Towards a pragmatic theory of medical explanations of disease

What counts as a "good" medical explanation? How should clinicians explain illness to patients? Can only medical clinicians generate these explanations? In my dissertation, I argue that explanations of disease, as derived from philosophy of science research, have been applied wrongly to the clinical practice of explaining patients' sicknesses. I argue for an improved theory of pragmatic medical explanations where explanations of health and disease are collaborative efforts between doctors and patients. Engaging patients as epistemic agents of explanation empowers them as participants in generating information regarding their own health, thus improving patients' abilities to make autonomous and informed health care decisions. Such an approach meets with all we would like to say about scientific explanations, i.e., that they do not devolve into relativism, and they retain scientific meaning. I provide an overview of the major theories in philosophy of science about scientific explanation in Chapter 2, including the works of Hempel, Salmon, Kitcher, van Fraassen, Schaffner, and Railton.; Paul Thagard (How Scientists Explain Disease) and Kenneth Schaffner (Discovery and Explanation in Biology and Medicine) have argued medical explanations should be structured as scientific explanations. In Chapter 3, I critique this move as improperly characterizing the relationship between two types of medical explanations: biomedical research explanations (from the laboratory) and clinical explanations (developed as part of doctor-patient interacti ons). Philosophers of science have advocated primarily ontic models of disease explanation that focus on complex causal-mechanistic interactions, e.g., between the environment, the body, genetics, and infectious agents. Yet ontic approaches remain inadequate as a basis for clinical explanations given that such approaches to medical explanations often fail to meet patients' explanatory needs.; I argue in Chapter 4 that clinicians and patients generate medical explanations through collaborative efforts. I utilize Lynn Hankinson Nelson's concept of communities (rather than individuals) as primary epistemic agents. I show how clinicians, patients, and clinician-patient groups shape explanatory requests and responses. This rectifies Thagard's oversight by recognizing how willing and competent patients often take on active and beneficial roles in generating medical explanations.; Rather than rely upon exclusively causal-mechanistic schemas, I argue in Chapter 5 that medical explanations are best understood as erotetic projects (explanations that answer the situated why-questions of the particular patients and clinicians involved). I draw heavily upon Bas van Fraassen's work on pragmatic explanations in The Scientific Image . This model allows the generating of medical explanations to be collaborative projects that account for both clinicians' and patients' interests as shaping medical explanations. Their personal interests shape the why-question asked, as well as the contrast classes and relevance relations (that is, the explanatory concepts that regulate what information appropriately can be considered as part of the medical explanation).; In Chapter 6 I argue for the inclusion of the values of a feminist science (as developed by Helen Longino) as additional pragmatic features that shape medical explanations. This move allows for articulation of the moral-political components of generating and evaluating medical explanations, explanations as projects undertaken to reflect the interests of clinicians and patients. These improvements to medical explanations allow for a wider range of explanatory work, for example, accounting for social determinants of health as explanatory.