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Inclusion of Philosophy of Chiropractic in Educational Program Outcomes

 Policy Statement of the Foundation for Vertebral Subluxation Research


Philosophy can be divided into five branches which address the following questions:


Metaphysics: Study of Existence. What's out there?

Epistemology: Study of Knowledge. How do I know about it?

Ethics: Study of Action. What should I do?

Politics: Study of Force. What actions are permissible?

Esthetics: Study of Art. What can life be like?


There is a hierarchical relationship between these branches. At the root is Metaphysics, the study of existence and the nature of existence. Closely related is Epistemology, the study of knowledge and how we know about reality and existence. Dependent on Epistemology is Ethics, the study of how man should act. Ethics is dependent on Epistemology because it is impossible to make choices without knowledge. A subset of Ethics is Politics: the study of how men should interact in a proper society and what constitutes proper. Esthetics, the study of art and sense of life is slightly separate, but depends on Metaphysics, Epistemology, and Ethics. i


CCE International Standards


Of particular interest are epistemology, which relates to evidence and clinical decision making, and ethics.  The Councils on Chiropractic Education International INTERNATIONAL CHIROPRACTIC ACCREDITATION STANDARDS ii provide, inter alia:


2.3 The program must comply with generally accepted standards of professional ethics…


Ethics is a branch of philosophy (supra). 


Furthermore, Section 3.1.3 lists the following among the required competencies for a chiropractic graduate:


3.1.3 [A]ppreciates chiropractic history and the unique paradigm of chiropractic health care…


The “unique paradigm of chiropractic care” has been articulated by the Association of Chiropractic Colleges (ACC), and accepted by major chiropractic organizations, including:


• The Council on Chiropractic Education

• The International Chiropractor's Association

• The American Chiropractic Association

• The World Federation of Chiropractic

• The Congress of Chiropractic State Associations

• The Association of Chiropractic Colleges

• The Federation of Chiropractic Licensing Boards

• National Board of Chiropractic Examiners

• The National Association of Chiropractic Attorneys

• The Council on Chiropractic Practice


The ACC Paradigm states the following concerning the subluxation:


Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.

A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.

A subluxation is evaluated, diagnosed and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.”  iii

The role of epistemology, a major branch of philosophy, addresses the study of knowledge, and is at the heart of evidence-based practice.  The CCE International Standard 3.2.4 requires a knowledge of epistemology and the rules of evidence, as it requires the chiropractic graduate “acquires the ability critically to appraise scientific and clinical knowledge…”  iv


CCE-USA Standards


The U.S. Council on Chiropractic Education’s Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status[v]require that the curriculum include “clinical decision making,” and “professional practice ethics”  (p. 18), and that the student must demonstrate an ability to “ recognize the professional and ethical boundaries expected of the doctor/patient relationship” (p. 30).  Furthermore, the student must “exhibit reasoning and understanding in using sources (such as the available literature and clinical experience) to support the diagnosis” (p. 36), and must “be aware of the ethical standards expected of a doctor of chiropractic” (p. 48).


These standards clearly require study of at least two branches of philosophy, epistemology and ethics.


World Health Organization (WHO) Guidelines on Basic Training and Safety in Chiropractic


The World Health Organization (WHO) has promulgated guidelines for basic training and safety in chiropractic. vi This document discusses philosophy and the basic theories of chiropractic, noting that:


            The concepts and principles that distinguish and differentiate the philosophy of

            chiropractic from other health care professions are of major significance to most

            chiropractors and strongly influence their attitude and approach towards health care.


            A majority of practitioners within the profession would maintain that the philosophy

            of chiropractic includes, but is not limited to, concepts of holism, vitalism, naturalism,

            conservatism, critical rationalism, humanism and ethics.  (p. 5)


Regarding “Full chiropractic education,” Section 4.4.5 includes “history, principles and health care philosophy pertinent to chiropractic” and “ethics and jurisprudence pertaining to the practice of chiropractic.” (p. 12)


Annex 3: A sample full (conversion) programme, and Annex 4: A sample limited (conversion) programme, includes courses in Chiropractic History and Principles and Philosophy of Chiropractic.  (p. 35, 37)


Guidance as to What Would be Required in this Area


A review of the above documents indicates that there should be no difficulty in providing guidance as to what exactly would be required in this area. 


The Foundation for Vertebral Subluxation urges all chiropractic education programs to comply with these standards by including the following course work in the philosophy of chiropractic at a minimum:


·         Chiropractic History

·         Chiropractic Principles and Health Care Philosophy

·         Branches of Philosophy

·         Epistemology and Evidence-Based Practice

·         Philosophy and Clinical Decision Making

·         The Chiropractic Paradigm

·         Professional Ethics


Graduates of any chiropractic program which fail to include such minimum instruction in philosophy should be ineligible for licensure or registration until they complete such course work through another accredited chiropractic institution.