian.
Ellis is exceptional as Music Man Hill, a charming con man with a touch of slime, who sells band instruments and uniforms by convincing townspeople he can teach their children to play in a magnificent marching band without learning a note. But Hill doesn't count on falling in love with the town librarian.
Director Dr. Jean Andrews has assembled a cast of more than 50 bubbly, talented children and enthusiastic adults. The sets are superb, especially the giant train engine that starts the show and then splits to reveal the railroad car inside. All the scene changes are smooth and fast, which gives a gloss and professional quality to the production.
Randy Vanderhoofven is funny as the excitable Mayor Shinn, but his lines are sometimes hard to understand, while Anne DeCloss as his wife, adds a touch of the scamp to her elegant role as a society leader and culture promoter. Bill Stephan, director of the Civic Center, gets into the spirit of the play as Harold Hill's old partner in crime, Marcellus Washburn. Stephan creates an animated, hearty character trying to help out a friend, while singing and dancing up a storm in "Shipoopi."
The Music Man is filled with delightful vignettes such as the four battling school board members played by David Stillman, Kyle Young, Erick Pew and Bob DeCloss. Once they realize they can harmonize, their hatred flies out the window and they become an endlessly singing quartet of chums.
Another surprise for audiences will be the alternating appearances of Nampa Mayor Tom Dale and the former Idaho Press-Tribune publisher, Jim Barnes. On opening night, Barnes performed the role of one of the traveling salesman on the train, hiding behind--what else?--a newspaper. Barnes looks a bit like a traveler who finds himself in disreputable company but good-naturedly makes the best of the situation.
Two of the younger members of the cast, Chris Brand (with a dazzling smile) and Kyrie Vickers as the mayor's daughter, bring their own sparkle and dancing charm to the show. In fact, all the dancing--and there's lots of it--is brilliantly choreographed by Annie Kennedy. She knows how to keep the steps simple enough for the newest dancers, yet spirited and flashy enough to keep audience toes tapping.
Combining the rousing music from the great little orchestra, the eye candy of the rainbows of period costumes and the charming performers, this show is a summer gift that will sing and dance its way into your heart, as it's been doing ever since it first appeared on Broadway in 1957.
Article copyright Bar Bar Inc.
WHEELING, W.Va. - A man who knocked down an 82-year-old woman and tried to snatch her purse, ran away with nothing after she refused to give it up. The Wheeling woman was attacked at about 5 p.m. Wednesday as she and her husband were walking to one of their favorite's restaurants, said police Lt. Gary Gaus.
Police later arrested and charged Ricky Booth, 20 in the attempted purse snatching after an eyewitness gave them the license plate number of the gold Pontiac Grand Prix in which the would-be thief escaped.
The woman was treated at Ohio Valley Medical Center and later released, Gaus said.
Booth is charged with first-degree attempted robbery.
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Information from: The Intelligencer, http://www.theintelligencer.net
Vancouver - Ondine Biopharma Corp. has filed a preliminary short form prospectus in certain provinces of Canada to qualify, on a commercially reasonable efforts basis, the offering through Canaccord Capital Corp. and Sprott securities Inc. of common shares of the company. The offering may also occur by private placement in the US, the UK and other jurisdictions in Europe. Proceeds from this offering will be used to finance the ongoing development of the company's PhotoDynamic Disinfection technology and general working capital.
LONDON - Paul McCartney says he's "doing fine," despite the turmoil surrounding the breakup of his marriage. McCartney, who appeared Monday at a news conference to launch his new classical album, "Ecce Cor Meum (Behold My Heart)," did not comment directly on his split from his second wife, Heather Mills McCartney.
Asked how he had been coping in recent months, McCartney said: "I'm doing fine thank you. It's OK.
"I'm enjoying music. It's something I love to do. It's something that sustains me. So I'm enjoying it, finishing this project off and also the next one."
McCartney said he started "Ecce Cor Meum" when his first wife, Linda, was still alive. After she died of breast cancer in 1998, "it stalled me," the 64-year-old former Beatle said.
"I took a year or so before I could get back into it. The interlude in the middle is a particularly sad melody and is what got me going again," he said. "Her spirit is very much in this. It would have been her birthday yesterday so it's very appropriate."
McCartney said the lyrics of "Ecce Cor Meum" were inspired by what he believes is important in life.
"When I came around to thinking, `what do I want the words to say?' I just wrote down a whole load of things that interest me about truth, about love, about honesty and about kindness. Stuff that I thought was important in life."
Paul and Heather Mills McCartney announced their separation in May after four years of marriage. They have begun divorce proceedings in an increasingly acrimonious split. The couple have a 2-year-old daughter, Beatrice.
"Ecce Cor Meum," which is being released by EMI Classics, is the pop star's fourth classical album. His first, "The Liverpool Oratorio," was released in 1991.
Britain's Magdalen College Oxford commissioned McCartney to create the music more than eight years ago in celebration of a new concert hall.
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EMI is part of EMI Group PLC.
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On the Net:
Paul McCartney: http://www.paulmccartney.com/main.php
Israeli military officials say the country's navy chief has apologized after he was sighted in a strip club.
Adm. Eli Marom was spotted by a reporter in the Go-Go Girls club in downtown Tel Aviv this week.
The officials say Marom apologized in a letter to the military chief of staff. Marom said it was a one-time slip and was not in keeping with the values expected of a military officer.
His behavior is not a crime, but is seen as scandalous for a commander meant to lead by example.
The Maariv newspaper quoted strippers identified as Celine and Jacqueline saying they had not realized who Marom was.
The officials said Wednesday that Marom was not likely to be disciplined. They spoke anonymously because the military had not officially released details.
Over the last two and a half millennia—since the beginnings of Greek philosophy and medicine—there have been rich conceptual reflections regarding medical findings, reasoning in medicine, the status of knowledge claims in medicine, and the special concepts that structure the science and art of medicine. The philosophy of medicine is a corpus of considerations and writings uniting these reflections by contributors as diverse as Plato, Aristotle, and Galen; René Descartes, Immanuel Kant, and Georg W. F. Hegel; and contemporary thinkers. Because these examinations of medicine are philosophical in different senses, the term philosophy of medicine is ambiguous, covering a heterogeneous field of intellectual concerns. For the purpose of this overview, they have been collected under four categories.
The first category, speculative philosophy of medicine, has existed from the beginning of medicine. Speculative medicine may be characterized as the attempt to discover the basic philosophical principles that lie behind the practice of medicine. Here philosophy attempts to discover theoretical frameworks or foundations that give shape or content to clinical data. In this sense, philosophy of medicine provides a priori points of departure for medical knowledge and practice. The second category, the logic of medicine, brings together attempts to clarify the character of scientific reasoning in medicine. It identifies the basic principles that make medicine a coherent science. This category of philosophy of medicine studies, for example, the way in which diagnoses are made and judged to be accurate in medical practice and research. A third area of the philosophy of medicine may be understood as a subspecialty of philosophy of science. This area is concerned with what is accepted as knowledge in medicine and the healthcare professions. Much of the recent exploration of the status of concepts of health and disease or the status of the unconscious and explanation in psychoanalysis falls into this third category. Finally, a fourth category describes the explorations of other philosophical issues that have special salience in healthcare, for example, the nature of persons and its implications for the morality of abortion. Philosophy of medicine in this fourth sense would include bioethics.
Just as there is ambiguity concerning the meaning of "philosophy" in "philosophy of medicine," so there is ambiguity about the compass of medicine. Medicine can be construed as a body of knowledge, skills, and social practices concerned with the health and pathology of humans. In its modern sense, medicine encompasses theory and practice, science and art. Traditionally medicine is the origin of all systematic concerns with healing, including nursing and the allied health sciences. The focus of the philosophy of medicine, as a consequence, can have a broad or narrow scope.
The ancient Greek philosophers sought to understand the world on a rational rather than a supernatural basis. Early Greek medicine was influenced by philosophers who held that the primary goal of a scientist was to find one basic principle or set of principles that would explain the natural world known by the senses. These physicians developed theories as to how the body worked and how diseases might be understood and controlled. At first, there was little concern to justify these theories in experience or observation. One finds, then, a tension in early Greek medicine between those physicians who grounded medicine in rational speculation—the rationalists—and those who grounded medicine in experience—the empiricists.
This tension is evident in the Hippocratic corpus. In the corpus there is approval for theorizing that "lays its foundation in incident, and deduces its conclusions in accordance with phenomena" (Jones, p. 313). Nevertheless, the Hippocratic author rejects the systematic sweep of more speculative thought:
Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science, what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. (Jones, p. 53)
The author is rejecting what might be termed speculative or metaphysical medicine—namely, the attempt to construct a theory of medicine on the basis of self-evident, or basic, principles or concepts. The author also writes that medicine has no need of "an empty postulate," a concept that is not based in experience, because it has at hand the means for verifiable knowledge.
René Descartes (1596–1650) held that he could determine the fundamental laws of metaphysics, physics, and medicine (Descartes) by reason alone, without appeal to experience. On the basis of his work in speculative, metaphysical medicine, Descartes predicted that he would live an additional century or so, achieving a life span of one and a half centuries. He believed his own theories would issue in simple revisions of daily routine leading to such extensions of life expectancy (Descartes). Descartes's Treatise of Man (1662) attempts a mechanistic anatomy and physiology expressed in terms of matter and motion. Descartes explains how the human body works by comparing it to a machine. He found that this mechanistic approach could explain the physical functioning of the human body but not rational behavior. Still, Descartes's philosophical reflections concerning the body provided a framework for later explanations of human functioning that also relied on mechanical metaphors.
The success of Isaac Newton (1642–1727) in offering systematic explanations in physics inspired attempts to do this in medicine. The eighteenth-century Scottish physician John Brown (1735–1788), for example, suggested that the concept of excitability could serve medicine as the concept of gravity had served Newtonian physics: as the single concept upon which all explanations of health and disease could ultimately rest. Stimulation or excitation and response to it, he argued, resulted in an equilibrium or disequilibrium that defined health and disease, respectively. If an imbalance became too extreme, death would result. Brown's work attracted the attention of philosophers, including Hegel (1770–1831). This philosophy of medicine—as the gray area between scientific, empirical medicine and the philosophy of nature—led to the modern understanding of medicine that brings together empirical observation and theoretical construction (Tsouyopoulos).
Twentieth-century historians of medicine have appreciated this interplay between empirical and speculative medicine under the title "philosophy of medicine." William Szumowski in 1949 and Owsei Temkin in 1956 spoke of the importance of the philosophy of medicine. It is to Szumowski that much of the rebirth of the interest in this term, perhaps first coined by Elisha Bartlett in 1844, can be attributed. Lester King (1978) has used the term to identify the theoretical reflections undertaken by both physicians and philosophers engaged in speculative as well as other conceptual explorations of medicine.
The relationship between medical reasoning and medical practice has been an area of perennial philosophical controversy and investigation. In ancient Greek and Roman medicine, the disputes between the rationalists and empiricists were, in part, disputes about how knowledge claims in medicine ought to be justified. By the Renaissance, medicine had failed to achieve the success in healing that is often attributed to it today. This failure to achieve therapeutic success led to attempts to make medicine more scientific, in the hope of duplicating the success of fields like astronomy and physics. Thomas Sydenham (1624–1689), whose Observationes medicae appeared in a third edition in 1676, proposed a disciplined methodology of observation and treatment. Sydenham brought to medicine the scientific method of Francis Bacon (1561–1626), which sought to ground reasoning in experience, observation, and data.
This method, however, raised questions about observer bias of which Syndenham was aware. The principal difficulty is that an investigator's findings may be influenced by his or her presuppositions. These concerns about observer bias were taken up in the eighteenth century by such theoreticians of medicine as Françlois Boissier de Sauvages de la Croix (1706–1767) in his Nosologia methodica sistens morborum classes juxta sydenhami mentem et botanicorum ordinem (1768). Influenced by the writings of Thomas Sydenham and Carolus Linnaeus, Sauvages organized diseases into a structure of class, order, genus, and species. In his Nosologia there is an appreciation of medical observation as well as a concern for a logical rigor that sought to coherently relate observations to predicted outcomes. Sauvages's principal undertaking included a classification of diseases primarily based on their signs and symptoms rather than on their causes. He also sought to tie observed signs of illness to relationships that had been noted between past, present, and predicted future states of patients. The logical rigor of disciplined observation and the collection of facts is also evident in the work of William Cullen (1710–1790) and Thomas Percival (1740–1804).
The major revolutions in medical understanding born of advances in anatomy and physiology in the late eighteenth and nineteenth centuries, along with the recognition that many established treatments did not work, required a fundamental reassessment of medicine. Philosophical reflections concerning medical reasoning gave way to major treatises concerning the character of reasoning in medicine. Works such as Sir Gilbert Blane's Elements of Medical Logick (1819), Elisha Bartlett's Philosophy of Medical Science (1844), and F. R. Oesterlen's Medizinische Logik (1852) range from listing the elementary principles of life to concern with material fallacies in medicine, including excessive deference to authority, fashion, or speculative reasoning without sufficient empirical observation. Oesterlen's work, which advanced criteria for inductive reasoning in medicine based on the work of John Stuart Mill, included an analysis of the methods and means of medical investigation, the character of the inductive method in medicine, and the status of experiments, hypotheses, analogies, terminologies, definitions, and classifications. He viewed medical logic as the application of general logical principles to the field of medicine for the purpose of securing a coherent inductive and empirical science that would be free from a priori speculation. His work was followed by other studies, including Władysław Bieganski's Logika medycyny (1894) and Richard Koch's Die ärztliche Diagnose (1920).
Growing philosophical sophistication characterizes twentieth-century assessments of medical knowledge and medical reasoning. Types of medical knowledge may correspond to the different functions of medicine. Medicine can be understood in a threefold manner: biological medicine, clinical research, and clinical practice. Biological medicine is concerned mainly with scientific research in biology, whereas clinical research is focused on the development of the knowledge and technology used in clinical medicine. Finally, the area of clinical practice involves the realities of patients and disease. A philosophical concern of those writing on the logic of medicine has been to clarify the nature of each type of medical knowledge and the relationship of these different areas of medical knowledge and reasoning to one another (Wulff et al., 1986).
Since the middle of the twentieth century, a renewed interest in the logic of medical reasoning and the character of medical decision making has been expressed in the computer reconstruction of differential diagnosis. This literature has examined the logic and principles of medical reasoning—for example, the applicability of Bayes's Theorem to medical decision making (Lusted; Wulff, 1976); the logic of the taxonomy of disease and classification, including the application of set theory to the analysis of clinical judgments (Feinstein); and the role played by morbidity, mortality, and other costs in determining when and how diagnoses are framed. For example, because of the human and financial costs, one will be much more concerned about false positive diagnoses of AIDS than of athlete's foot. Recent works have given special attention to the process of making diagnoses, including the principles of differential diagnosis (Caplan, 1986; Engelhardt et al.; Wulff, 1976), as well as the elaboration of nosologies as instruments for gathering clinical information. Many of these reflections have stressed the hidden role of values and conceptual assumptions in the process and logic of medical diagnosis (Schaffner; Peset and Gracia; King, 1982).
Philosophy of medicine may also be understood as a self-conscious reflection on the status of special concepts, such as health and disease, deployed in medicine. Rudolf Virchow (1821–1902), for example, argued that designating a state of affairs as an illness has a stipulative character; that is, such concepts are defined by agreement and there are no clear natural types or divisions of nature corresponding to nosological categories. This sense of the philosophy of medicine places the accent on issues in the theory of knowledge and the examination of what should count as a medical theory or explanation. In this, it is distinguished from speculative philosophy of medicine and from the more narrow concerns with the rules of evidence and inference proper to medicine that are the focus of medical logic and medical decision theory.
Since the 1950s a considerable literature has developed that is directed to the status of concepts such as health, disease, illness, disability, and disorder. Whether such concerns constitute a subspecialty of the philosophy of science is disputed (Caplan, 1992; Wulff, 1992). There has also been interest in the character of medical explanation (Canguilhem). This literature has also explored the application of such terms to nonhuman animals. In addition, there has been attention to the extent to which these concepts are normative and the extent to which nonnormative, value-free concepts can be elaborated. Those who have argued in favor of weak or strong normative understandings of concepts such as health, disease, and illness have also addressed the character and kind of values that structure such concepts. Investigations have included the extent to which concepts of disease are instrumental to medical practice, or instead identify natural divisions in reality. In addition, there have been attempts to place medicine within the general compass of philosophical explorations of scientific theory (Kliemt). Finally, the significant changes about the relationship of theories, facts, and values in the understanding of the history and philosophy of science that occurred in the 1960s and 1970s were anticipated in Ludwik Fleck's 1935 study of changes in the meaning of syphilis and venereal disease from the fifteenth to the early twentieth century (Fleck).
Even if one were to hold that medicine offers no conceptual or philosophical problems not already present in the subject matter of the philosophy of science or the philosophy of biology (Caplan, 1992), there would still be merit in exploring the ways in which philosophical study and analysis can be directed to the understanding of medicine, as well as to the healthcare sciences and arts in general. In this sense, the philosophy of medicine encompasses the ways in which the philosophy of science, the philosophy of biology, the philosophy of mind, moral philosophy, and so on are engaged in order better to understand medicine. Perhaps one would wish to characterize such explorations as philosophy about medicine rather than of medicine, in the sense that the tools, analyses, and insights of philosophy in general are brought to the particular subject matter of medicine. Calling this endeavor the philosophy of medicine underscores the heuristic advantage of treating the domain as a whole, as a single focus of attention. There is also the advantage of recognizing that general issues of justice, fairness, rights, and duties confront the special challenge of taking account of the development of humans from conception to death.
In medicine, special questions of intergenerational justice become salient, distinctions between human biological and human personal life are raised, the irremediable character of loss must be confronted, and comparisons must be made between claims for the alleviation of suffering versus the postponement of death. Though the definitions of futility, of ordinary versus extraordinary treatment, and of the beginning of life and the beginning of death may arise outside the compass of medicine, such definitions take on a special philosophical cast and character in the context of medicine. The recognition that there is this special concatenation of conceptual issues is appreciated in employing the term philosophy of medicine. This use of the term approximates the one employed by the European Society for the Philosophy of Medicine and Health Care (founded 1987), which encompasses bioethics within a constellation of philosophical concerns and undertakings. The philosophy of medicine as speculative medicine, as the logic of medicine, and as the philosophy of the science of medicine all spring from the acknowledgment that medicine constitutes one of the cardinal areas of intellectual and moral attention, central to human life, and is worthy of sustained conceptual analysis and philosophical regard.
h. tristram engelhardt, jr.
kevin wm. wildes (1995)
bibliography revised
SEE ALSO: Medicine, Anthropology of; Medicine, Art of; Medicine, Profession of; Medicine, Sociology of; Professional-Patient Relationship: Historical Perspectives
Bartlett, Elisha. 1844. An Essay on the Philosophy of Medical Science. Philadelphia: Lea and Blanchard.
Bieganski, Władysław. 1894. Logika Medycyny. Warsaw: Kowalewski.
Blane, Gilbert. 1819. Elements of Medical Logick. London: T. and G. Underwood.
Canguilhem, Georges. 1978. On the Normal and the Pathological, tr. Carolyn R. Fawcett. Dordrecht, Netherlands: D. Reidel.
Caplan, Arthur L. 1986. "Exemplary Reasoning? A Comment on Theory Structure in Biomedicine." Journal of Medicine and Philosophy 11(1): 93–105.
Caplan, Arthur L. 1992. "Does the Philosophy of Medicine Exist?" Theoretical Medicine 13(1): 67–77.
Carrick, Paul. 2001. Medical Ethics in the Ancient World. Washington, D.C.: Georgetown University Press.
Carson, Ronald A., and Burns, Chester R., eds. 1997. Philosophy of Medicine and Bioethics: A Twenty-Year Retrospective and Critical Appraisal (Philosophy and Medicine, vol. 50). New York: Kluwer Academic Publishers.
Culver, Charles M., and Gert, Bernard. 1997. Philosophy in Medicine. New York: Oxford University Press.
Descartes, René. 1983 (1644). Principles of Philosophy, tr. Valentine R. Miller and Reese P. Miller. Dordrecht, Netherlands: D. Reidel.
Engelhardt, H. Tristram; Spicker, Stuart F.; and Towers, Bernard, eds. 1979. Clinical Judgment: A Critical Appraisal. Dordrecht, Netherlands: Kluwer.
Engelhardt Jr., H. Tristam, ed. 2000. The Philosophy of Medicine: Framing the Field. New York: Kluwer Academic Publishers.
Feinstein, Alvan R. 1967. Clinical Judgment. Baltimore: Williams and Wilkins.
Fleck, Ludwik. 1979 (1935). Entstehung und Entwicklung einer wissenschaftlichen Tatsache: Einfuhrüng in die Lehre vom Denkstil und Denkkollektiv. Basel: Benno Schwabe. tr. Fred Bradley and Thaddeus J. Trenn as Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press.
Humphreys, Paul. 1989. The Chances of Explanation: Causal Explanation in the Social, Medical, and Physical Sciences. Princeton, NJ: Princeton University Press.
Jones, William H. S., tr. 1923. Hippocrates. New York: Putnam.
Khushf, George. 1997. "Why Bioethics Needs the Philosophy of Medicine: Some Implications of Reflection on Concepts of Health and Disease." Theoretical Medicine 18(1–2): 145–163.
King, Lester S. 1978. The Philosophy of Medicine: The Early Eighteenth Century. Cambridge, MA: Harvard University Press.
King, Lester S. 1982. Medical Thinking: A Historical Preface. Princeton, NJ: Princeton University Press.
Kliemt, Hartmut. 1986. Grundzüge der Wissenschaftstheorie: Eine Einführung fur Mediziner und Pharmazeuten. Stuttgart, Germany: Gustav Fischer.
Koch, Richard. 1920. Die ärztliche Diagnose. Wiesbaden, Germany: Bergmann.
Kopelman, Loretta M., and McCullough, Laurence. 1999. "Hume, Bioethics, and Philosophy of Medicine." Journal of Medicine and Philosophy 24(4): 315–321.
Lusted, Lee B. 1968. Introduction to Medical Decision Making. Springfield, IL: Charles C. Thomas.
Percival, Thomas. 1776. Philosophical, Medical, and Experimental Essays. London: Joseph Johnson.
Pellegrino, Edmund D. 2001. "The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions." Journal of Medicine and Philosophy 26(6): 559–579.
Pellegrino, Edmund D. 2001. "Philosophy of Medicine: Should it be Teleologically or Socially Construed?" Kennedy Institute of Ethics Journal 11(2): 169–180.
Pellegrino, Edmund D., and Thomasma, David C. 1997. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.
Peset, José Luis, and Gracia, Diego, eds. 1992. The Ethics of Diagnosis. Dordrecht, Netherlands: Kluwer.
Schaffner, Kenneth F., ed. 1985. Logic of Discovery and Diagnosis in Medicine. Berkeley: University of California Press.
Szumowski, W. 1949. "La Philosophie de la médicine, son histoire, son essence, sa dénomination et sa définition." Archives internationales de l'histoire des sciences 9: 1097–1141.
Temkin, Owsei. 1956. "On the Interrelationship of the History and the Philosophy of Medicine." Bulletin of the History of Medicine 30(3): 241–251.
Tsouyopoulos, Nelly. 1982. Andreas Roschlaub und die romantische Medizin: Die philosophischen Grundlagen der modernen Medizin. Stuttgart, Germany: Gustav Fischer.
Wulff, Henrik. 1976. Rational Diagnosis and Treatment. Oxford: Blackwell Scientific Publications.
Wulff, Henrik. 1992. "Philosophy of Medicine—from a Medical Perspective." Theoretical Medicine 13(1): 79–85.
Wulff, Henrik R.; Pedersen, Stig Andur; and Rosenberg, Raben. 1986. Philosophy of Medicine: An Introduction. Oxford: Blackwell Scientific Publications.
van der Eijk, Philip. 2004. Medicine and Philosophy in Greek and Roman Antiquity. New York: Cambridge University Press.
Medicine, Philosophy ofOver the last two and a half millennia—since the beginnings of Greek philosophy and medicine—there have been rich conceptual reflections regarding medical findings, reasoning in medicine, the status of knowledge claims in medicine, and the special concepts that structure the science and art of medicine. The philosophy of medicine is a corpus of considerations and writings uniting these reflections by contributors as diverse as Plato, Aristotle, and Galen; René Descartes, Immanuel Kant, and Georg W. F. Hegel; and contemporary thinkers. Because these examinations of medicine are philosophical in different senses, the term philosophy of medicine is ambiguous, covering a heterogeneous field of intellectual concerns. For the purpose of this overview, they have been collected under four categories.
The first category, speculative philosophy of medicine, has existed from the beginning of medicine. Speculative medicine may be characterized as the attempt to discover the basic philosophical principles that lie behind the practice of medicine. Here philosophy attempts to discover theoretical frameworks or foundations that give shape or content to clinical data. In this sense, philosophy of medicine provides a priori points of departure for medical knowledge and practice. The second category, the logic of medicine, brings together attempts to clarify the character of scientific reasoning in medicine. It identifies the basic principles that make medicine a coherent science. This category of philosophy of medicine studies, for example, the way in which diagnoses are made and judged to be accurate in medical practice and research. A third area of the philosophy of medicine may be understood as a subspecialty of philosophy of science. This area is concerned with what is accepted as knowledge in medicine and the healthcare professions. Much of the recent exploration of the status of concepts of health and disease or the status of the unconscious and explanation in psychoanalysis falls into this third category. Finally, a fourth category describes the explorations of other philosophical issues that have special salience in healthcare, for example, the nature of persons and its implications for the morality of abortion. Philosophy of medicine in this fourth sense would include bioethics.
Just as there is ambiguity concerning the meaning of "philosophy" in "philosophy of medicine," so there is ambiguity about the compass of medicine. Medicine can be construed as a body of knowledge, skills, and social practices concerned with the health and pathology of humans. In its modern sense, medicine encompasses theory and practice, science and art. Traditionally medicine is the origin of all systematic concerns with healing, including nursing and the allied health sciences. The focus of the philosophy of medicine, as a consequence, can have a broad or narrow scope.
The ancient Greek philosophers sought to understand the world on a rational rather than a supernatural basis. Early Greek medicine was influenced by philosophers who held that the primary goal of a scientist was to find one basic principle or set of principles that would explain the natural world known by the senses. These physicians developed theories as to how the body worked and how diseases might be understood and controlled. At first, there was little concern to justify these theories in experience or observation. One finds, then, a tension in early Greek medicine between those physicians who grounded medicine in rational speculation—the rationalists—and those who grounded medicine in experience—the empiricists.
This tension is evident in the Hippocratic corpus. In the corpus there is approval for theorizing that "lays its foundation in incident, and deduces its conclusions in accordance with phenomena" (Jones, p. 313). Nevertheless, the Hippocratic author rejects the systematic sweep of more speculative thought:
Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science, what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. (Jones, p. 53)
The author is rejecting what might be termed speculative or metaphysical medicine—namely, the attempt to construct a theory of medicine on the basis of self-evident, or basic, principles or concepts. The author also writes that medicine has no need of "an empty postulate," a concept that is not based in experience, because it has at hand the means for verifiable knowledge.
René Descartes (1596–1650) held that he could determine the fundamental laws of metaphysics, physics, and medicine (Descartes) by reason alone, without appeal to experience. On the basis of his work in speculative, metaphysical medicine, Descartes predicted that he would live an additional century or so, achieving a life span of one and a half centuries. He believed his own theories would issue in simple revisions of daily routine leading to such extensions of life expectancy (Descartes). Descartes's Treatise of Man (1662) attempts a mechanistic anatomy and physiology expressed in terms of matter and motion. Descartes explains how the human body works by comparing it to a machine. He found that this mechanistic approach could explain the physical functioning of the human body but not rational behavior. Still, Descartes's philosophical reflections concerning the body provided a framework for later explanations of human functioning that also relied on mechanical metaphors.
The success of Isaac Newton (1642–1727) in offering systematic explanations in physics inspired attempts to do this in medicine. The eighteenth-century Scottish physician John Brown (1735–1788), for example, suggested that the concept of excitability could serve medicine as the concept of gravity had served Newtonian physics: as the single concept upon which all explanations of health and disease could ultimately rest. Stimulation or excitation and response to it, he argued, resulted in an equilibrium or disequilibrium that defined health and disease, respectively. If an imbalance became too extreme, death would result. Brown's work attracted the attention of philosophers, including Hegel (1770–1831). This philosophy of medicine—as the gray area between scientific, empirical medicine and the philosophy of nature—led to the modern understanding of medicine that brings together empirical observation and theoretical construction (Tsouyopoulos).
Twentieth-century historians of medicine have appreciated this interplay between empirical and speculative medicine under the title "philosophy of medicine." William Szumowski in 1949 and Owsei Temkin in 1956 spoke of the importance of the philosophy of medicine. It is to Szumowski that much of the rebirth of the interest in this term, perhaps first coined by Elisha Bartlett in 1844, can be attributed. Lester King (1978) has used the term to identify the theoretical reflections undertaken by both physicians and philosophers engaged in speculative as well as other conceptual explorations of medicine.
The relationship between medical reasoning and medical practice has been an area of perennial philosophical controversy and investigation. In ancient Greek and Roman medicine, the disputes between the rationalists and empiricists were, in part, disputes about how knowledge claims in medicine ought to be justified. By the Renaissance, medicine had failed to achieve the success in healing that is often attributed to it today. This failure to achieve therapeutic success led to attempts to make medicine more scientific, in the hope of duplicating the success of fields like astronomy and physics. Thomas Sydenham (1624–1689), whose Observationes medicae appeared in a third edition in 1676, proposed a disciplined methodology of observation and treatment. Sydenham brought to medicine the scientific method of Francis Bacon (1561–1626), which sought to ground reasoning in experience, observation, and data.
This method, however, raised questions about observer bias of which Syndenham was aware. The principal difficulty is that an investigator's findings may be influenced by his or her presuppositions. These concerns about observer bias were taken up in the eighteenth century by such theoreticians of medicine as Françlois Boissier de Sauvages de la Croix (1706–1767) in his Nosologia methodica sistens morborum classes juxta sydenhami mentem et botanicorum ordinem (1768). Influenced by the writings of Thomas Sydenham and Carolus Linnaeus, Sauvages organized diseases into a structure of class, order, genus, and species. In his Nosologia there is an appreciation of medical observation as well as a concern for a logical rigor that sought to coherently relate observations to predicted outcomes. Sauvages's principal undertaking included a classification of diseases primarily based on their signs and symptoms rather than on their causes. He also sought to tie observed signs of illness to relationships that had been noted between past, present, and predicted future states of patients. The logical rigor of disciplined observation and the collection of facts is also evident in the work of William Cullen (1710–1790) and Thomas Percival (1740–1804).
The major revolutions in medical understanding born of advances in anatomy and physiology in the late eighteenth and nineteenth centuries, along with the recognition that many established treatments did not work, required a fundamental reassessment of medicine. Philosophical reflections concerning medical reasoning gave way to major treatises concerning the character of reasoning in medicine. Works such as Sir Gilbert Blane's Elements of Medical Logick (1819), Elisha Bartlett's Philosophy of Medical Science (1844), and F. R. Oesterlen's Medizinische Logik (1852) range from listing the elementary principles of life to concern with material fallacies in medicine, including excessive deference to authority, fashion, or speculative reasoning without sufficient empirical observation. Oesterlen's work, which advanced criteria for inductive reasoning in medicine based on the work of John Stuart Mill, included an analysis of the methods and means of medical investigation, the character of the inductive method in medicine, and the status of experiments, hypotheses, analogies, terminologies, definitions, and classifications. He viewed medical logic as the application of general logical principles to the field of medicine for the purpose of securing a coherent inductive and empirical science that would be free from a priori speculation. His work was followed by other studies, including Władysław Bieganski's Logika medycyny (1894) and Richard Koch's Die ärztliche Diagnose (1920).
Growing philosophical sophistication characterizes twentieth-century assessments of medical knowledge and medical reasoning. Types of medical knowledge may correspond to the different functions of medicine. Medicine can be understood in a threefold manner: biological medicine, clinical research, and clinical practice. Biological medicine is concerned mainly with scientific research in biology, whereas clinical research is focused on the development of the knowledge and technology used in clinical medicine. Finally, the area of clinical practice involves the realities of patients and disease. A philosophical concern of those writing on the logic of medicine has been to clarify the nature of each type of medical knowledge and the relationship of these different areas of medical knowledge and reasoning to one another (Wulff et al., 1986).
Since the middle of the twentieth century, a renewed interest in the logic of medical reasoning and the character of medical decision making has been expressed in the computer reconstruction of differential diagnosis. This literature has examined the logic and principles of medical reasoning—for example, the applicability of Bayes's Theorem to medical decision making (Lusted; Wulff, 1976); the logic of the taxonomy of disease and classification, including the application of set theory to the analysis of clinical judgments (Feinstein); and the role played by morbidity, mortality, and other costs in determining when and how diagnoses are framed. For example, because of the human and financial costs, one will be much more concerned about false positive diagnoses of AIDS than of athlete's foot. Recent works have given special attention to the process of making diagnoses, including the principles of differential diagnosis (Caplan, 1986; Engelhardt et al.; Wulff, 1976), as well as the elaboration of nosologies as instruments for gathering clinical information. Many of these reflections have stressed the hidden role of values and conceptual assumptions in the process and logic of medical diagnosis (Schaffner; Peset and Gracia; King, 1982).
Philosophy of medicine may also be understood as a self-conscious reflection on the status of special concepts, such as health and disease, deployed in medicine. Rudolf Virchow (1821–1902), for example, argued that designating a state of affairs as an illness has a stipulative character; that is, such concepts are defined by agreement and there are no clear natural types or divisions of nature corresponding to nosological categories. This sense of the philosophy of medicine places the accent on issues in the theory of knowledge and the examination of what should count as a medical theory or explanation. In this, it is distinguished from speculative philosophy of medicine and from the more narrow concerns with the rules of evidence and inference proper to medicine that are the focus of medical logic and medical decision theory.
Since the 1950s a considerable literature has developed that is directed to the status of concepts such as health, disease, illness, disability, and disorder. Whether such concerns constitute a subspecialty of the philosophy of science is disputed (Caplan, 1992; Wulff, 1992). There has also been interest in the character of medical explanation (Canguilhem). This literature has also explored the application of such terms to nonhuman animals. In addition, there has been attention to the extent to which these concepts are normative and the extent to which nonnormative, value-free concepts can be elaborated. Those who have argued in favor of weak or strong normative understandings of concepts such as health, disease, and illness have also addressed the character and kind of values that structure such concepts. Investigations have included the extent to which concepts of disease are instrumental to medical practice, or instead identify natural divisions in reality. In addition, there have been attempts to place medicine within the general compass of philosophical explorations of scientific theory (Kliemt). Finally, the significant changes about the relationship of theories, facts, and values in the understanding of the history and philosophy of science that occurred in the 1960s and 1970s were anticipated in Ludwik Fleck's 1935 study of changes in the meaning of syphilis and venereal disease from the fifteenth to the early twentieth century (Fleck).
Even if one were to hold that medicine offers no conceptual or philosophical problems not already present in the subject matter of the philosophy of science or the philosophy of biology (Caplan, 1992), there would still be merit in exploring the ways in which philosophical study and analysis can be directed to the understanding of medicine, as well as to the healthcare sciences and arts in general. In this sense, the philosophy of medicine encompasses the ways in which the philosophy of science, the philosophy of biology, the philosophy of mind, moral philosophy, and so on are engaged in order better to understand medicine. Perhaps one would wish to characterize such explorations as philosophy about medicine rather than of medicine, in the sense that the tools, analyses, and insights of philosophy in general are brought to the particular subject matter of medicine. Calling this endeavor the philosophy of medicine underscores the heuristic advantage of treating the domain as a whole, as a single focus of attention. There is also the advantage of recognizing that general issues of justice, fairness, rights, and duties confront the special challenge of taking account of the development of humans from conception to death.
In medicine, special questions of intergenerational justice become salient, distinctions between human biological and human personal life are raised, the irremediable character of loss must be confronted, and comparisons must be made between claims for the alleviation of suffering versus the postponement of death. Though the definitions of futility, of ordinary versus extraordinary treatment, and of the beginning of life and the beginning of death may arise outside the compass of medicine, such definitions take on a special philosophical cast and character in the context of medicine. The recognition that there is this special concatenation of conceptual issues is appreciated in employing the term philosophy of medicine. This use of the term approximates the one employed by the European Society for the Philosophy of Medicine and Health Care (founded 1987), which encompasses bioethics within a constellation of philosophical concerns and undertakings. The philosophy of medicine as speculative medicine, as the logic of medicine, and as the philosophy of the science of medicine all spring from the acknowledgment that medicine constitutes one of the cardinal areas of intellectual and moral attention, central to human life, and is worthy of sustained conceptual analysis and philosophical regard.
h. tristram engelhardt, jr.
kevin wm. wildes (1995)
bibliography revised
SEE ALSO: Medicine, Anthropology of; Medicine, Art of; Medicine, Profession of; Medicine, Sociology of; Professional-Patient Relationship: Historical Perspectives
Bartlett, Elisha. 1844. An Essay on the Philosophy of Medical Science. Philadelphia: Lea and Blanchard.
Bieganski, Władysław. 1894. Logika Medycyny. Warsaw: Kowalewski.
Blane, Gilbert. 1819. Elements of Medical Logick. London: T. and G. Underwood.
Canguilhem, Georges. 1978. On the Normal and the Pathological, tr. Carolyn R. Fawcett. Dordrecht, Netherlands: D. Reidel.
Caplan, Arthur L. 1986. "Exemplary Reasoning? A Comment on Theory Structure in Biomedicine." Journal of Medicine and Philosophy 11(1): 93–105.
Caplan, Arthur L. 1992. "Does the Philosophy of Medicine Exist?" Theoretical Medicine 13(1): 67–77.
Carrick, Paul. 2001. Medical Ethics in the Ancient World. Washington, D.C.: Georgetown University Press.
Carson, Ronald A., and Burns, Chester R., eds. 1997. Philosophy of Medicine and Bioethics: A Twenty-Year Retrospective and Critical Appraisal (Philosophy and Medicine, vol. 50). New York: Kluwer Academic Publishers.
Culver, Charles M., and Gert, Bernard. 1997. Philosophy in Medicine. New York: Oxford University Press.
Descartes, René. 1983 (1644). Principles of Philosophy, tr. Valentine R. Miller and Reese P. Miller. Dordrecht, Netherlands: D. Reidel.
Engelhardt, H. Tristram; Spicker, Stuart F.; and Towers, Bernard, eds. 1979. Clinical Judgment: A Critical Appraisal. Dordrecht, Netherlands: Kluwer.
Engelhardt Jr., H. Tristam, ed. 2000. The Philosophy of Medicine: Framing the Field. New York: Kluwer Academic Publishers.
Feinstein, Alvan R. 1967. Clinical Judgment. Baltimore: Williams and Wilkins.
Fleck, Ludwik. 1979 (1935). Entstehung und Entwicklung einer wissenschaftlichen Tatsache: Einfuhrüng in die Lehre vom Denkstil und Denkkollektiv. Basel: Benno Schwabe. tr. Fred Bradley and Thaddeus J. Trenn as Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press.
Humphreys, Paul. 1989. The Chances of Explanation: Causal Explanation in the Social, Medical, and Physical Sciences. Princeton, NJ: Princeton University Press.
Jones, William H. S., tr. 1923. Hippocrates. New York: Putnam.
Khushf, George. 1997. "Why Bioethics Needs the Philosophy of Medicine: Some Implications of Reflection on Concepts of Health and Disease." Theoretical Medicine 18(1–2): 145–163.
King, Lester S. 1978. The Philosophy of Medicine: The Early Eighteenth Century. Cambridge, MA: Harvard University Press.
King, Lester S. 1982. Medical Thinking: A Historical Preface. Princeton, NJ: Princeton University Press.
Kliemt, Hartmut. 1986. Grundzüge der Wissenschaftstheorie: Eine Einführung fur Mediziner und Pharmazeuten. Stuttgart, Germany: Gustav Fischer.
Koch, Richard. 1920. Die ärztliche Diagnose. Wiesbaden, Germany: Bergmann.
Kopelman, Loretta M., and McCullough, Laurence. 1999. "Hume, Bioethics, and Philosophy of Medicine." Journal of Medicine and Philosophy 24(4): 315–321.
Lusted, Lee B. 1968. Introduction to Medical Decision Making. Springfield, IL: Charles C. Thomas.
Percival, Thomas. 1776. Philosophical, Medical, and Experimental Essays. London: Joseph Johnson.
Pellegrino, Edmund D. 2001. "The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions." Journal of Medicine and Philosophy 26(6): 559–579.
Pellegrino, Edmund D. 2001. "Philosophy of Medicine: Should it be Teleologically or Socially Construed?" Kennedy Institute of Ethics Journal 11(2): 169–180.
Pellegrino, Edmund D., and Thomasma, David C. 1997. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.
Peset, José Luis, and Gracia, Diego, eds. 1992. The Ethics of Diagnosis. Dordrecht, Netherlands: Kluwer.
Schaffner, Kenneth F., ed. 1985. Logic of Discovery and Diagnosis in Medicine. Berkeley: University of California Press.
Szumowski, W. 1949. "La Philosophie de la médicine, son histoire, son essence, sa dénomination et sa définition." Archives internationales de l'histoire des sciences 9: 1097–1141.
Temkin, Owsei. 1956. "On the Interrelationship of the History and the Philosophy of Medicine." Bulletin of the History of Medicine 30(3): 241–251.
Tsouyopoulos, Nelly. 1982. Andreas Roschlaub und die romantische Medizin: Die philosophischen Grundlagen der modernen Medizin. Stuttgart, Germany: Gustav Fischer.
Wulff, Henrik. 1976. Rational Diagnosis and Treatment. Oxford: Blackwell Scientific Publications.
Wulff, Henrik. 1992. "Philosophy of Medicine—from a Medical Perspective." Theoretical Medicine 13(1): 79–85.
Wulff, Henrik R.; Pedersen, Stig Andur; and Rosenberg, Raben. 1986. Philosophy of Medicine: An Introduction. Oxford: Blackwell Scientific Publications.
van der Eijk, Philip. 2004. Medicine and Philosophy in Greek and Roman Antiquity. New York: Cambridge University Press.
Medicine, Philosophy ofOver the last two and a half millennia—since the beginnings of Greek philosophy and medicine—there have been rich conceptual reflections regarding medical findings, reasoning in medicine, the status of knowledge claims in medicine, and the special concepts that structure the science and art of medicine. The philosophy of medicine is a corpus of considerations and writings uniting these reflections by contributors as diverse as Plato, Aristotle, and Galen; René Descartes, Immanuel Kant, and Georg W. F. Hegel; and contemporary thinkers. Because these examinations of medicine are philosophical in different senses, the term philosophy of medicine is ambiguous, covering a heterogeneous field of intellectual concerns. For the purpose of this overview, they have been collected under four categories.
The first category, speculative philosophy of medicine, has existed from the beginning of medicine. Speculative medicine may be characterized as the attempt to discover the basic philosophical principles that lie behind the practice of medicine. Here philosophy attempts to discover theoretical frameworks or foundations that give shape or content to clinical data. In this sense, philosophy of medicine provides a priori points of departure for medical knowledge and practice. The second category, the logic of medicine, brings together attempts to clarify the character of scientific reasoning in medicine. It identifies the basic principles that make medicine a coherent science. This category of philosophy of medicine studies, for example, the way in which diagnoses are made and judged to be accurate in medical practice and research. A third area of the philosophy of medicine may be understood as a subspecialty of philosophy of science. This area is concerned with what is accepted as knowledge in medicine and the healthcare professions. Much of the recent exploration of the status of concepts of health and disease or the status of the unconscious and explanation in psychoanalysis falls into this third category. Finally, a fourth category describes the explorations of other philosophical issues that have special salience in healthcare, for example, the nature of persons and its implications for the morality of abortion. Philosophy of medicine in this fourth sense would include bioethics.
Just as there is ambiguity concerning the meaning of "philosophy" in "philosophy of medicine," so there is ambiguity about the compass of medicine. Medicine can be construed as a body of knowledge, skills, and social practices concerned with the health and pathology of humans. In its modern sense, medicine encompasses theory and practice, science and art. Traditionally medicine is the origin of all systematic concerns with healing, including nursing and the allied health sciences. The focus of the philosophy of medicine, as a consequence, can have a broad or narrow scope.
The ancient Greek philosophers sought to understand the world on a rational rather than a supernatural basis. Early Greek medicine was influenced by philosophers who held that the primary goal of a scientist was to find one basic principle or set of principles that would explain the natural world known by the senses. These physicians developed theories as to how the body worked and how diseases might be understood and controlled. At first, there was little concern to justify these theories in experience or observation. One finds, then, a tension in early Greek medicine between those physicians who grounded medicine in rational speculation—the rationalists—and those who grounded medicine in experience—the empiricists.
This tension is evident in the Hippocratic corpus. In the corpus there is approval for theorizing that "lays its foundation in incident, and deduces its conclusions in accordance with phenomena" (Jones, p. 313). Nevertheless, the Hippocratic author rejects the systematic sweep of more speculative thought:
Certain physicians and philosophers assert that nobody can know medicine who is ignorant what a man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science, what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. (Jones, p. 53)
The author is rejecting what might be termed speculative or metaphysical medicine—namely, the attempt to construct a theory of medicine on the basis of self-evident, or basic, principles or concepts. The author also writes that medicine has no need of "an empty postulate," a concept that is not based in experience, because it has at hand the means for verifiable knowledge.
René Descartes (1596–1650) held that he could determine the fundamental laws of metaphysics, physics, and medicine (Descartes) by reason alone, without appeal to experience. On the basis of his work in speculative, metaphysical medicine, Descartes predicted that he would live an additional century or so, achieving a life span of one and a half centuries. He believed his own theories would issue in simple revisions of daily routine leading to such extensions of life expectancy (Descartes). Descartes's Treatise of Man (1662) attempts a mechanistic anatomy and physiology expressed in terms of matter and motion. Descartes explains how the human body works by comparing it to a machine. He found that this mechanistic approach could explain the physical functioning of the human body but not rational behavior. Still, Descartes's philosophical reflections concerning the body provided a framework for later explanations of human functioning that also relied on mechanical metaphors.
The success of Isaac Newton (1642–1727) in offering systematic explanations in physics inspired attempts to do this in medicine. The eighteenth-century Scottish physician John Brown (1735–1788), for example, suggested that the concept of excitability could serve medicine as the concept of gravity had served Newtonian physics: as the single concept upon which all explanations of health and disease could ultimately rest. Stimulation or excitation and response to it, he argued, resulted in an equilibrium or disequilibrium that defined health and disease, respectively. If an imbalance became too extreme, death would result. Brown's work attracted the attention of philosophers, including Hegel (1770–1831). This philosophy of medicine—as the gray area between scientific, empirical medicine and the philosophy of nature—led to the modern understanding of medicine that brings together empirical observation and theoretical construction (Tsouyopoulos).
Twentieth-century historians of medicine have appreciated this interplay between empirical and speculative medicine under the title "philosophy of medicine." William Szumowski in 1949 and Owsei Temkin in 1956 spoke of the importance of the philosophy of medicine. It is to Szumowski that much of the rebirth of the interest in this term, perhaps first coined by Elisha Bartlett in 1844, can be attributed. Lester King (1978) has used the term to identify the theoretical reflections undertaken by both physicians and philosophers engaged in speculative as well as other conceptual explorations of medicine.
The relationship between medical reasoning and medical practice has been an area of perennial philosophical controversy and investigation. In ancient Greek and Roman medicine, the disputes between the rationalists and empiricists were, in part, disputes about how knowledge claims in medicine ought to be justified. By the Renaissance, medicine had failed to achieve the success in healing that is often attributed to it today. This failure to achieve therapeutic success led to attempts to make medicine more scientific, in the hope of duplicating the success of fields like astronomy and physics. Thomas Sydenham (1624–1689), whose Observationes medicae appeared in a third edition in 1676, proposed a disciplined methodology of observation and treatment. Sydenham brought to medicine the scientific method of Francis Bacon (1561–1626), which sought to ground reasoning in experience, observation, and data.
This method, however, raised questions about observer bias of which Syndenham was aware. The principal difficulty is that an investigator's findings may be influenced by his or her presuppositions. These concerns about observer bias were taken up in the eighteenth century by such theoreticians of medicine as Françlois Boissier de Sauvages de la Croix (1706–1767) in his Nosologia methodica sistens morborum classes juxta sydenhami mentem et botanicorum ordinem (1768). Influenced by the writings of Thomas Sydenham and Carolus Linnaeus, Sauvages organized diseases into a structure of class, order, genus, and species. In his Nosologia there is an appreciation of medical observation as well as a concern for a logical rigor that sought to coherently relate observations to predicted outcomes. Sauvages's principal undertaking included a classification of diseases primarily based on their signs and symptoms rather than on their causes. He also sought to tie observed signs of illness to relationships that had been noted between past, present, and predicted future states of patients. The logical rigor of disciplined observation and the collection of facts is also evident in the work of William Cullen (1710–1790) and Thomas Percival (1740–1804).
The major revolutions in medical understanding born of advances in anatomy and physiology in the late eighteenth and nineteenth centuries, along with the recognition that many established treatments did not work, required a fundamental reassessment of medicine. Philosophical reflections concerning medical reasoning gave way to major treatises concerning the character of reasoning in medicine. Works such as Sir Gilbert Blane's Elements of Medical Logick (1819), Elisha Bartlett's Philosophy of Medical Science (1844), and F. R. Oesterlen's Medizinische Logik (1852) range from listing the elementary principles of life to concern with material fallacies in medicine, including excessive deference to authority, fashion, or speculative reasoning without sufficient empirical observation. Oesterlen's work, which advanced criteria for inductive reasoning in medicine based on the work of John Stuart Mill, included an analysis of the methods and means of medical investigation, the character of the inductive method in medicine, and the status of experiments, hypotheses, analogies, terminologies, definitions, and classifications. He viewed medical logic as the application of general logical principles to the field of medicine for the purpose of securing a coherent inductive and empirical science that would be free from a priori speculation. His work was followed by other studies, including Władysław Bieganski's Logika medycyny (1894) and Richard Koch's Die ärztliche Diagnose (1920).
Growing philosophical sophistication characterizes twentieth-century assessments of medical knowledge and medical reasoning. Types of medical knowledge may correspond to the different functions of medicine. Medicine can be understood in a threefold manner: biological medicine, clinical research, and clinical practice. Biological medicine is concerned mainly with scientific research in biology, whereas clinical research is focused on the development of the knowledge and technology used in clinical medicine. Finally, the area of clinical practice involves the realities of patients and disease. A philosophical concern of those writing on the logic of medicine has been to clarify the nature of each type of medical knowledge and the relationship of these different areas of medical knowledge and reasoning to one another (Wulff et al., 1986).
Since the middle of the twentieth century, a renewed interest in the logic of medical reasoning and the character of medical decision making has been expressed in the computer reconstruction of differential diagnosis. This literature has examined the logic and principles of medical reasoning—for example, the applicability of Bayes's Theorem to medical decision making (Lusted; Wulff, 1976); the logic of the taxonomy of disease and classification, including the application of set theory to the analysis of clinical judgments (Feinstein); and the role played by morbidity, mortality, and other costs in determining when and how diagnoses are framed. For example, because of the human and financial costs, one will be much more concerned about false positive diagnoses of AIDS than of athlete's foot. Recent works have given special attention to the process of making diagnoses, including the principles of differential diagnosis (Caplan, 1986; Engelhardt et al.; Wulff, 1976), as well as the elaboration of nosologies as instruments for gathering clinical information. Many of these reflections have stressed the hidden role of values and conceptual assumptions in the process and logic of medical diagnosis (Schaffner; Peset and Gracia; King, 1982).
Philosophy of medicine may also be understood as a self-conscious reflection on the status of special concepts, such as health and disease, deployed in medicine. Rudolf Virchow (1821–1902), for example, argued that designating a state of affairs as an illness has a stipulative character; that is, such concepts are defined by agreement and there are no clear natural types or divisions of nature corresponding to nosological categories. This sense of the philosophy of medicine places the accent on issues in the theory of knowledge and the examination of what should count as a medical theory or explanation. In this, it is distinguished from speculative philosophy of medicine and from the more narrow concerns with the rules of evidence and inference proper to medicine that are the focus of medical logic and medical decision theory.
Since the 1950s a considerable literature has developed that is directed to the status of concepts such as health, disease, illness, disability, and disorder. Whether such concerns constitute a subspecialty of the philosophy of science is disputed (Caplan, 1992; Wulff, 1992). There has also been interest in the character of medical explanation (Canguilhem). This literature has also explored the application of such terms to nonhuman animals. In addition, there has been attention to the extent to which these concepts are normative and the extent to which nonnormative, value-free concepts can be elaborated. Those who have argued in favor of weak or strong normative understandings of concepts such as health, disease, and illness have also addressed the character and kind of values that structure such concepts. Investigations have included the extent to which concepts of disease are instrumental to medical practice, or instead identify natural divisions in reality. In addition, there have been attempts to place medicine within the general compass of philosophical explorations of scientific theory (Kliemt). Finally, the significant changes about the relationship of theories, facts, and values in the understanding of the history and philosophy of science that occurred in the 1960s and 1970s were anticipated in Ludwik Fleck's 1935 study of changes in the meaning of syphilis and venereal disease from the fifteenth to the early twentieth century (Fleck).
Even if one were to hold that medicine offers no conceptual or philosophical problems not already present in the subject matter of the philosophy of science or the philosophy of biology (Caplan, 1992), there would still be merit in exploring the ways in which philosophical study and analysis can be directed to the understanding of medicine, as well as to the healthcare sciences and arts in general. In this sense, the philosophy of medicine encompasses the ways in which the philosophy of science, the philosophy of biology, the philosophy of mind, moral philosophy, and so on are engaged in order better to understand medicine. Perhaps one would wish to characterize such explorations as philosophy about medicine rather than of medicine, in the sense that the tools, analyses, and insights of philosophy in general are brought to the particular subject matter of medicine. Calling this endeavor the philosophy of medicine underscores the heuristic advantage of treating the domain as a whole, as a single focus of attention. There is also the advantage of recognizing that general issues of justice, fairness, rights, and duties confront the special challenge of taking account of the development of humans from conception to death.
In medicine, special questions of intergenerational justice become salient, distinctions between human biological and human personal life are raised, the irremediable character of loss must be confronted, and comparisons must be made between claims for the alleviation of suffering versus the postponement of death. Though the definitions of futility, of ordinary versus extraordinary treatment, and of the beginning of life and the beginning of death may arise outside the compass of medicine, such definitions take on a special philosophical cast and character in the context of medicine. The recognition that there is this special concatenation of conceptual issues is appreciated in employing the term philosophy of medicine. This use of the term approximates the one employed by the European Society for the Philosophy of Medicine and Health Care (founded 1987), which encompasses bioethics within a constellation of philosophical concerns and undertakings. The philosophy of medicine as speculative medicine, as the logic of medicine, and as the philosophy of the science of medicine all spring from the acknowledgment that medicine constitutes one of the cardinal areas of intellectual and moral attention, central to human life, and is worthy of sustained conceptual analysis and philosophical regard.
h. tristram engelhardt, jr.
kevin wm. wildes (1995)
bibliography revised
SEE ALSO: Medicine, Anthropology of; Medicine, Art of; Medicine, Profession of; Medicine, Sociology of; Professional-Patient Relationship: Historical Perspectives
Bartlett, Elisha. 1844. An Essay on the Philosophy of Medical Science. Philadelphia: Lea and Blanchard.
Bieganski, Władysław. 1894. Logika Medycyny. Warsaw: Kowalewski.
Blane, Gilbert. 1819. Elements of Medical Logick. London: T. and G. Underwood.
Canguilhem, Georges. 1978. On the Normal and the Pathological, tr. Carolyn R. Fawcett. Dordrecht, Netherlands: D. Reidel.
Caplan, Arthur L. 1986. "Exemplary Reasoning? A Comment on Theory Structure in Biomedicine." Journal of Medicine and Philosophy 11(1): 93–105.
Caplan, Arthur L. 1992. "Does the Philosophy of Medicine Exist?" Theoretical Medicine 13(1): 67–77.
Carrick, Paul. 2001. Medical Ethics in the Ancient World. Washington, D.C.: Georgetown University Press.
Carson, Ronald A., and Burns, Chester R., eds. 1997. Philosophy of Medicine and Bioethics: A Twenty-Year Retrospective and Critical Appraisal (Philosophy and Medicine, vol. 50). New York: Kluwer Academic Publishers.
Culver, Charles M., and Gert, Bernard. 1997. Philosophy in Medicine. New York: Oxford University Press.
Descartes, René. 1983 (1644). Principles of Philosophy, tr. Valentine R. Miller and Reese P. Miller. Dordrecht, Netherlands: D. Reidel.
Engelhardt, H. Tristram; Spicker, Stuart F.; and Towers, Bernard, eds. 1979. Clinical Judgment: A Critical Appraisal. Dordrecht, Netherlands: Kluwer.
Engelhardt Jr., H. Tristam, ed. 2000. The Philosophy of Medicine: Framing the Field. New York: Kluwer Academic Publishers.
Feinstein, Alvan R. 1967. Clinical Judgment. Baltimore: Williams and Wilkins.
Fleck, Ludwik. 1979 (1935). Entstehung und Entwicklung einer wissenschaftlichen Tatsache: Einfuhrüng in die Lehre vom Denkstil und Denkkollektiv. Basel: Benno Schwabe. tr. Fred Bradley and Thaddeus J. Trenn as Genesis and Development of a Scientific Fact. Chicago: University of Chicago Press.
Humphreys, Paul. 1989. The Chances of Explanation: Causal Explanation in the Social, Medical, and Physical Sciences. Princeton, NJ: Princeton University Press.
Jones, William H. S., tr. 1923. Hippocrates. New York: Putnam.
Khushf, George. 1997. "Why Bioethics Needs the Philosophy of Medicine: Some Implications of Reflection on Concepts of Health and Disease." Theoretical Medicine 18(1–2): 145–163.
King, Lester S. 1978. The Philosophy of Medicine: The Early Eighteenth Century. Cambridge, MA: Harvard University Press.
King, Lester S. 1982. Medical Thinking: A Historical Preface. Princeton, NJ: Princeton University Press.
Kliemt, Hartmut. 1986. Grundzüge der Wissenschaftstheorie: Eine Einführung fur Mediziner und Pharmazeuten. Stuttgart, Germany: Gustav Fischer.
Koch, Richard. 1920. Die ärztliche Diagnose. Wiesbaden, Germany: Bergmann.
Kopelman, Loretta M., and McCullough, Laurence. 1999. "Hume, Bioethics, and Philosophy of Medicine." Journal of Medicine and Philosophy 24(4): 315–321.
Lusted, Lee B. 1968. Introduction to Medical Decision Making. Springfield, IL: Charles C. Thomas.
Percival, Thomas. 1776. Philosophical, Medical, and Experimental Essays. London: Joseph Johnson.
Pellegrino, Edmund D. 2001. "The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions." Journal of Medicine and Philosophy 26(6): 559–579.
Pellegrino, Edmund D. 2001. "Philosophy of Medicine: Should it be Teleologically or Socially Construed?" Kennedy Institute of Ethics Journal 11(2): 169–180.
Pellegrino, Edmund D., and Thomasma, David C. 1997. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.
Peset, José Luis, and Gracia, Diego, eds. 1992. The Ethics of Diagnosis. Dordrecht, Netherlands: Kluwer.
Schaffner, Kenneth F., ed. 1985. Logic of Discovery and Diagnosis in Medicine. Berkeley: University of California Press.
Szumowski, W. 1949. "La Philosophie de la médicine, son histoire, son essence, sa dénomination et sa définition." Archives internationales de l'histoire des sciences 9: 1097–1141.
Temkin, Owsei. 1956. "On the Interrelationship of the History and the Philosophy of Medicine." Bulletin of the History of Medicine 30(3): 241–251.
Tsouyopoulos, Nelly. 1982. Andreas Roschlaub und die romantische Medizin: Die philosophischen Grundlagen der modernen Medizin. Stuttgart, Germany: Gustav Fischer.
Wulff, Henrik. 1976. Rational Diagnosis and Treatment. Oxford: Blackwell Scientific Publications.
Wulff, Henrik. 1992. "Philosophy of Medicine—from a Medical Perspective." Theoretical Medicine 13(1): 79–85.
Wulff, Henrik R.; Pedersen, Stig Andur; and Rosenberg, Raben. 1986. Philosophy of Medicine: An Introduction. Oxford: Blackwell Scientific Publications.
van der Eijk, Philip. 2004. Medicine and Philosophy in Greek and Roman Antiquity. New York: Cambridge University Press.
