Intuition in Medicine
A Philosophical Defense of Clinical Reasoning
256 pages
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20 halftones
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6 x 9
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© 2012
Intuition is central to discussions about the nature of scientific and philosophical reasoning and what it means to be human. In this bold and timely book, Hillel D. Braude marshals his dual training as a physician and philosopher to examine the place of intuition in medicine.
Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—Braude here examines intuition as it occurs at different levels and in different contexts of clinical reasoning. He argues that not only does intuition provide the bridge between medical reasoning and moral reasoning, but that it also links the epistemological, ontological, and ethical foundations of clinical decision making. In presenting his case, Braude takes readers on a journey through Aristotle’s Ethics—highlighting the significance of practical reasoning in relation to theoretical reasoning and the potential bridge between them—then through current debates between regulators and clinicians on evidence-based medicine, and finally applies the philosophical perspectives of Reichenbach, Popper, and Peirce to analyze the intuitive support for clinical equipoise, a key concept in research ethics. Through his phenomenological study of intuition Braude aims to demonstrate that ethical responsibility for the other lies at the heart of clinical judgment.
Braude’s original approach advances medical ethics by using philosophical rigor and history to analyze the tacit underpinnings of clinical reasoning and to introduce clear conceptual distinctions that simultaneously affirm and exacerbate the tension between ethical theory and practice. His study will be welcomed not only by philosophers but also by clinicians eager to justify how they use moral intuitions, and anyone interested in medical decision making.
Stephen Buetow | Journal of Evaluation in Clinical Practice
“[A] sweeping but richly crafted historical journey. . . . Intuition in Medicine is a stimulating, concise and reasonably priced text that is likely to appeal to a wide range of academic readers for its ability to challenge and advance medical and moral thinking about clinical reasoning, the place of intuition in medicine and what it means to be human.”
Elaine W. Cotlove | Journal of the American Medical Association
“This book is monumental in the depth and breadth of its scholarship.”
John Safranek | Review of Metaphysics
“Intuition in Medicine is insightful in warning of the subversion of clinical reasoning by the blind application of statistics, oblivious both to the role of intuition in clinical practice and the human character of the doctor-patient encounter. Braude broadly succeeds in relating Aristotelian epistemology to the practice of medicine and thereby overcoming the dehumanization and Cartesian dualism that threatens the practice of medicine.”
Alfred I. Tauber, Boston University | Medcal History
“Braude must be congratulated for offering a grand synthesis that his topic deserves. . . . An intellectually enriched account of what truly threatens humane medicine and what is required for authentic reasoned clinical care.”
Kathryn Montgomery, Northwestern University Feinberg School of Medicine
“Hillel Braude’s book is brilliant. There’s nothing like it—this is a true, deep, scholarly, philosophical, historical work with real staying power.”
James Giordano, Oxford Centre for Neuroethics, University of Oxford
“Drawing on philosophy, science, ethics, and a wealth of personal experience as a physician and philosopher, Hillel D. Braude offers keen insight into the essence of medicine as an intellectual and moral endeavor. Braude explores the nature of medical knowledge and its application in both the objective and subjective aspects of reasoning, decision making, and patient interaction that define the act of medicine and its realization in the clinical encounter. This important new book carries on in the spirit and tenor of Pellegrino and Thomasma, and I believe rightfully takes its place with such seminal studies as an invaluable work on the skill and art of practical wisdom in medicine."
Sander L. Gilman, Emory University
“Hillel D. Braude’s Intuition in Medicine: A Philosophical Defense of Clinical Reasoning is the first serious attempt to understand medical intuition as an intrinsic part of both the scientific process and the world of therapy. Sophisticated but not esoteric, Braude’s study is able to provide a reasoned and balanced account of the intuitive process, freeing intuition from the world of medical magic thinking and placing it at the center of medicine. A major contribution to medical humanities.”
Richard M. Zaner, Vanderbilt University Medical Center
“Hillel D. Braude’s book is a remarkable achievement that should be carefully studied by all those who seek to understand the nature of clinical reasoning. He provides an important analysis of the major figures in the still ongoing disputes between evidence-based medical models and those that insist on the place of intuition and tacit knowledge. Moreover, he is eminently fair to all the parties to these disputes, and in the process uncovers central historical themes that have long fueled them—from his important and balanced analysis of Aristotle’s phronesis through Galton’s discovery of correlation and Polanyi’s study of tacit knowledge, along with those still currently involved in these issues. A splendid accomplishment that is both deeply informed of these discussions and highly intelligent and fair in its assessments and conclusions.”
Contents
Acknowledgments
Introduction
Introduction
One: Intuition in Medical and Moral Reasoning
Two: Moral Intuitionism
Three: The Place of Aristotelian Phronesis in Clinical Reasoning
Four: Aristotle’s Practical Syllogism: Accounting for the Individual through a Theory of Action and Cognition
Five: Individual and Statistical Physiognomy: The Art and Science of Making the Invisible Visible
Six: Clinical Intuition versus Statistical Reasoning
Seven: Contingency and Correlation: The Significance of Modeling Clinical Reasoning on Statistics
Eight: Abduction: The Intuitive Support of Clinical Induction
Two: Moral Intuitionism
Three: The Place of Aristotelian Phronesis in Clinical Reasoning
Four: Aristotle’s Practical Syllogism: Accounting for the Individual through a Theory of Action and Cognition
Five: Individual and Statistical Physiognomy: The Art and Science of Making the Invisible Visible
Six: Clinical Intuition versus Statistical Reasoning
Seven: Contingency and Correlation: The Significance of Modeling Clinical Reasoning on Statistics
Eight: Abduction: The Intuitive Support of Clinical Induction
Conclusion: Medical Ethics beyond Ontology
Bibliography
Index
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