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Abstract
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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