Palliating uncertainty: tools from the pragmatism of William James, MD

Thesis

William Osler, the father of modern medicine, said, “Medicine is a science of uncertainty…” In palliative (end-of-life) care, uncertainty extends through biological, psychological, sociological, and spiritual domains and is felt by patients, caregivers, and healthcare providers. Yet, in the experience of many, uncertainty remains inadequately addressed. Traditional responses to uncertainty often involve overtreatment, over-investigation, and overmedicalization, and these approaches to uncertainty result in much suffering. This dissertation proposes an approach that I call “Palliating Uncertainty.” I draw on William James’ pragmatism to reframe uncertainty not always as a problem to be solved with more knowledge and technology, but as an experience to be palliated.

James, a nineteenth-century physician and philosopher, developed pragmatism as a philosophy of action rather than absolute truth. I engage with his pragmatism as an “attitude of orientation” that shifts attention away from futile quests for certainty and towards meaningful action. The goals of Palliating Uncertainty are to alleviate the suffering caused by uncertainty and enable individuals to live—and even flourish—amidst uncertainty.

Part I: Managing Expectations About Uncertainty examines taxonomies of medical uncertainty, critiques the assumption that more knowledge cures uncertainty, situates James’ pragmatism within his struggles with the uncertainty of illness, and constructs the approach of Palliating Uncertainty by uniting pragmatism with the ethos of palliative care. Part II: Turning Attention to Action develops this approach in the context of five cases of uncertainty in end-of-life care. Part III: Living with Uncertainty draws on spiritual/religious notions of mystery and relationality in James’ work to connect three key themes that run throughout this dissertation: acknowledging uncertainty, taking action, and seeking support in relationships. The conclusion emphasizes the holding of uncertainty together in community and suggests uncertainty is solved (or, rather, “salved”) in the act of living. I close with some practical steps forward for integrating the approach of Palliating Uncertainty into practice.

Authors: Dempsey, A

• DOI: 10.5287/ora-b7e6jxmok
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: medical uncertainty; pragmatism; decision making; palliative care; palliating uncertainty; end-of-life care; uncertainty in medicine; mystery; mysticism; William James; uncertainty; spirituality; religion
• Subjects: Medicine; Decision making; Religion and science; Philosophy; Uncertainty--Religious aspects--Christianity; Spirituality; Mystery; Uncertainty; Theology, Practical; Palliative treatment; Pragmatism; Clinical medicine; Theology; Terminal care