Evidence-based or person-centered? An ontological debate

Abstract

Evidence-based medicine (EBM) continues to be vigorously debated and person-centered healthcare (PCH) has been proposed as an improvement. But is PCH offered as a supplement to or as a replacement of EBM? Prima facie PCH only concerns the practice of medicine, while the contended features of EBM also include specific methods and the biomedical model. In this paper I argue that there are good philosophical reasons to see PCH as a radical alternative to the existing medical paradigm of EBM, since the two seem committed to conflicting ontologies. I will aim to make explicit some of the most fundamental assumptions that motivate EBM and PCH in order to show that the choice between them ultimately comes down to ontological preference. While EBM has a solid foundation in positivism, or what I here call Humeanism, PCH is more consistent with causal dispositionalism. I conclude that if there is a paradigmatic revolution on the way in medicine, it is first of all one of ontology.