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Knowledge in Interactive Disciplines an Analysis of Knowledge in Education and Health Care

30 In her dissertation Knowledge in interactive disciplines, Anneli Sarvirnaki analyses a central and timely, yet complex and confusing topic of high relevance within nursing as well as education. A philosophical study, the dissertation discusses epistemological issues related to the central question: What kinds of knowledge are inherent in and are needed in interactive disciplines like nursing and education. The dissertation is very thorough and comprehensive. The author does, for the most part, a convincing job of synthesizing highly diverse and, at times, conflicting viewpoints and ideas related to the major topics treated in the dissertation. The dissertation is organized around four major issues: 1) the role of knowledge in interactive disciplines, 2) the kinds of knowledge existing in interactive disciplines, 3) the role of science in these disciplines, and 4) the character of theories in interactive disciplines. These issues are-discussed against an epistemological background (chapter 2) that consists of a useful historical review of philosophical literature related to epistemology, as well as a thematic review of three central concepts in the report (living, acting, knowing). Sarvirnaki argues that action is apriori to knowledge, that the role of knowledge is to guide action, and that knowledge in interactive disciplines consists of value-knowledge, factual knowledge and procedural knowledge. Practical knowledge, the major concept in the dissertation, encompasses all three kinds of knowledge, according to Sarvirnaki. Sarvimaki maintains, furthermore, that the role of science is to articulate and create new knowledge that may guide action. The aim of theories is, ultimately, to be practical, that is to guide action. The author acknowledges that her argumentation is based, in large measure, on the pragmatic tradition (especially Dewey, Lewis and Rescher) (p. 31) and on what she calls »modified constructivism« (p. 50). The major part of the dissertation (chapter 4), delineates the characteristics of practical knowledge. This analysis is based on the author's description of the character of interactive disciplines. In the first part of this chapter, the author argues that nursing and education are "moral forms of lite« (p. 790. This argument is based on ideas developed by Wittgenstein, and the main point being made is that the task of education as well as nursing is to »preserve a life-form that is considered valuable or to improve it, if it is not considered satisfying« (p. 81). This task requires that the individual practitioners as well as the collectives making up the practices take a position on "the question of valuable lite-Iorms« (p. 84). Sarvimaki maintains, furthermore, that "questions about what kind of life is worth living and about how one should live are moral questions(p. 83-84). This argument is an interesting one. However, it gives rise to problems throughout the dissertation, because the author does not discuss explicity, in concrete terms, what nursing and education as moral forms of life entail. Nevertheless, it becomes clear that the author has quite definite ideas about this, as is expressed indirectly, for example, in the following quote: "As a manifestation of a moral life-form the relationship should have an altruistic character(p. 102, my emphasis). However, her argumentation for this view is sketchy and does not convince the reader that this is a necessary and the only possible conclusion. The major part of chapter 4 describes the three components of practical knowledge. The discussion of value-knowledge is closely related to the moral character of interactive disciplines. Value-knowledge is defined as the practitioner (and the collective) having »appropriate« values, that is »actinq appropriately(pp. 118, 120). The problem associated with this discussion is that the author does not discuss on what basis valueknowledge can be judged as knowledge versus ignorance. As a matter of fact, she explicitly refuses to discuss sources of truth criteria related to value-knowledge (p. 52-53). Later in the report, however, Sarvirnaki nevertheless contrasts value-knowledge with value-ignorance and argues that practitioners who exhibit value-knowledge act in terms of "an altruistic, caring relationship, in trying to help another person to health and wellbeing, in respecting the feelings, needs and wishes of the other, in standing up for the oppressed, in respecting the dignity and rights of the other etc.« (p. 162). In her discussion of factual knowledge, Sarvirnaki does provide some discussion of truth criteria, whereas this topic again is not dealt with in relation to abilities. On the whole, the treatment of the question of acceptance of knowledge as knowledge is not adequately treated in the dissertation, despite the central place of this issue in a study proposing an alternative espistemology for interactive disciplines. The author asserts that practical knowledge is the necessary basis upon which practitioners in interactive disciplines ought to practice. Then, an adequate discussion of