INCOMMENSURABILITY - ITS IMPLICATIONS FOR THE PATIENT-PHYSICIAN RELATION

Scientific authority and physician authority are both challenged by Th omas Kuhn's concept of incommensurability. If competing ''paradigms'' or ''world views'' cannot rationally be compared, we have no means to judge the truth of any particular view. However, the notion of local o r partial incommensurability might provide a framework for understandi ng the implications of contemporary philosophy of science for medicine . We distinguish four steps in the process of translating medical scie nce into clinical decisions: the doing of the science, the appropriati on of the scientific findings by the clinician, the transfer of the fi ndings from the clinician to the patient, and the choice of a treatmen t regimen. Incommensurability can play a role in each stage. There is at least some theory- and value-ladenness in science that is dependent on the world view of those who construct the scientific theories. Cli nicians who must use the results of scientific research will inevitabl y interpret the research from the standpoint of their own world view. There may be further incommensurability when these data are communicat ed to the patient. Finally, clinician and patient values must come int o play in any decision about choice of treatment. No stage of medical research or practice is value-free. This position does not imply relat ivism; some scientific accounts are better than others. However, the c hallenge of the incommensurabilists shows that further analysis is nee ded to establish how particular accounts are better or worse.