Does medicine need a base?: A critique of modest foundationalism

But the scientific spirit requires a man to be at all times ready to dump his whole cartload of beliefs, the moment experience is against them. The desire to learn forbids him to be perfectly cocksure that he knows already. Besides, positive science can only rest on experience; and experience can never result in absolute certainty, exactitude, necessity or universality. It is an honour and privilege to provide a commentary on Miles Little’s thoughtful and provocative chapter (Chapter 14). In this chapter I will try to make amends for confusion created in some of my previous work that Little criticises. To that end I will clarify some of the terms that I have used in previous essays, particularly ‘emergent’. I will, however, stand by my critique of foundationalism, rooted in either values or evidence. I will argue that it may be best to dispense with the concern for foundations entirely as unproductive and misleading. I will defend a version of fallibilism as most relevant to our understanding of evidence and values in medicine. After this, I will invert Little’s FAP model and argue that what he has termed F-values are neither pre-normative nor foundational, but rather serve as regulative ideals. I will argue that there is nothing axiomatic about the A-values and that the P-values are where most of what is relevant to medicine transpires. In my chapter I will acknowledge sincere intellectual debts to Charles Taylor, Hilary Putnam and Peter Galison, though the animating spirit is largely Peircean.