{"title":"Osteoporosis and risk of fracture: reference class problems are real.","authors":"Nicholas Binney","doi":"10.1007/s11017-022-09590-3","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":46703,"journal":{"name":"Theoretical Medicine and Bioethics","volume":" ","pages":"375-400"},"PeriodicalIF":1.5000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9700603/pdf/","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Theoretical Medicine and Bioethics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11017-022-09590-3","RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/9/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ETHICS","Score":null,"Total":0}
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.
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