The invisible thread: Intuition in medical and moral reasoning

Ariadne's thread in the myth of Theseus and the Minotaur is symbolic for the intuitive element of human cognition. Its mythic depth alludes to the animal and corporeal basis of human thought. The question of intuition is important in discussions about the nature of scientific reasoning, and the nature of being human. This dissertation analyzes the "invisible thread" of intuition in the medical context.;Medicine as neither art nor science but a mixture of both crystallizing around individuals is a pre-eminent field for investigation into the nature of practical reasoning. Intuition provides the prism through which this study reflects on the individual particular within professional structures of medical reasoning. Broadly speaking, intuition refers to a pre-conceptual element of human cognition. It also has specific meanings within particular epistemological traditions. Within philosophy it refers to direct certainty attained through sensible perception, and within medicine it pertains to cognitive processes cognition associated with practical reasoning. Clinical intuition provides an empathetic means for physicians to visualize the inner essence of individual patients, taking account of the continual flux of temporal physiological changes. However, because of the uncertainty and vagueness surrounding intuition, its use is controversial. Rather than defining and using a single concept of intuition, this study analyzes intuition as it occurs in different contexts of clinical reasoning. This emphasis on intuition provides a means for this study to investigate epistemological, ontological, and ethical issues in relation to clinical reasoning.;While the approach taken here is fundamentally interdisciplinary, this investigation may be conceived as a project in philosophical anthropology that is ever mindful of the importance for clinical reasoning of a moral image. Aristotle's insight in the Nicomachean Ethics that practical reasoning requires a form of proof sufficient for its context, not necessarily mathematical, informs every level of this analysis. By focusing on tacit elements of clinical reasoning, this approach challenges a positivist notion of medical science, and provides a critique of rationalism that is not necessarily irrational. By developing a theory of clinical reasoning that draws on personal phenomenologically lived clinical experience; this analysis is intended to overcome the chasm between philosophical theory and clinical practice.