"Doctor Knows Best"
On the Epistemic Authority of the Medical Practitioner
DOI:
https://doi.org/10.5195/pom.2021.49Keywords:
Epistemic authority, Medical authority, Expertise, Doctor-patient relationshipAbstract
We often consider medical practitioners to be epistemic authorities: “Doctor knows best,” as the saying goes. The place of expert judgment in evidence-based medicine hierarchies, and the crucial role of patient preferences and values in medical decision-making, however, pose problems for making sense of such authority. I argue that there is an account of such medical epistemic authority that does justice to the complexities of the doctor–patient relationship, while maintaining that medical practitioners hold an epistemically privileged position. Such a view can better inform medical practice by clearly illuminating the distinct roles of patients and doctors in decision-making processes.
References
Baumberger, Christoph, Claus Beisbart, and Georg Brun. 2017. “What Is Understanding? An Overview of Recent Debates in Epistemology and Philosophy of Science.” In Explaining Understanding: New Perspectives from Epistemology and Philosophy of Science, edited by Stephen Grimm, Christoph Baumberger, and Sabine Ammon, 1–34. New York: Routledge.
Bjerring, Jens Christian and Jacob Busch. 2020. “Artificial Intelligence and Patient-Centered Decision-Making.” Philosophy and Technology 34: 349–71. https://doi.org/10.1007/s13347-019-00391-6.
Carel, Havi and Ian James Kidd. 2014. “Epistemic Injustice in Healthcare: A Philosophical Analysis.” Medicine, Health Care and Philosophy 17: 529–40. https://doi.org/10.1007/s11019-014-9560-2.
Coady, David. 2006. “When Experts Disagree.” Episteme 3, no. 1–2: 68–79. https://doi.org/10.3366/epi.2006.3.1-2.68.
Constantin, Jan and Thomas Grundmann. 2020. “Epistemic Authority: Preemption through Source Sensitive Defeat.” Synthese 197, no. 9: 4109–30. https://doi.org/10.1007/s11229-018-01923-x.
Croce, Michel. 2017. “Expert-Oriented Abilities vs. Novice-Oriented Abilities: An Alternative Account of Epistemic Authority.” Episteme 15, no. 4: 476–98. https://doi.org/10.1017/epi.2017.16.
Dormandy, Katherine. 2018. “Epistemic Authority: Preemption or Proper Basing?” Erkenntnis 83, no. 4: 773–91. https://doi.org/10.1007/s10670-017-9913-3.
Evidence-Based Medicine Working Group. 1992. “Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine.” JAMA 268, no. 17: 2420–25. https://doi.org/10.1001/jama.1992.03490170092032.
Genin, Konstantin and Thomas Grote. 2021. “Randomized Control Trials in Medical AI: A Methodological Critique.” Philosophy of Medicine 2, no. 1: 1–15. https://doi.org/10.5195/philmed.2021.27.
Goldman, Alvin I. 2011. “Experts: Which Ones Should You Trust?” In Social Epistemology: Essential Readings, edited by Alvin I. Goldman and Dennis Whitcomb, 109–33. New York: Oxford University Press.
Haynes, R. Brian, P.J. Devereaux, and Gordon H. Guyatt. 2002. “Clinical Expertise in the Era of Evidence-Based Medicine and Patient Choice.” BMJ Evidence-Based Medicine 7, no. 2: 36–38. http://dx.doi.org/10.1136/ebm.7.2.36.
Henry, Stephen G. 2006. “Recognizing Tacit Knowledge in Medical Epistemology.” Theoretical Medicine and Bioethics 27: 187–213. https://doi.org/10.1007/s11017-006-9005-x.
Howick, Jeremy. 2011. The Philosophy of Evidence-Based Medicine. Chichester: Wiley-Blackwell, BMJ Books.
Jäger, Christoph. 2016. “Epistemic Authority, Preemptive Reasons, and Understanding.” Episteme 13, no. 2: 167–85. https://doi.org/10.1017/epi.2015.38.
Kukla, Rebecca. 2007. “How Do Patients Know?” Hastings Center Report 37, no. 5: 27–35. https://doi.org/10.1353/hcr.2007.0074.
Matheson, David. 2005. “Conflicting Experts and Dialectical Performance: Adjudicating Heuristics for the Layperson.” Argumentation 19: 145–58. https://doi.org/10.1007/s10503-004-7041-0.
McMyler, Benjamin. 2011. Testimony, Trust, and Authority. New York: Oxford University Press.
Mumpower, Jeryl L. and Thomas R. Stewart. 1996. “Expert Judgement and Expert Disagreement.” Thinking and Reasoning 2, no. 2–3: 191–212. https://doi.org/10.1080/135467896394500.
Priest, Maura. 2017. “Intellectual Humility: An Interpersonal Account.” Ergo 4, no. 16. https://doi.org/10.3998/ergo.12405314.0004.016.
Raz, Joseph. 1988. The Morality of Freedom. Oxford: Clarendon Press.
Rządezcka, Marcin. 2020. “The Philosophy of Expertise in the Age of Medical Informatics: How Healthcare Technology Is Transforming Our Understanding of Expertise and Expert Knowledge.” Studies in Logic, Grammar, and Rhetoric 63, no. 76: 209–25. https://doi.org/10.2478/slgr-2020-0035.
Sackett, David L., William M.C. Rosenberg, J.A. Muir Gray, R. Brian Haynes, and W. Scott Richardson. 1996. “Evidence Based Medicine: What It Is and What It Isn’t.” BMJ 312: 71–72. https://doi.org/10.1136/bmj.312.7023.71.
Schwartz, Barry and Roseanna Sommers. 2013. “Affective Forecasting and Well-Being.” In The Oxford Handbook of Cognitive Psychology, edited by Daniel Reisberg, 704–17. New York: Oxford University Press.
Smith, Richard. 2015. “David Sackett.” BMJ 305. https://doi.org/10.1136/bmj.h2639.
Solomon, Miriam. 2015. “Expert Disagreement and Medical Authority.” In Philosophical Issues in Psychiatry III, edited by Kenneth S. Kendler and Josef Parnas, 60–72. Oxford: Oxford University Press.
Stasiuk, Katarzyna, Yoram Bar-tal, and Renata Maksymiuk. 2016. “The Effect of Physicians’ Treatment Recommendations on Their Epistemic Authority: The Medical Expertise Bias.” Journal of Health Communication 21, no. 1: 92–99. https://doi.org/10.1080/10810730.2015.1049308.
Wieten, Sarah. 2018. “Expertise in Evidence-Based Medicine: A Tale of Three Models.” Philosophy, Ethics, and Humanities in Medicine 13, no. 2. https://doi.org/10.1186/s13010-018-0055-2.
Zagzebski, Linda. 2012. Epistemic Authority: A Theory of Trust, Authority, and Autonomy in Belief. New York: Oxford University Press.
———. 2016. “Replies to Christoph Jäger and Elizabeth Fricker.” Episteme 13, no. 2: 187–94. https://doi.org/10.1017/epi.2015.39.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
- The Author agrees to digitally sign the Publisher’s final formatted PDF version of the Work.