Medical Causation and Realism

Causation and realism are two important notions that are essential for understanding any worldview, especially medical worldviews. The notion of causation refers to the act of bringing about or producing an effect (Horner and Westacott, 2000). In other words, causes are responsible for the fabrication or creation of events and entities within a given world. Causation is based on the principle that natural phenomena may have sources other than themselves, i.e. they need not be necessarily self-originating or self-generating. The notion of causation has had a tumultuous history in philosophical thought, especially with Hume’s accusation that there is no necessary connection between cause and effect. Be that as it may, causation still plays an important role in almost any medical worldview with respect to knowledge and practice. Physicians and patients are both interested in the causes of diseases and poor health, as well as good health and wellbeing. Identifying a disease’s cause is the first step often towards the possibility of treating a patient’s diseased state or illness.

Realism, as a metaphysical notion, has also been vigorously contested during the history of western philosophy (Horner and Westacott, 2000). Today it pertains to the belief that there are real objects, especially at the level of the unobservable, which exist independent of the mind. In other words, reality is not reducible to a universal mind. Contemporary realism is a reaction to Kant’s transcendental idealism, which claims that we cannot know reality in and of itself apart from our cognitive capacities, and to Hegel’s absolute idealism, which asserts that mind is the supreme source for all knowledge and understanding. Although there are a variety of realistic positions, they are broadly divided into direct and indirect realism.1 The different forms of realism share a fundamental belief in the existence of objects that exhibit mind-independent properties or qualities.