Thesis ID: CBB985451535

Measuring "Well": Clinical Measuring Practices and Philosophy of Measurement (2023)


This dissertation examines three successful, patient-centric measuring practices in the Anglo-American clinical context, spanning from the early 19th century to today: (1) the use of “drops” as a fluid unit in medicine and pharmacy, (2) the measurement of cervical dilation by hand (digital cervimetry) for labor assessment, and (3) the Apgar Score for newborn health assessment. I also briefly introduce a discussion of (4) the Patient Generated Index (PGI) and the Schedule for Evaluation of Individualized Quality of Life (SEIQoL) for measuring patient status and outcomes. All four practices were developed to ensure preferable patient outcomes, at the expense of precisely representing empirical states. A better understanding of the “non-standard” clinical measuring practices of the 19th and 20th centuries shows that the ethical-epistemic challenge of having both “patient-centric” and “evidence-based” measurement has a much longer history than the recent emergence of these terms would suggest. I discuss the ethical and epistemic challenges which had to be overcome when validating these measures, and consider how the successful (and failed) endeavors of past practitioners can inform methodological issues faced in the formation of clinical indexes today. I introduce the notion of “epistemic audiences,” and argue that units (and accompanying scales) of measurement serve as “epistemic conduits” for these audiences, transforming observations into difference-making data toward relevant judgments and/or actions. By examining the ways that these non-standard measuring practices challenge dominant theoretical frameworks in philosophy of measurement, I form recommendations for how we can improve philosophy of measurement to better account for the historical success of these practices: (1) the scope of philosophy of measurement should expand to encompass entire measuring practices; (2) measurement success should be understood “ecologically,” as being fit within a “niche” of pragmatic, physical, and temporal constraints and demands; and (3) the “problem of coordination” should be extended to include the relevant set of judgments (the landscape of decision-making at hand), in order to move towards a clinically relevant philosophy of measurement.

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Authors & Contributors
Sartori, Sergio
Chaudhry, Humayun J.
Depew, David J.
Dupree, Marguerite Wright
Hurwitz, Brian
Jasen, Patricia
Canadian Bulletin of Medical History/Bulletin Canadienne d'Histoire de la Medecine
Notes and Records: The Royal Society Journal of the History of Science
Science and Education
Science as Culture
Science, Technology, and Human Values
Social Studies of Science
Oxford University Press
Pavia University Press
Massachusetts Institute of Technology, MIT
McGill University
Ashgate Publishing
Lexington Books
Metric system
Measuring instruments
Down, John Langdon Haydon
Dumont d'Urville, Jules Sébastien Cézar
Lister, Joseph, Baron
Ross, James Clark
Wilkes, Charles
Time Periods
21st century
20th century
19th century
18th century
Great Britain
United States
Royal College of Surgeons, London
Royal Society of London
National Institute of Mental Health (U.S.)
International Bureau of Weights and Measures
Convention du mètre (1875)

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