The Genome on the Horizon: Practical Reasoning in the Age of Personalized Medicine

Abstract

The vision for personalized medicine is rooted in the hope that omics-based laboratory technologies will be used to tailor medical care to the individual needs of patients, including by providing patients with direct access to information about their genome. In order for this vision to bring about positive change in healthcare, it requires a more robust account of the way scientific knowledge can be applied to the circumstances of individual patients. This dissertation is intended to provide such an account, with a particular focus on explaining how personalized medicine might be incorporated along with other science-based traditions in clinical decision-making. Building on the pragmatist perspective of Jeffrey Stout, and the practical philosophy of Alasdair MacIntyre and Hans Georg Gadamer, I develop a hermeneutic account of clinical practical reasoning that demonstrates how healthcare providers are able to draw on a range of traditions when developing a clinical course of action. This effort to synthesize different sources of knowledge, however, highlights that healthcare providers must continue to play an important role in health and wellness, despite the personalized medicine vision for "empowered" patients to take independent responsibility for applying omics-based results to their health.