Event Title
Resituating evidence in feminist science studies
Start Date
26-6-2010 1:00 PM
End Date
26-6-2010 2:30 PM
Description
This presentation is part of the Feminism and Empiricism (Quinean Themes) track.
Taking it to now be fairly uncontroversial to claim that there are values operating in science, this examination concerns the role evidence plays in justifying value-laden scientific claims. This question underlies current debates in the philosophy of medicine over evidence-based medicine. While the promise of the evidence-based movement still captivates most healthcare professionals and administrators, a small cadre of critics argue that the evidence-based effort to ground medical decision-making in the most rigorous sources of scientific evidence obscures the social values that necessarily enter into all decision-making contexts, the complex social context of clinical practice being no exception. To try to derive a formal methodology governed by pre-established rules, guidelines, and hierarchies of information misplaces the contextual and social features of biomedical knowledge and practice, thereby obscuring the power interests that so problematically dictate large factions of biomedical research and practice.
The problem that follows, however, is the possible relativist implications of this finding. The evidence-based medicine critics embrace post-positivist themes such as the underdetermination of theory by the evidence, the theory-ladenness of our scientific claims and the fallibilism of knowledge claims, in order to criticize EBM’s tacit theory of evidence, but then fail to formulate a constructive alternative theory of evidence within this fact-value interplay. This is an undesirable end, as nobody wants to abandon evidence in the medical context. There seems to be consensus that it is a worthy pursuit to motivate a philosophy of medicine that is responsive to the evidence. What the critics of evidence-based medicine are encouraging, then, is the development of a more honest and accurate theory of evidence that recognizes the social context in which biomedicine operates. Yet my review of some of this critical literature will show that the epistemological insight derived from critical science studies seem to confound rather than motivate the constructive project of offering an alternative theory of evidence.
Feminist empiricism should offer some solutions to this stalemate, as this theoretical framework respects the empiricist constraints that the critics want to maintain and the seeming difficulty of admitting to the value-ladenness of science without losing its normativity. Both Lynn Hankinson Nelson (1993) and Helen Longino (1990; 2001) offer anti-foundationalist theories of evidence within a framework of normative science claims. Both build on Quine’s fact/value holism to devise holistic theories of evidence that broaden the standards of evidence to properly admit the social features of science that are missing from the evidence based perspective, among other scientistic programmes.
Yet, I will argue that these theories of evidence fail to guide medical decision-making because of some undesirable consequences of Quinean fact-value holism: the denial that our values have logical content and are therefore not empirically examinable relativises even these nuanced conceptions of evidence. The charge of relativism was first articulated by Sharyn Clough (2003; 2004), who detailed the resulting damage to the normativity of feminist science claims. However, a naturalized look at how facts and values actually interact in medical decision-making suggests that this fact/value holism is not realistic. I will provide an illustrative example of a physician devising a treatment recommendation for a patient to demonstrate that in practice, facts and values intermingle in the decision-making process without indeterminacy and subsequent appeals to moral and political frameworks, as feminist empiricism suggests. In the end, value-laden evidence can retain its adjudicative force and normativity.
And so, the post-positivist evidence-based medicine critics need not despair over the sociality of scientific knowledge. While clinical evidence does not settle treatment decision-making, the insertion of values is not vanquish evaluation and rational choice. Our values, background assumptions, and other so-called “filters” are informed by empirical content and are open to examination, evaluation, and justified acceptance or refutation. In the end recognizing that medicine operates within a social context enhances rather than confounds scientific activity.
Resituating evidence in feminist science studies
This presentation is part of the Feminism and Empiricism (Quinean Themes) track.
Taking it to now be fairly uncontroversial to claim that there are values operating in science, this examination concerns the role evidence plays in justifying value-laden scientific claims. This question underlies current debates in the philosophy of medicine over evidence-based medicine. While the promise of the evidence-based movement still captivates most healthcare professionals and administrators, a small cadre of critics argue that the evidence-based effort to ground medical decision-making in the most rigorous sources of scientific evidence obscures the social values that necessarily enter into all decision-making contexts, the complex social context of clinical practice being no exception. To try to derive a formal methodology governed by pre-established rules, guidelines, and hierarchies of information misplaces the contextual and social features of biomedical knowledge and practice, thereby obscuring the power interests that so problematically dictate large factions of biomedical research and practice.
The problem that follows, however, is the possible relativist implications of this finding. The evidence-based medicine critics embrace post-positivist themes such as the underdetermination of theory by the evidence, the theory-ladenness of our scientific claims and the fallibilism of knowledge claims, in order to criticize EBM’s tacit theory of evidence, but then fail to formulate a constructive alternative theory of evidence within this fact-value interplay. This is an undesirable end, as nobody wants to abandon evidence in the medical context. There seems to be consensus that it is a worthy pursuit to motivate a philosophy of medicine that is responsive to the evidence. What the critics of evidence-based medicine are encouraging, then, is the development of a more honest and accurate theory of evidence that recognizes the social context in which biomedicine operates. Yet my review of some of this critical literature will show that the epistemological insight derived from critical science studies seem to confound rather than motivate the constructive project of offering an alternative theory of evidence.
Feminist empiricism should offer some solutions to this stalemate, as this theoretical framework respects the empiricist constraints that the critics want to maintain and the seeming difficulty of admitting to the value-ladenness of science without losing its normativity. Both Lynn Hankinson Nelson (1993) and Helen Longino (1990; 2001) offer anti-foundationalist theories of evidence within a framework of normative science claims. Both build on Quine’s fact/value holism to devise holistic theories of evidence that broaden the standards of evidence to properly admit the social features of science that are missing from the evidence based perspective, among other scientistic programmes.
Yet, I will argue that these theories of evidence fail to guide medical decision-making because of some undesirable consequences of Quinean fact-value holism: the denial that our values have logical content and are therefore not empirically examinable relativises even these nuanced conceptions of evidence. The charge of relativism was first articulated by Sharyn Clough (2003; 2004), who detailed the resulting damage to the normativity of feminist science claims. However, a naturalized look at how facts and values actually interact in medical decision-making suggests that this fact/value holism is not realistic. I will provide an illustrative example of a physician devising a treatment recommendation for a patient to demonstrate that in practice, facts and values intermingle in the decision-making process without indeterminacy and subsequent appeals to moral and political frameworks, as feminist empiricism suggests. In the end, value-laden evidence can retain its adjudicative force and normativity.
And so, the post-positivist evidence-based medicine critics need not despair over the sociality of scientific knowledge. While clinical evidence does not settle treatment decision-making, the insertion of values is not vanquish evaluation and rational choice. Our values, background assumptions, and other so-called “filters” are informed by empirical content and are open to examination, evaluation, and justified acceptance or refutation. In the end recognizing that medicine operates within a social context enhances rather than confounds scientific activity.