循证医学中的工具理性主义导向及其困境

Direction of Instrumental Rationalism in Evidence-based Medicine and Its Dilemma

诞生于20世纪90年代的循证医学深藏着工具理性主义的导向,其特征是工具理性过度膨胀价值理性相对缺失,实质合理性与形式合理性二者不平衡发展。因此,循证医学面临一些方法论难题:一是忽略了证据本身的差异性和不可通约性,不能实现对不同来源的证据的评价、评级和整合;二是把技术的规范性和程序性推到了过高的位置,而忽略了医学本身的复杂性和医疗体验的重要性。工具理性主义主导下的循证医学预设了一种机械观的世界图景,这实际上形成了某种绝对主义和技术至上,导致了某种"循证霸权"和"循证僵化",减少甚至杜绝了哲学反思和人文情怀进入诊疗过程的契机,造成了循证医学发展的现实困境。

Evidence-based medicine,which was born in the 1990 s,is under the direction of Instrumental Rationalism which means both excessive expansion of instrumental rationality and lack of value rationality,and both unbalanced development of substantive rationality and formal rationality.Therefore,there are two methodological difficulties that evidence-based medicine face.Firstly,it ignores the difference and incommensurability of the evidence,and fails to evaluate,rate and integrate the evidence from different sources.Secondly,it pushes the normative and procedural nature of technology to a high position so that both the complexity of medicine and the importance of medical experience are ignored.Based on the fact that mechanical view has been dominated by the instrumental rationalism of evidence-based medicine,some absolute and technological supremacy is actually formed in the medical field,which has led to some kind of"evidence-based hegemony"and"evidence-based rigid"and reduced or even eliminated the philosophical reflection and humanity into the diagnosis and treatment process.All of this has caused the practical dilemma of evidence-based medicine.