Papers by S. Joshua Thomas
Psyche, 2024
Reflections on grief and metaphor.
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine
Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come... more Significant contributions to debates in the philosophy of evidence-based medicine (EBM) have come from a variety of different philosophical quarters, yet mainstream discourse in the field has been largely devoid of contributions from scholars working in the pragmatist tradition. This is a particularly conspicuous omission, given pragmatism’s commitment to the melioristic view that philosophy both can, and should, be about the business of concretely bettering the human estate. Two exceptions to this oversight come from Brian Walsh and Maya Goldenberg. Unfortunately, in both cases, the misapplication of pragmatist thinking leads to the mistaken view that EBM is committed to some form of pernicious objectivism. This article aims to revise these pragmatist critiques in order to bring them more consistently in line with pragmatist values and commitments. Doing so shows that EBM is defensible on pragmatist grounds against objectivist attacks.
Journal of evaluation in clinical practice, Jan 30, 2016
Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciou... more Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciously reductive. Although these attacks are overwhelmingly framed as critiques of evidence-based medicine, they standardly target the research wing of EBHC upon which evidence-based medicine is dependent, and increasingly extend to adjacent health care disciplines, such as nursing. One of the most persistent forms this line of attack has taken is the allegation that EBHC, with its emphasis on the hierarchy of evidence, grounded in the use of randomized controlled trials, and the clinical guidelines developed on their basis, fails to recognize the patient as the complex self she is, treating her instead as merely a quantifiable, medical-scientific object. By reducing the patient to certain quantifiable dimensions, the patient as self is allegedly 'erased'. In short, the complaint is that an evidence-based approach to health care has no room for the self. Contrary to this persistentl...
Transactions of the Charles S. Peirce Society, 2014
Steady engagement, over the last decade or so, with the classical pragmatists has led Philip Kitc... more Steady engagement, over the last decade or so, with the classical pragmatists has led Philip Kitcher to develop a position he calls "ethical pragmatic naturalism." Ethical pragmatic naturalism has three legs: an analytic history, a metaethical stance, and a normative position. The first two of these extend and expand pragmatist, especially Deweyan, insights in novel and illuminating, if not entirely unproblematic, ways. In particular, we are offered a plausible, naturalistic account of how our species moved from its pre-ethical state to where it is today, as well as a metaethical account that takes progress, rather than truth, to be primary. The normative position, developed on the basis of the analytic history and metaethical stance, attempts to combine a refined version of Adam Smith's theory of "social mirroring" with Deweyan moral experimentalism. I contend that Kitcher's focus here falls too heavily on the cognitive dimensions of the ethical project, overemphasizing efforts of rule-formation, the alleged construction of an internalized "impartial spectator," and an experimentalism construed primarily, if not exclusively, in terms of thought experiments. Consequently, Kitcher's position hews far more closely to the traditional picture he is ciritcal of than it does to the revolutionary Dewey he claims as inspiration. I suggest that Kitcher's position would be strengthened by a more robust construal of experimentalism, grounded in Deweyan habit, that puts greater emphasis on reconstruction of environing conditions as a crucial part of our toolkit for progressive change.
Evidence & Policy A Journal of Research Debate and Practice, 2023
This commentary preview responds to Gade in ‘When is it justified to claim that a practice or pol... more This commentary preview responds to Gade in ‘When is it justified to claim that a practice or policy is evidence-based? Reflections on evidence and preferences’ ( Evidence & Policy , XX(XX): 1–10, DOI: 10.1332/174426421X16905606522863 ). Full text available upon request.
Cambridge Quarterly of Healthcare Ethics
:This article aims to do two things. First, it argues that moralization of health occurs not only... more :This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of “overridingness” when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individuals’ overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual’s values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.
Cambridge Quarterly of Healthcare Ethics, 2019
This article aims to do two things. First, it argues that moralization of health occurs not only ... more This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of "overridingness" when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individu-als' overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual's values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.
Transactions of the Charles S. Peirce Society, 2017
Our understanding of the importance for, and the influence on the American philosophical traditio... more Our understanding of the importance for, and the influence on the American philosophical tradition of Native American thought has been usefully extended in a number of ways in recent decades. With a few notable exceptions, however, scant attention has been paid to the unique contribution to the history of American thought made by Black Elk, the preeminent wicasa wakan, or holy man, of the first reservation generation of the Oglala Lakota. Scholarship on Black Elk’s religious life has struggled between two interpretive possibilities. Traditionalists are concerned to preserve the image of Black Elk as fully native and traditional, a member of the resistance, if not exactly an open insurrectionist. By contrast, the Catholic camp is concerned to claim Black Elk for the Church, championing him as a great conversion success story. Holler has pointed out that both camps fail to overcome their respective burdens of proof with regard to claims of exclusive observance, however. Thus, he hypothesizes that Black Elk comfortably practiced “dual participation,” contending that the fundamental, relevant religious category for the Lakota was sacred power, not propositional truth. An orientation toward sacred power alone is inadequate to account for Black Elk’s dual participation, however; it may illuminate a necessary condition for Black Elk’s dual participation, but it does little to explain the particular form his dual participation took. To that end, this essay argues there are at least two specific, novel and creative hermeneutic strategies – reverse typology and remythologization – developed and deployed by Black Elk as partial means of harmonizing traditional Lakota religion and Catholicism. Taken together with the basic orientation toward power rather than truth, these strategies not only provide us with a fuller understanding of the theological basis of Black Elk’s particular form of dual participation, but also recommend Black Elk as a far more sophisticated and significant intellectual figure than he generally receives credit for being.
Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciou... more Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciously reductive. Although these attacks are overwhelmingly framed as critiques of evidence-based medicine, they standardly target the research wing of EBHC upon which evidence-based medicine is dependent, and increasingly extend to adjacent health care disciplines, such as nursing. One of the most persistent forms this line of attack has taken is the allegation that EBHC, with its emphasis on the hierarchy of evidence, grounded in the use of randomized controlled trials, and the clinical guidelines developed on their basis, fails to recognize the patient as the complex self she is, treating her instead as merely a quantifiable, medical-scientific object. By reducing the patient to certain quantifiable dimensions, the patient as self is allegedly ‘erased’. In short, the complaint is that an evidence-based approach to health care has no room for the self. Contrary to this persistently held view, it is argued here that EBHC does have room for the self. Review of these critiques suggests they can be categorized into two groups: soft critiques and strong critiques. Soft critiques tend to take a more measured tone grounded in empirical concerns about the dangers of an evidence-based approach to health care, whereas strong critiques tend to make sweeping claims grounded in theoretical commitments to anti-foundationalist philosophical frameworks. While both soft and strong critiques ultimately fail to make the case that EBHC has no room for the self, the empirical concerns of soft critiques nevertheless present a challenge EBHC advocates would do well to take seriously and address.
With the potential to alleviate disease and ameliorate illness, and thereby to promote the condit... more With the potential to alleviate disease and ameliorate illness, and thereby to promote the conditions for human flourishing, few human endeavors have the emancipatory potential of medicine. And yet, despite being in the age of evidence-based practice, medicine has come increasingly under criticism as a territorializing force exerting a kind of dehumanizing, colonizing pressure on patients and practitioners alike. Overwhelmingly, these attacks lean on the work of philosophers like Heidegger, Foucault, and Deleuze and Guattari. This line of criticism fails on two fronts. First, it represents a form of reductive ideological dogmatism that ignores facts on the ground – a rather ironic fact, since that charge is one of the primary allegations made by this camp against evidence-based medicine (EBM). Second, this line of attack hinges to a great extent on a consistent failure to recognize and appreciate the distinction between EBM and biomedicine. Disentangling EBM from biomedicine is an important and urgent task, therefore. When properly disentangled, it becomes clear that charges of an inherent, pernicious reductivism leveled against EBM in fact are aimed at pernicious features of biomedicine’s model of health. Evidence- based medicine is best understood as a method, not a doctrine. As method, EBM is not intrinsically reductive. Yet, like any method, it can be applied improperly, yielding reductive practices. Far less well appreciated is that healthcare professionals’ interpretive frameworks influence their practices, and, moreover, that the biomedical model represents the current prevailing model of health. This is perhaps the most important reason why EBM and biomedicine must be disentangled; in order for EBM to recover its emancipatory potential, it must liberate itself from the biomedical model, and, further, it must develop an alternate model of health consistent not only with its methodology, but with its values. In this endeavor pragmatism offers particularly
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Steady engagement, over the last decade or so, with the classical pragmatists has led Philip Kitc... more Steady engagement, over the last decade or so, with the classical pragmatists has led Philip Kitcher to develop a position he calls “ethical pragmatic naturalism.” Ethical pragmatic naturalism has three legs: an anlytic history, and metaethical stance, and a normative position. The first two of these extend and expand pragmatist, especially Deweyan, insights in novel and illuminating, if not entirely unproblematic, ways. In particular, we are offered a plausible, naturalistic account of how our species moved from its pre-ethical state to where it is today, as well as a metaethical account that takes progress, rather than truth, to be primary. The normative position, developed on the basis of the analytic history and metaethical stance, attempts to combine a refined version of Adam Smith’s theory of “social mirroring” with Deweyan moral experimentalism. I contend that Kitcher’s focus here falls too heavily on the cognitive dimensions of the ethical project, overemphasizing efforts of rule-formation, the alleged construction of an internalized “impartial spectator,” and an experimentalism construed primarily, if not exclusively, in terms of thought experiments. Consequently, Kitcher’s position hews far more closely to the traditional picture he is ciritcal of than it does to the revolutionary Dewey he claims as inspiration. I suggest that Kitcher’s position would be strengthened by a more robust construal of experimentalism, grounded in Deweyan habit, that puts greater emphasis on reconstruction of environing conditions as a crucial part of our toolkit for progressive change.
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Papers by S. Joshua Thomas
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