Any Nihilists here?

[Bucky Ball]

I think your experience in not seeing the word factual very often might represent the work of the committees rather than the majority position of contemporary moral philosophy. Moral realism isn't novel or rare, it's the standard assumption.  I would be horrified if some provider did or didn't give me care based on non factual premises and statements.

The word fact / factual was used in the thread. 
I was simply commenting on the use of the (same) word. 

Moral realism is assumed, as you say. 
A diagnosis is almost never a "fact", it's an (hopefully) informed judgement, until proven (if ever).
A diagnosis is a "working hypothesis", (which is often changed from the initial impression) in complex inpatient cases anyway.
The History and Physical very often includes (in academic medicine anyway), the statement "differential (diagnoses) include : (then a list of possible diagnoses).

A possible "purpose" might be seen as "the survival of the species". Individuals are clearly not individually important in that process,
and the fact that 99 % of all species that ever existed are extinct, probably negates this view, unless the fact we are not extinct might counter that.