Theoretical medicine最新文献

The principle that everybody should have access to essential health care is in conflict with the notion that property rights should be respected. The Kantian doctrine of rights is explored in order to solve this conflict. Kant's notion of a legislative will is explained and used to show the inherent limits of the legal terms "property" and "ownership" (it can refer only to things external to subjects and to possible objects of choice). What is internal to the subject is outside of the realm of the legislative will. A law excluding those unable to pay from access to essential health care would not be just. A law granting that access would be just.

This paper examines the origin and the development of the mechanistic model of the human body and health in terms of Max Weber's theory of rationalization. It is argued that the development of Western scientific medicine is a part of the broad process of rationalization that began in sixteenth century Europe as a result of the Reformation. The development of the mechanistic view of the human body in Western medicine is consistent with the ideas of calculability, predictability, and control-the major tenets of the process of rationalization as described by Weber. In recent years, however, the limitations of the mechanistic model have been the topic of many discussions. George Engel, a leading advocate of general systems theory, is one of the leading proponents of a new medical model which includes the general quality of life, clean environment, and psychological, or spiritual stability of life. The paper concludes with consideration of the potential of Engel's proposed new model in the context of the current state of rationalization in modern industrialized society.

Instead of presupposing reality as the "realists" do, a genetic theory of knowledge attempts to understand scientific knowledge through the psychological origins of both the concepts, and the operations on which these concepts are based. Adopting the viewpoint of genetic epistemology, the envisaged theory of medicine will have to perform a threefold task: (1) A revision and reformulation of the psycho-physical problem and the development of a model for the living body; (2) A revision of our views concerning the relationship between humans and the inanimate and animate environment; and (3) The development of a concept for the construction of individual reality and its consequences for the patient-physician relationship.

The tradition of anthropological medicine in philosophy of medicine is analyzed in relation to the earlier interest in epistemological issues in medicine around the turn of the century as well as to the current interest in medical ethics. It is argued that there is a continuity between epistemological, anthropological and ethical approaches in philosophy of medicine. Three basic ideas of anthropologically-oriented medicine are discussed: the rejection of Cartesian dualism, the notion of medicine as science of the human person, and the necessity of a comprehensive understanding of disease. Next, it is discussed why the anthropological movement has been superseded by the increasing interest in medical ethics. It is concluded that the present-day moral issues cannot be interpreted and resolved without clarification of the underlying anthropological images.

In his concept of an anthropological physiology, F.J.J. Buytendijk has tried to lay down the theoretical and scientific foundations for an anthropologically-oriented medicine. The aim of anthropological physiology is to demonstrate, empirically, what being specifically human is in the most elementary physiological functions. This article contains a sketch of Buytendijk's life and work, an overview of his philosophical-anthropological presuppositions, an outline of his idea of an anthropological physiology and medicine, and a discussion of some epistemological and methodological problems. It is demonstrated that Buytendijk's design of an anthropological physiology is fragmentary and programmatic and that his methodology offers few points of contact for specific anthropological experimental research. Notwithstanding, it is argued that Buytendijk's description of the subjective, animated body forms a pre-eminent point of reference for all research in physiology and psychology in which the specific human aspect is not ignored beforehand.

This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883-1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel's warning against a dehumanization of medicine when the "person" of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.

The situation of present day psychiatry is described as being dominated by an empiricist perspective. The limitations of this perspective are analyzed and a rough sketch of the hermeneutical approach in psychiatry is offered. It is argued that a fully developed hermeneutical psychiatry implies a reference towards anthropological themes. Three of them, time, historicity and corporality, are investigated.

Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy. In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation ("learning to live with") and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems.