Papers by Michael Loughlin
Annual conference of the Chartered Society of Physiotherapy, speaker against the motion “This hou... more Annual conference of the Chartered Society of Physiotherapy, speaker against the motion “This house believes that, in the absence of research evidence, an intervention should not be used”: The motion sounds inherently reasonable so why oppose it? Its rhetorical plausibility disguises a crucial lack of clarity, and lack of consensus among expert commentators, practitioners and policy-makers, about the proper understanding of "research evidence" in the context of physiotherapy. In an area where the "gold standard" of double-blind RCTs is not applicable, there is a real need to be clear on the nature of proper research evidence, before we agree to any general propositions limiting the nature of proper practice. It is rational to know what you are voting for before you vote for it, not to find out afterwards that you in fact voted for something which limits you in ways you did not anticipate. Practitioners in this area need to defend their corner and to develop and a...
Complementary Medicine Research
The Bloomsbury Companion to Contemporary Philosophy of Medicine
The ideas and terminology of person-centred care have been part of health discourse for a very lo... more The ideas and terminology of person-centred care have been part of health discourse for a very long time. Arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity and the need to treat the patient as a person is articulated persuasively by clinical authors in the early twentieth century. Yet it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and associated ideas including patient expertise, co-production and shared decision-making, are not simply “fine ideals” or “ethical add-ons” to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. The underlying conviction of this volume - one belief that, despite their differences, unites all of its contributors - is that PCC should not become the latest “revolutionary” concept to be “operatio...
Journal of Evaluation in Clinical Practice, 2018
Clinical Ethics, 2017
Contributors to the debate on ethical rationing bring with them assumptions about the proper role... more Contributors to the debate on ethical rationing bring with them assumptions about the proper role of moral theories in practical discourse, which seem reasonable, realistic and pragmatic. These assumptions function to define the remit of bioethical discourse and to determine conceptions of proper methodology and causal reasoning in the area. However well intentioned, the desire to be realistic in this sense may lead us to judge the adequacy of a theory precisely with reference to its ability to deliver apparently determinate answers to questions that strike most practitioners and patients as morally arbitrary. By providing ethical solutions that work given the world as it is, work in clinical ethics may serve to endorse or protect from scrutiny the very structures that need to change if real moral progress is to be possible. Such work can help to foster the illusion that fundamentally arbitrary decisions are ‘grounded’ in objective, impartial reasoning, bestowing academic credibilit...
European Journal for Person Centered Healthcare, 2014
In their important discussion paper presenting person-centred medicine (PCM) as ‘an emergent mode... more In their important discussion paper presenting person-centred medicine (PCM) as ‘an emergent model of modern clinical practice’ [1], Miles and Mezzich note a rather obvious comparison between the rhetoric of their own favoured ‘model’ and the rhetoric of the evidence-based medicine (EBM) movement. For all their differences, PCM and EBM have something in common. While we may disagree about what evidence is or indeed just not be sure what it is, we are generally agreed that we are in favour of it. A movement that is all about promoting the use of evidence in medicine sounds about as uncontroversial as it gets. I might be oblivious to scientific debates about the nature of evidence and have no idea how to define the term, but I know that I want anyone treating me to use evidence, all the same. I may wonder what else medical decisions should be based on, if not evidence? [2]. Similarly, it would make very little sense to be ‘against’ persons. I may have never given a moment’s thought to...
Journal of evaluation in clinical practice, 2015
Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy sec... more Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy 'at the bedside'? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions - about what we should do in any given situation - are embedded within whole understandings of the situation, inseparable from our beliefs about what is the case (metaphysics), what it is that we feel we can claim to know (epistemology), as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct ar...
DSM, IDC, RDoC, and Beyond, 2014
Philosophy, Psychiatry, & Psychology, 2010
Sykes characterizes the inference in the following terms: If there is no known physical cause fo... more Sykes characterizes the inference in the following terms: If there is no known physical cause for a symptom or disorder, the cause must be psychological (2010, 290). He notes the glaring fallacy of mistaking an epistemological point (that a physical cause is not, at present, ...
Journal of Evaluation in Clinical Practice, 2004
... Michael Loughlin PhD. ... Correspondence: Michael Loughlin PhD,. *Correspondence: Dr MichaelL... more ... Michael Loughlin PhD. ... Correspondence: Michael Loughlin PhD,. *Correspondence: Dr MichaelLoughlin Manchester Metropolitan University Alsager Campus Hassall Road Alsager Stoke-on-Trent ST7 2HL UK E-mail: [email protected]. Publication History. ...
Journal of Evaluation in Clinical Practice, 2010
Journal of Evaluation in Clinical Practice, 2011
Journal of Evaluation in Clinical Practice, 2009
Journal of Evaluation in Clinical Practice, 2013
Editors' introduction to 4th Philosophy of Medicine thematic issue of JECP
Journal of Evaluation in Clinical Practice, 2012
Health Care Analysis, 2012
Scientism is a philosophy which purports to define what the world &am... more Scientism is a philosophy which purports to define what the world 'really is'. It adopts what the philosopher Thomas Nagel called 'an epistemological criterion of reality', defining what is real as that which can be discovered by certain quite specific methods of investigation. As a consequence all features of experience not revealed by those methods are deemed 'subjective' in a way that suggests they are either not real, or lie beyond the scope of meaningful rational inquiry. This devalues capacities that (we argue) are in fact essential components of good reasoning and virtuous practice. Ultimately, the implications of scientism for statements of value undermine value-judgements essential for science itself to have a sound basis. Scientism has implications, therefore, for ontology, epistemology and also for which claims we can assert as objective truths about the world. Adopting scientism as a world view will have consequences for reasoning and decision-making in clinical and other contexts. We analyse the implications of this approach and conclude that we need to reject scientism if we are to avoid stifling virtuous practice and to develop richer conceptions of human reasoning.
Journal of evaluation in clinical practice, 2014
The role of philosophy in discussions of clinical practice was once regarded by many as restricte... more The role of philosophy in discussions of clinical practice was once regarded by many as restricted to a very limited version of 'medical ethics', one that has been extensively criticized in the pages of this journal and elsewhere for being at once philosophically untenable and practically unhelpful [1-4]. While this uninspiring view of the nature and scope of applied philosophy has by no means been eradicated, over a number of years there has been a resurgence of interest in the philosophy of medicine and health care as an intellectually serious and practically significant enterprise. Controversies about evidence, value, clinical knowledge, judgement, integrity and ethics have required practitioners and policy-makers to confront the epistemic and moral basis of practice, while philosophers have found in these debates ways to invigorate and reframe the investigation of long-standing philosophical problems, about the nature of reasoning, science, knowledge and practice, and the relationships between epistemology and ethics, morals and politics [1,5-7]. Applied philosophy has moved a long way from the simplistic application of ethical theories to artificially constructed 'dilemmas', to become a rigorous engagement with questions of medical epistemology, metaphysics, and moral and practical reasoning. The Journal of Evaluation in Clinical Practice (JECP) has played no small part in these developments. From its inception, it has consistently raised questions of an underlying, conceptual nature that all manner of influential commentators either ignored or openly dismissed in pronouncing on how to improve the organization of health services, the ethics of practitioners, the reasoning of clinicians and a host of other issues central to the delivery of health care. bs_bs_banner
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Papers by Michael Loughlin