The chapter delves into the question of whether medicine is a science, examining arguments that suggest medicine is not a science due to differing aims, progress criteria, and moral commitments (as proposed by Munson 1981; Pellegrino 1998; Miller and Miller 2014). The chapter counters these arguments by challenging assumptions about science’s aims. Rather than simply increasing knowledge, the chapter defends the "Understanding Thesis" (informed by debates in epistemology and philosophy of science with reference to authors such as Kitcher 2001; 2008; 2011; Kvanvig 2003; Bird 2007; 2019a; 2019b; Douglas 2009; Pritchard 2010; Grimm 2014; Potochnik 2017), which holds that science’s aim is understanding, making the world more transparent. This aim is inherently practical, driven by our interest in manipulating the environment and bolstering our agency, thus making scientific inquiry responsive to promoting human agency and autonomy. As such, science, like medicine, is a moral enterprise, and there is no significant difference in terms of aims, progress criteria, or moral commitments that would disqualify medicine from being considered a science. It concludes by discussing the implications of this for scientists’ responsibilities.

The chapter, informed by the Systematicity and Understanding Theses, discusses how understanding in medicine bolsters human agency. Rejecting the initial pathocentric proposal of medicine’s aim (Pellegrino 2001; McAndrew 2019; Hershenov 2020), it advocates the Autonomy Thesis that argues medicine’s goal is not merely treating disease, but promoting health to enhance autonomy (Christman 2009). It adopts a "positive" notion of health that is more than disease absence (Venkatapuram 2013; Nordenfelt 2017) and establishes its relation with well-being and autonomy. The chapter introduces a pluralistic view of health concept difficulties through the lens of "conceptual engineering" and refutes criticisms suggesting the Autonomy Thesis’s permissiveness. The investigation is confined to "mainstream medicine" (Broadbent 2019, ch. 1) and considers the internal morality of medicine (Brody and Miller 1998; Pellegrino 2001). It strives to define a broad yet rigorous aim of medicine that applies to various branches.

The chapter is dedicated to critically engaging contemporary accounts. It explores views from Pellegrino (2001), Broadbent (2019), and four "list approaches" (Callahan et al. 1996; Brody and Miller 1998; Brülde 2001; Boorse 2016). This is a rather considerable amount of material to delve into in a single chapter, but the aim of the reconstruction is not to do justice to all the details of these accounts; rather it is to focus on examining to what extent they are able to overcome or bypass the challenges faced in Chapter 6 when working towards the final iteration of the Autonomy Thesis. Subjecting these competing views to critical scrutiny is not merely an essentially adversarial procedure, but also a means to assist in framing the proposal presented in the chapter. By inspecting the most relevant aspects of these accounts in light of the challenges considered in Chapter 6, the chapter also provides further reinforcement for the Autonomy Thesis by considering paths that our inquiry chose not to take.

Serving as the conclusion of the book, this chapter encapsulates the critical discussions and key points articulated throughout. Reflecting briefly on Roy Porter’s seminal work, “The Greatest Benefit to Mankind,” it emphasizes that, although the book presents substantial conclusions and potential solutions, it does not purport to have offered a full picture. Instead, it posits that a promising direction for further research has been established. The chapter acknowledges the significance of philosophical inquiry into medicine while also cautioning against ignoring the inherent limitations of such work. It concludes with the hope that this book will act as a catalyst for ongoing interdisciplinary research at the intersection of philosophy and medicine.

Serving as an introduction to the book, this chapter starts out with some reflections on how confrontation with disease is a universal human experience that has shaped healing practices throughout history. The introduction briefly illustrates that with the rise of scientific medicine in the nineteenth century, the landscape of these practices underwent significant changes, setting the stage for the twin phenomena of medical socialization and medicalization of social life. These transformative processes, along with medicine’s numerous advances and limitations, are explored in more detail in the ensuing chapters. This introductory chapter not only provides a historical context and presents key issues to be addressed, but it also lays out the goals and structure of the entire book.

The chapter delves into the specific kind of understanding aimed at in medicine, starting from the Understanding Thesis. Drawing on recent work by Broadbent (2019), debates in the epistemology of understanding (Kvanvig 2009; Grimm 2012; Khalifa 2017), and scholarship on the aims of inquiry, the chapter unpacks what it means to understand something, differentiating types of understanding, and using the history of scurvy to explore understanding a disease in medicine. The hypothesis is that biomedical understanding of a disease requires grasping a mechanistic explanation of the disease. This understanding of causal and constitutive relationships draws on an influential account of causation (Woodward 2003; 2010; 2015) and work on mechanistic explanations in biological sciences and neuroscience (Thagard 2003; 2005; Craver 2007; Nervi 2010; Kaplan and Craver 2011; Darrason 2018). However, it argues that biomedical understanding is necessary but not sufficient for clinical understanding, which combines biomedical understanding of a disease with personal understanding of an illness. This chapter revisits the distinction between "understanding" and "explanation" from debates in the field.

This chapter takes on the nature of scientific activity, particularly in medicine, setting out to defend the "Systematicity Thesis," which posits that medicine, like science, is systematic inquiry. Referencing literature on the demarcation issue in philosophy of science, it maintains that despite the failure of established approaches, the issue should not be abandoned. Science, it suggests, is a family resemblance concept unified not by an intrinsic property but by a relational property that allows gradational differences from nonscientific pursuits. Using Hoyningen-Huene’s (2013) account of systematicity as a necessary criterion for science, the chapter shows that both medical science and clinical medicine meet this criterion. In a critical dialogue with Oreskes (2019), the thesis is applied and tested, demonstrating that homeopathy lacks the systematicity present in scientific pursuits, making it vulnerable to biases. It also underscores that systematicity fosters reasoning and inquiry that yield reliable knowledge and understanding.

The chapter begins by probing skeptical criticism, with key contributors like Stegenga (2018) questioning our unwavering trust in contemporary medicine. Next, it delves into the criticism of overmedicalization (see Moynihan and Cassels 2005; Conrad 2007; Le Fanu 2012; Parens 2013), viewed as an inappropriate use of medical resources for sociopolitical issues. The chapter also investigates the criticism of objectification related to the quality of care, drawing from thinkers like Cassell (2004), Haque and Waytz (2012), and Topol (2019). Rounding out the chapter, utilizing insights from Popper (2000) and Haslanger (2018), it identifies these criticisms as both social and internal to the practice of medicine. It concludes that medicine is falling short of its own standards, thereby posing fundamental questions about its nature and purpose to be explored in the succeeding chapters.

The chapter defends a particular philosophical engagement with medicine (i.e., normative philosophy of medicine) that is directly connected to the problem of determining the nature of philosophical inquiry. It starts with the discontinuity view, notably advocated by Pellegrino (1986; 2001), suggesting philosophy and science are discrete. Two primary arguments support the discontinuity view: science is empirical while philosophy is conceptual (Dummett 2010), and science is descriptive while philosophy is normative (Thomasson 2015; 2017). The chapter critically examines and ultimately rejects these claims, introducing the continuity view as an alternative, positing a close relationship between philosophical inquiry and science. Building on the works of Sober (2008), Kaiser (2019), and Kitcher (2011), a normative philosophy of science approach is proposed, distinguishing three levels of analysis (aims, nature, and key concepts), which mirror the types of questions posed by modern medical challenges. The chapter concludes by endorsing philosophy of medicine as a legitimate subdiscipline of philosophy of science, and arguing for the comprehensive value of this approach over conventional perspectives.

The chapter revisits the criticisms and challenges presented at the book’s outset. It highlights how the book’s central theses - the Systematicity, Understanding, and Autonomy Theses - help resolve issues related to skepticism, overmedicalization, and objectification in medicine. The chapter argues that a moderate position, supported by these theses, provides better understanding of these challenges and suggests potential solutions. The criticisms of skepticism are countered by increased systematicity in knowledge-seeking. Concerns of overmedicalization are tackled through the Autonomy Thesis, which argues that medicalization is justifiable if a condition is harmful and adequately understood by medicine. Objectification, as examined through the Autonomy Thesis, can impede medicine’s aim by undermining personal understanding. The chapter emphasizes the necessity of counteracting the potential decrease in personal understanding caused by standardization and technological advances.