Means, Ends and Medical Care [Hardcover]

In this remarkable book, Gary Wright focuses thirty years experience as a family physician, and his Ph.D. in philosophy, to address the nature of good medical reasoning. Wright folds cognitive science into a pragmatist framework developed by John Dewey; this alternative view of mind and medical judgment leads to a model of reasoning that offers realistic guidance for medical decisions, one that each of us would want our own physicians to adopt.

In this remarkable book, Gary Wright brings his thirty years of experience as a physician in pediatric and family medicine together with his Ph.D. in philosophy to address the important problem of the nature of good medical reasoning. His intimate experiential knowledge of the founding assumptions of managed health care in America today is abundantly evident in his powerful critique of the overly simplistic models of medical judgment that ground most of our health programs. Writing with exceptional clarity, heart-felt compassion for the physical and emotional suffering of patients, and deep philosophical insight into the nature of human cognition, Wright uses the conceptual tools of recent cognitive science to analyze and critique some of the most basic underlying conceptions of contemporary medical care. To make it clear why we desperately need a richer, more nuanced account of medical reasoning, Wright gives a brilliant analysis of the complex internal structure of our concepts of health and disease, showing that our present models are wholly incapable of dealing with the realities of actual human disease. He then shows the error of assuming that we always know in advance what the medical and moral ends are for any medical situation. This leads to a radical questioning of so-called rational actor or economic models of rationality that are popular in medicine today.

However, Wrights project is not merely critical. More constructively, he draws extensively on empirical reseală•