Causality in the Philosophy of Medicine and of Epidemiology

Abstract

Epistemological analysis of the health sciences practices has recently become more present in the philosophical debate over the last decades, and it is crucial in the dramatic context of the pandemic in which we currently live. Contributing to this analysis, this article presents an introduction to the themes approached in philosophy of medicine and in philosophy of epidemiology, especially the exam of the role of causality, which is of fundamental importance for the understanding of the relation between health and disease. The notion of INUS cause, proposed by the philosopher J. L. Mackie and adapted to epidemiology by Kenneth Rothman, allows the precise depiction of the multicausal interactions that co-operate to the alteration of a state of health. However, Rothman's model does not encompass important concepts of epidemiology. This is an imprecision that I aim to mend by proposing a temporal representation of the multicausal set that, among other things, allows for the planning of accurate interventions, focusing on preventing the installation of a disease. The delimitation of the causal set is also called into question, since the multicausal perspective does not intrinsically delimit any criterion on where to finalize the selection of causal factors. I point to manipulability as the health sciences' characteristic approach to the selection of factors in which to intervene, and that the recognition of this perspective is important for the philosophical understanding of causality itself.