Causal dispositionalism and evidence based healthcare

Abstract

In this chapter, physiotherapist Roger Kerry explores the relationship between the principles of causal dispositionalism, presented in the first part of this book, and the practice of evidence based healthcare (EBHC) (previously evidence based medicine). EBHC is structured around a framework which, although alluding to the integration of multiple sources of evidence, firmly prioritises data from well-controlled population studies in both clinical and policy decision making, as we saw in Part I. In doing so, EBHC deemphasises the role of ‘lower quality’ information sources, such as observational studies, laboratory studies, clinical experience, etc. The rationale for such prioritisation lies in the way that the evidence based framework conceptualises causation. By examining the EBHC evidence hierarchy, a clear neo-Humean notion of causation is evident at the heart of EBHC. In the CauseHealth project, neo-Humeanism is seen as problematic for clinical practice and dispositionalism offers a causal theory which takes real-world complexity and context-sensitivity as its starting point. Can a new practice framework be offered which is based on evidence, yet underpinned by a dispositional ontology? If so, how would this look?.