What do we stand for? The philosophy of chiropractic must internally satisfy the questions of ‘Where are we going?’ and ‘How should we act?’
There is little doubt that the philosophy of chiropractic instills much debate with passionate voices on all sides of the issue. Yet a philosophy of chiropractic can exist that goes beyond the current philosophical premises of vitalism, holism, naturalism, therapeutic conservatism and/or humanism.
A philosophy is needed which can guide an economic and social policy and include embracing the ever-changing evidence from science. Such a philosophy should attempt to accommodate future scientific thinking, be skeptical of findings and be credible and communicable to potential health care consumers. In the quest for public acceptance there is a need for external constituents to be able to grasp what the profession stands for and where the profession is headed. For internal constituents in the profession there is the need to find common ground to promote a growth mindset.
Chiropractic, like all professions entrusted by the public, must internally satisfy the questions of “Where are we going?” and “How should we act?” and “What is true and what is false?” The purpose of this essay is to present an operational philosophy of chiropractic medicine that goes beyond the current philosophical premises noted, denote basic principles and demonstrate an application of these principles.
Policy issues and ‘medicine’
There is the need to embrace a paradigm shift. Instead of thinking in the context of clinical issues and matters of the profession, such a philosophy thinks about policy issues that can impact a nation via social, political and economic policy.
The term “medicine” has already roused much passion among chiropractors. However, the addition of the term “medicine” is used to fully describe chiropractic’s potential as an emerging health care enterprise and offers more clarity along with the concept of competing in the larger health care area. This clarity can be appreciated in that it is not mired with past (and controversial) concepts such as “subluxation” and “innate intelligence” which have failed to propel the profession forward and caused much internal division.
An operational definition of a philosophy of chiropractic can be put forth as a philosophy of a health care profession that embraces the patient as the focal point of care yet can advance itself within the larger health care community and society through health, political, social and economic policy.
New philosophy of chiropractic principles
To establish a new philosophy of chiropractic medicine, principles that form a framework need to be brought forth. The political theorist Russell Kirk (1918-94) established 10 principles to be a “body of sentiments, rather than a system of ideological dogmata.”
These 10 principles can form the necessary framework for philosophy of the chiropractic profession:
- Moral Order Human: This basic principle suggests that nature is a constant, and moral truths are permanent.
- Custom, Convention, and Continuity: This principle is understood to mean that custom enables people to live together peaceably; convention as the contrivance to avoid perpetual disputes about rights and duties and continuity as being the means of linking generation to generation.
- Prescription: Things established by immemorial usage, so that the mind of humans do not run to the contrary.
- Prudence: Public measures ought to be judged by probable long-range consequences, not merely by temporary advantage or popularity.
- Variety: Affection for the proliferating intricacy of long-established social institutions and modes of life.
- Imperfectability: Human nature suffers irremediably from certain grave faults.
- Freedom and Property Linkage: Freedom and property are closely linked.
- Voluntary Community and Involuntary Collectivism: A successful spirit of community is made locally and voluntarily. A distant political direction that is centralized and uninterested can become hostile.
- Prudent Restraints Upon Power and Human Passions: A just government maintains a healthy tension between the claims of authority and the claims of liberty.
- Permanence and Change: The permanence of a society is formed by those enduring interests and convictions that give stability and continuity. Progression is that spirit and that body of talents which urges one toward prudent reform and improvement.
These basic principles can serve as the foundation for a much wider discussion and debate. The following are premises based on these principles to begin the process of advancing the profession:
- Moral Order: Moral truths are consistent, guided by sound ethics, for patient care and professional behavior. These moral truths are supported for people to live in a peaceful society.
- Custom, Convention, and Continuity: A recognition and appreciation of long-standing practices, traditions, and respect for institutions of society are vital for the overall well-being of a nation. At the same time, contriving to avoid perpetual disputes about the rights and duties of the patient and the rights and duties of the clinician. Current state laws regarding matters of chiropractic interest and for society, while subject to the profession and enacted via laws by the citizenry, enables people to live together peaceably through the upholding of law; there exist core aspects of the profession that remain consistent, i.e. spinal manipulation and the profession of chiropractic medicine, with appreciation for the social contract.
- Prescription: There are those in the history of science and medicine who inspire and encourage investigation. The basic tenets of science guide the chiropractic medicine practitioner in order to keep from contrary actions such as pseudoscience. There is respect and regard for a nation’s founders and those who propelled it to greatness, and for a nation’s unique culture and history.
- Prudence: Public health measures and other measures introduced for the good of society and individuals are judged by their probable long-range consequences, not because they are popular or provide a temporary political advantage. Chiropractic medicine seeks to empower individuals and promote basic freedoms.
- Variety: Affection for the established scientific processes that exist; variety in the establishment of innovative methods to deal with neuro-musculoskeletal conditions is encouraged through the scientific method. The chiropractic clinician makes use of additional diagnostic, therapeutic, pharmacologic and rehabilitation modalities to serve a greater population of patients. Chiropractic medicine realizes that society will have all levels of economic classes and that such classifications signify a healthy society.
- Imperfectability: Human nature suffers under its own weight from the psychological to the genetic. Because of this imperfectability, human biological systems break down and need repair, thus negating the philosophy of self-healing without choice. Individual responsibility is the key to effective patient care and not dependent upon the doctor to make a patient into a “new healthy.” This includes acknowledgement that utopia or utopian measures can never come to fruition.
- Freedom and Property Linkage: Chiropractic medicine advocates for personal freedom and individual rights of self-determination of the patient and society as a whole. Chiropractic medicine promotes the ownership of personal property, asset and wealth accumulation and responsibility for that property. It also advocates for the constitutionally guaranteed rights provided by their nation and advocates for property ownership and the individual as consumer. Chiropractic medicine promotes market-based solutions to complex economic issues and incentives for growth of the profession, society and the patient.
- Voluntary Community and Involuntary Collectivism: Chiropractic medicine practitioners advocate for individual human rights, achievement, individual responsibility and the power of individual human potential. Chiropractic medicine advocates for the local community to voluntarily empower itself and opposes collectivism that forces individuals and/or groups to the will of an uninterested and unrepresentative entity.
- Prudent Restraints Upon Power and Human Passions: Chiropractic medicine physicians advocate for prudent restraints on the practice of chiropractic medicine; prudent restraints on what is advertised, practiced and advocated so as human passions do not impede upon progress. Chiropractic medicine advocates for limited government that does not impede upon personal liberty and promotes the rule of law, as no one person is above the law.
- Permanence and Change: Chiropractic medicine embraces the permanence of those things inherent to the operation of health care to ensure stability and continuity; for chiropractic medicine to progress it must acknowledge that change is necessary and healthy.
Chiropractic must stand on principles
Given all the current social, political and economic arguments, there is a need for the profession to stand on principles. The profession needs to continue to discuss and debate principles that can resonate with the general populace that include not just health alone but the social, political and economic life of the patient, profession and nation.
TIMOTHY MIRTZ, DC, PHD, is an associate professor and chair of the Department of Secondary and Physical Education at Bethune-Cookman University in Daytona Beach, Fla. His areas of teaching expertise are biomechanics/kinesiology, adapted physical education, motor learning and development and elementary physical education methods. He also teaches post-graduate continuing education through the Florida Chiropractic Physician Association. He can be reached at firstname.lastname@example.org.