Evidence-Based Medicine: The Thin Ice of Evidence — A Philosophical Anatomy of Medicine Between Law and Life | Ukrainian Medical Journal

Stavytskyi V.V.

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Evidence-Based Medicine: The Thin Ice of Evidence — A Philosophical Anatomy of Medicine Between Law and Life

Evidence-Based Medicine: The Thin Ice of Evidence — A Philosophical Anatomy of Medicine Between Law and Life

August 14, 2026

Stavytskyi V.V.

УДК: 61:001

DOI: 10.32471/umj.1680-3051.279731

Keywords :

axiology,

clinical reasoning,

epistemological pluralism,

evidence-based medicine,

ontology of the patient,

philosophy of medicine,

surgical intuition

Resume

The article provides a philosophical, methodological, ontological, and axiological analysis of the crisis in evidence-based medicine. The author explores the transformation of evidence-based medicine from a noble imperative of integrating scientific data, clinical expertise, and patient values into a bureaucratized administrative standard. An ontological gap between population statistics and the unique life-world of the patient is substantiated. Randomized controlled trials operate with a «statistical phantom,» whereas the clinician works with a «subject of suffering.» From an epistemological standpoint, the limitations of the falsifiability criterion in emergency medicine and surgery are demonstrated, given that each case is unique and the cost of an error is a human life. The necessity of epistemological pluralism is substantiated, recognizing observational studies, pathophysiological modeling, and clinical experience as equal sources of knowledge. Through the lens of embodied cognition philosophy and predictive processing of the brain, the nature of surgical intuition is revealed as automated pattern recognition, forged by practice and solidified at the somatic level. It is shown that replacing the doctor-patient dialogue with a rigid protocol leads to alienation and the development of «defensive medicine.» A model for a future epistemological synthesis is proposed: a transition from biological reductionism to complex holism, where evidence-based medicine serves as a reliable navigational compass rather than an administrative cage. The medicine of tomorrow must rest on three unshakable pillars: scientific evidence, the embodied expertise of the clinician, and the personal values and preferences of the patient.

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