|Amoretti and Lalumera|
As philosophers, one of our interests is the interplay of facts and values in medical sciences. We think that debunking the myth of science as purely factual is a contribution that philosophers can usefully bring to society. We also think that science can be nevertheless objective and trustworthy, but not in virtue of being purely factual – as many philosophers have argued recently. In a recent paper, we focused on mortality statistics during the pandemic.
This definition underpins a mechanistic conception of causality. However, the guiding principle that should inform the selection of one single underlying cause is explicitly the possibility of prevention of deaths to the benefit of public health (WHO 2018, 2.19.2). Thus, we argued, a prudential or normative principle is used to select from among the causes pertinent to someone’s death. We also noted that the same prudential principle figures in the rules for certifying deaths due to HIV-AIDS, for analogous public health reasons, namely, to prevent the highest number of deaths.
In conclusion, a statement on a death certificate, identifying COVID-19 as the underlying cause of death, may be considered a non-purely descriptive predicate, as grounded on both factual (causal chains and the patient’s medical conditions before and at the time of death) and non-factual reasons (the importance of prevention of more deaths). We think that many arguments can be brought to defend such non-factual reasons. However, it is important to disentangle them from facts. Whereas facts can only be described, reasons can be argued for.