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[Response] Indian Journal of Medical Ethics Vol 8.No.4
Devadasan, Roopa
Devadasan, Roopa
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n194cs251.pdf
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"A positivist approach emphasises “facts” as perceived by the five senses as the basis of empirical evidence. When these facts are shared by a community of “objective observers”, the common ground becomes the basis of “truth” or “real” knowledge. In fact, the positivists would say this is the only truth, proven and set in stone. Interpretation does not play a role here, as the shared observation is considered to be true (1). However, this knowledge is still from a particular point of view, however closely shared. Western science, in its claim to be objective, separated the observer from the observed and was willy-nilly given pride of place in the hierarchy of knowledge. Medicine, claiming to be a science, needed to be free of “subjective values” (1). This is one limb of a doctor’s training; the attitude imbibed from it has repercussions which we shall see as we proceed. While positivism has its strengths, it appears that its methods cannot be applied to all knowledge. In the biomedical arena, the fact remains that, given clinical data, “normality” needs framing in the context of function and the individual. I remember the classic reflection of this in the popular “road to health” charts of the 1970s, where thousands of mothers, including myself, agonised that their babies were not achieving the desired weight for age (2). It took a while to set a norm for Indian babies, and I was left wondering if the norm for tribal babies was not different (given the specificity of the genetic pool). Second, and more important, for the doctor, “illness” is itself both a pathological and social construct. I have seen tribal women with sickle cell anaemia and a haemoglobin count of 6 grams carrying firewood home without complaints of feeling “unwell”"
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2011-10
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With permission of the license/copyright holder