Medical Prescriptions as Normative Statements
by Glen Wallace
Are medical prescriptions categorized as a normative or positive statements? Positive statements are ones describing a state of affairs now or in the future that has some way to test for veracity. Normative statements, on the other hand, present untestable value judgements about how things should or ought to be.
In a doctors office a prescription would typically be given after the physician makes some a posteriori conclusions about the patients empirical presentation, the signs and symptoms the patient is having. The physician at that time would then be taking either written or mental notes about the patients condition that still would be categorized as positive statements (rather than normative). While the doctor is still in the positive stage of reasoning she is still acting within the realm of her primarily scientific medical school training. But at some point the physician transitions over to formulating in her mind what should be done for the patient in the form of writing a prescription. It is at that point that I believe the MD has transitioned categorically over to a more philosophical area that she may not have received the best training in a schooling that focuses primarily in the purely descriptive, empirical, scientific realm. Medical school focuses primarily on how things are, not on deliberating on figuring out how things ought to be. But in writing a prescription, a doctor is doing just that — saying how things ought to be.
When a pre-scription is written, the doctor is writing (scribing) something that has not yet occurred (the ‘pre’ part)–taking some medicine. What is the doctor doing then? Is she making a prediction about what will occur in the future or is she stating what the patient ought to do — take ‘X’ medicine for so many days? I believe it is the latter. Given that the doctor is writing a prescription as a statement of how some future events, the patient taking some medicine, is better, or more ideal than some other future state of affairs, than the patient not taking some medicine, a prescription, then would correctly be categorized as a normative statement.
The difficulty that arises at this point is the ambiguity of not knowing what to do in cases of an apparent wash. Such a scenario occurs when given a certain diagnosis there are two possible treatment routes: One is the mainstream treatment that is well justified as being rather ineffective, has lots of bad side effects and is very expensive and the other route is an alternative treatment that is moderately justified as being very effective, with few if any side effects and is very affordable. There is no scientific way to determine what route a patient ought to take there. Rather, the values of the patient become paramount in determining the best course of action. However, a confusion persists whereby the common understanding is that a prescription is a statement that has the epistemological foundation supported by the scientific principle of testability.