The Wisdom of the Body: Science, Medicine and Epistemology
Brett McCarty, Doctoral Candidate in Theology, Duke Divinity School
The practices of medicine and science are currently being misconstrued and distorted through efforts to achieve objective, abstract truth, and should instead be pursued as continuing efforts at furthering the work of historical traditions of inquiry. In order to explain this claim, this paper examines the problematic epistemology assumed by many to be fundamental to medicine and science. It then offers an alternative constructive account of how ways of knowing should be construed within these practices, and concludes with labor and delivery as a case study in these contrasting epistemologies.
Evidence-based medicine is the gold standard for current medical practice, and its ever-increasing influence is changing medicine’s self-understanding. By emphasizing quantitative research data, it enables medicine to consider itself “scientific.” It is a mistake, however, to think of medicine as a scientific pursuit of timeless truth about health and the human body. Statistics from robust empirical studies do not display eternal truths about the human population, and to think that they do is to make an epistemological error. When medical practitioners forget the historically, socially, and spatially situated nature of scientific inquiry (and the evidence-based medicine it produces), they distort their practices in a deluded pursuit funded by fading Enlightenment-era conceptions of truth.
In contrast, medicine and science should be understood as traditioned forms of rational inquiry. Following the work of Alasdair MacIntyre, especially his *Whose Justice? Which Rationality?*, this paper claims that medicine and science are traditions, “argument[s] extended through time in which certain fundamental agreements are defined and redefined” through internal debate and external critique (12). Understood in this framework, evidence-based medicine is not the outworking of timeless truth, but instead one expression of historically-extended arguments found within scientific medicine. Statistical studies should be considered as modest efforts to further this tradition of inquiry, not as definitive pronouncements about reality. Stanley Hauerwas names medicine as a tradition in which practitioners pass on “the wisdom of the body from one generation to another” (*Suffering Presence*, 69). When properly understood, evidence-based medicine can contribute in a chastened way to this work.
In order to understand the difference between medicine as the ahistorical pursuit of truth, and medicine as a tradition attending to the wisdom of the body, the paper concludes by contrasting two approaches found within the practices of labor and delivery. The work of labor and delivery has been conceived of as a scientific enterprise by many expert obstetricians judging the particular situations of pregnant women against abstract normative accounts. In contrast, the increasing prevalence of birthing centers, home births, and midwives represents a backlash against this way of practicing labor and delivery as a science. In these two approaches, we can see two differing ways of knowing the laboring body. Recently, standard medical practice has begun to learn from the ways in which these alternative approaches tend to the laboring body, and in this synthesis we can see a constructive example of how evidence-based medicine can be incorporated as traditioned attention to the wisdom of the body.
The practices of medicine and science are currently being misconstrued and distorted through efforts to achieve objective, abstract truth, and should instead be pursued as continuing efforts at furthering the work of historical traditions of inquiry. In order to explain this claim, this paper examines the problematic epistemology assumed by many to be fundamental to medicine and science. It then offers an alternative constructive account of how ways of knowing should be construed within these practices, and concludes with labor and delivery as a case study in these contrasting epistemologies.
Evidence-based medicine is the gold standard for current medical practice, and its ever-increasing influence is changing medicine’s self-understanding. By emphasizing quantitative research data, it enables medicine to consider itself “scientific.” It is a mistake, however, to think of medicine as a scientific pursuit of timeless truth about health and the human body. Statistics from robust empirical studies do not display eternal truths about the human population, and to think that they do is to make an epistemological error. When medical practitioners forget the historically, socially, and spatially situated nature of scientific inquiry (and the evidence-based medicine it produces), they distort their practices in a deluded pursuit funded by fading Enlightenment-era conceptions of truth.
In contrast, medicine and science should be understood as traditioned forms of rational inquiry. Following the work of Alasdair MacIntyre, especially his *Whose Justice? Which Rationality?*, this paper claims that medicine and science are traditions, “argument[s] extended through time in which certain fundamental agreements are defined and redefined” through internal debate and external critique (12). Understood in this framework, evidence-based medicine is not the outworking of timeless truth, but instead one expression of historically-extended arguments found within scientific medicine. Statistical studies should be considered as modest efforts to further this tradition of inquiry, not as definitive pronouncements about reality. Stanley Hauerwas names medicine as a tradition in which practitioners pass on “the wisdom of the body from one generation to another” (*Suffering Presence*, 69). When properly understood, evidence-based medicine can contribute in a chastened way to this work.
In order to understand the difference between medicine as the ahistorical pursuit of truth, and medicine as a tradition attending to the wisdom of the body, the paper concludes by contrasting two approaches found within the practices of labor and delivery. The work of labor and delivery has been conceived of as a scientific enterprise by many expert obstetricians judging the particular situations of pregnant women against abstract normative accounts. In contrast, the increasing prevalence of birthing centers, home births, and midwives represents a backlash against this way of practicing labor and delivery as a science. In these two approaches, we can see two differing ways of knowing the laboring body. Recently, standard medical practice has begun to learn from the ways in which these alternative approaches tend to the laboring body, and in this synthesis we can see a constructive example of how evidence-based medicine can be incorporated as traditioned attention to the wisdom of the body.