Medical ethics, clinical judgment, and cognitive science: a critique of Wright’s Means, Ends, and Medical Care

Abstract

What do medical ethics, clinical judgment, and cognitive science have in common? Well, according to Gary Wright in his recent book, Means, Ends and Medical Care, second-generation cognitive science has shown that both medical ethics and clinical judgment find personal narrative and metaphorical thinking more helpful than abstract moral rules or prescribed medical protocols. Wright’s book will be particularly useful to physicians, health care administrators, and medical school educators because Wright is a physician with 30 years of experience who has also studied philosophy and cognitive science at the graduate level under the direction of Mark Johnson, one of the leading philosophers of cognitive science today. Wright’s discussion is grounded in the recent discoveries by second-generation cognitive science showing that most abstract thinking is based on metaphor, whose source domain is the human body, and in particular our sensorimotor systems. For example, the metaphorical notions that disease is imbalance and health is maintaining balance arise from the physical fact that we embodied beings can literally lose our balance, become disoriented, and actually fall down. Wright discusses seven metaphorical representations of disease: ‘‘(1) Disease Is Mechanical Breakdown (2) Disease Is The Abnormal, (3) Disease Is Disintegration (of the whole), (4) the related Disease Is Disorder, (5) Disease Is Imbalance, (6) Disease Is Loss Of A Vital Fluid and (7) Disease Is Being Under Attack’’ (p. 43). He notes that some of these metaphors are used in professional conceptualization and discourse, such as ‘‘Disease Is Disorder,’’ whereas others, like ‘‘Disease Is Being Under Attack,’’ are more prominent in the conversations and thinking of patients and the general public. The important point here is that everyone,