Abstract

This thesis applies approaches from the history and philosophy of science to explore the decision-making of contemporary physicians in a common clinical scenario: the treatment of patients with acute stroke. Acute stroke decision-making during the period 1960 to 2014 therefore serves as a case study to address broader questions about how doctors make decisions. I argue that acute stroke decision-making is dependent upon a historically-determined concept of the acute stroke, in that the contemporary meaning of the disease “acute stroke” was established in response to the efficacy of the drug tissue plasminogen activator as its treatment. Moreover, I propose that treatment decisions about the use of tPA for acute stroke involve simultaneous and inter-related processes of epistemic and ethical evaluation. Acute stroke decision-making can therefore be conceived as a medical, epistemic and ethical process, occurring within a historical context. This interpretation of acute stroke decision-making argues for the necessary role of the humanities — and especially of the history and philosophy of science — in the study of modern medical practice.