Osteoporosis and risk of fracture: reference class problems are real.

IF 1.5 3区 哲学 Q3 ETHICS
Theoretical Medicine and Bioethics Pub Date : 2022-12-01 Epub Date: 2022-09-17 DOI:10.1007/s11017-022-09590-3
Nicholas Binney
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引用次数: 2

Abstract

Elselijn Kingma argues that Christopher Boorse's biostatistical theory does not show how the reference classes it uses-namely, age groups of a sex of a species-are objective and naturalistic. Boorse has replied that this objection is of no concern, because there are no examples of clinicians' choosing to use reference classes other than the ones he suggests. Boorse argues that clinicians use the reference classes they do because these reflect the natural classes of organisms to which their patients belong. Drawing on a thorough exploration of how the disease osteoporosis is defined in adults, I argue that clinicians do indeed make choices about which reference classes to use in diagnosis. Clinicians use young adult reference classes to diagnose osteoporosis in elderly patients. They also use young female reference classes to diagnose osteoporosis in elderly males. Clinicians adjust their reference classes so that the diagnosis of osteoporosis reflects a person's risk of sustaining a fragility fracture. The ethical intuition that people with the same risk of fracture should receive the same diagnosis overwhelms the naturalistic intuition that reference classes should reflect natural classes of organisms of uniform functional design. Clinicians construct a variety of reference class types, including pathological reference classes and epidemiological population-specific reference classes, to serve this ethical intuition. I show how clinicians use several reference classes at once so that they can more accurately predict risk of fracture. Ultimately, the reference classes chosen and used in medical practice are quite different from those proposed in naturalistic philosophy of medicine.

骨质疏松症和骨折风险:参考类问题是真实存在的。
Elselijn Kingma认为Christopher Boorse的生物统计学理论并没有说明它所使用的参考类别——即物种性别的年龄群体——是如何客观和自然的。布尔斯回答说,这种反对意见无关紧要,因为除了他建议的课程外,没有临床医生选择使用参考课程的例子。Boorse认为,临床医生使用他们所做的参考分类是因为这些分类反映了他们的病人所属的自然生物类别。通过对成人骨质疏松症定义的深入研究,我认为临床医生确实可以选择在诊断中使用哪些参考分类。临床医生使用年轻成人参考类诊断骨质疏松症的老年患者。他们还使用年轻女性作为参考来诊断老年男性的骨质疏松症。临床医生调整他们的参考分类,以便骨质疏松症的诊断反映一个人维持脆性骨折的风险。具有相同骨折风险的人应该接受相同诊断的伦理直觉压倒了自然主义直觉,即参考类别应该反映具有统一功能设计的生物的自然类别。临床医生构建了各种参考类类型,包括病理参考类和流行病学人群特定参考类,以服务于这种伦理直觉。我展示了临床医生如何同时使用几个参考类,以便他们能够更准确地预测骨折的风险。最终,医学实践中选择和使用的参考类与自然主义医学哲学中提出的参考类有很大的不同。
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来源期刊
CiteScore
1.80
自引率
14.30%
发文量
43
期刊介绍: AIMS & SCOPE Theoretical Medicine and Bioethics examines clinical judgment and reasoning, medical concepts such as health and disease, the philosophical basis of medical science, and the philosophical ethics of health care and biomedical research Theoretical Medicine and Bioethics is an international forum for interdisciplinary studies in the ethics of health care and in the philosophy and methodology of medical practice and biomedical research. Coverage in the philosophy of medicine includes the theoretical examination of clinical judgment and decision making; theories of health promotion and preventive care; the problems of medical language and knowledge acquisition; theory formation in medicine; analysis of the structure and dynamics of medical hypotheses and theories; discussion and clarification of basic medical concepts and issues; medical application of advanced methods in the philosophy of science, and the interplay between medicine and other scientific or social institutions. Coverage of ethics includes both clinical and research ethics, with an emphasis on underlying ethical theory rather than institutional or governmental policy analysis. All philosophical methods and orientations receive equal consideration. The journal pays particular attention to developing new methods and tools for analysis and understanding of the conceptual and ethical presuppositions of the medical sciences and health care processes. Theoretical Medicine and Bioethics publishes original scholarly articles, occasional special issues on important topics, and book reviews. Related subjects » Applied Ethics & Social Responsibility – Bioethics – Ethics – Epistemology & Philosophy of Science – Medical Ethics – Medicine – Philosophy – Philosophy of Medicine – Surgery
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