Групповые убеждения в отношении страдания: казус экспертного выбора препарата от меланомы

Abstract

This article deals with pragmatic coexistence of several competing ontologies of the body and possibility of their reconstruction through epistemic phenomena, including group beliefs. In this regard, the research problem is the possibility of supplementing pragmatic consideration of forms of ontological coordination by the epistemological account of group reasoning in biomedicine. Decision making in the field ontological politics is considered to correspond to stabilizing the scientific fact in the epistemic field. Methods of social epistemology are used for reconstructing of this process. Forms of ontological coordination in this context does not appear as communication between different practices and points of view, but as a result of simultaneous coexistence of plural ontologies in the process of justifying a collective decision. Preparation of the guideline by the expert group of the British health regulator NICE is taken as case of such coexistence. NICE guideline contains recommendations for the administration of the drug ipilimumab to patients with metastatic melanoma for "default" use. These recommendations seem to go beyond the methodology of evidence-based medicine, based on its own ontology of bodily suffering. The search for other grounds for expert choice indicates two types of collective epistemic phenomena: group beliefs and group acceptances. Group beliefs have an epistemic basis and can be examined in the field of social epistemology. Group acceptances seem to be opaque for epistemology, and can be analyzed only through the social conditions of their formation. Thus, several dimensions of the epistemic reasoning of group decision are highlighted: 1) explicit knowledge, 2) group beliefs and 3) group acceptances.