This article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and (...) evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making. (shrink)

A number of problems and uncertainties have been raised by this brief review. Although they are well-known in philosophical and social scientific circles they are otherwise consistently ignored. But I call for a wider debate about them. If medicine cannot come to terms with its own confusing terminology and methodology; if medicine cannot stop raising expectations it cannot fulfil; if medicine does not deliberately restrict its boundaries; and if medicine does not take serious steps to explain why it chooses to (...) call some conditions states of health and others states of disease; then the result must be that health policy (which medicine largely continues to direct) will either be simply an arbitrary matter, or will be implemented on the basis of economic arguments. Where everything else is imprecise the discipline that offers precision will triumph. And the evidence of the moment is that this is exactly what is happening. (shrink)