Friedrich Nietzsche se ha convertido en uno de los exponentes más influyentes y conocidos de la filosofía. Y si bien muchos de sus conceptos fundamentales son cada vez mejor comprendidos y comentados, el mundo hispanohablante conoce menos de su filosofía terapéutica. Así, este artículo tiene por objetivo contribuir a enriquecer la lista de trabajos que han permitido redescubrir a Nietzsche no solo como un filósofo del ars vivendi, sino muy particularmente como filosofo de la medicina. En especial me detendré a (...) interpretar algunos de los planteamientos más fructíferos en su pensar para debates contemporáneos en filosofía de la medicina. (shrink)

Durch genomweite Analysen werden vielfältige gesundheitsrelevante Informationen über eine Person gewonnen. Solche Informationen können die Behandlung von Krankheiten verbessern. Sie ermöglichen aber auch Vorhersagen, ob eine Person und deren Verwandte in Zukunft möglicherweise erkranken werden. Der neuartige Charakter des Informationseingriffs und sein prädiktive Potential bedürfen der ethischen, juristischen und ökonomischen Reflexion, damit diese Technologie zum Wohl der Patienten, der Familienangehörigen und der Solidargemeinschaft eingesetzt werden kann. Die vorliegende Schrift leistet mit ihren interdisziplinären, vom BMBF finanzierten Analysen dazu einen Beitrag. Grundlagen (...) für einen ethisch und juristisch verantwortbaren Einsatz der Genomsequenzierung zu medizinischen Zwecken werden erörtert und Eckpunkte für Kostenanalysen sowie Elemente einer “Guten klinischen Praxis” präsentiert. (shrink)

What was classification as it first took modern form in the eighteenth century, how did it work, and how did it relate to earlier describing and ordering? We offer new answers to these questions by considering an example less well known than that of botany or zoology, namely medicine, and by reconstructing practice on paper. The first and best-known disease classification is the “nosology” of the Montpellier physician François Boissier de Sauvages de Lacroix. Its several editions, we show, were less (...) products than process: published tools for building a classification system. The disorder of a hitherto unstudied notebook that Boissier de Sauvages kept throughout this process provided a way of breaking with the topical order of earlier physicians’ humanistic commonplace books of disease observation while sustaining the paper practices those earlier physicians—and Sauvages himself as a student—had used to order disease. This suggests a different picture of historical change than that of a scholarly world of ordered words giving way to a scientific one of ordered things. Classification, in the case of Sauvages’ nosology, arose through an incomplete break with, and intensified practice of, a past way of ordering the described world. The humanist paper practice that had made observationes, differently applied, now made species. Classification into genera and species by similarity and difference, which Sauvages’ nosology shared with botany, was an algorithm of paper and ink practice—in its operation more machine-like than humanist textual practice yet in its effects more creative and re-creative of categories and questions of relationship. Thus a new empiricism of generalizations arose out of the older, Renaissance empiricism of particulars. (shrink)

The article examines the statements made by Immanuel Kant with reference to medicine as well as the impact of his philosophy on medicine. It describes the initial reaction of Kantian philosophy on medicine in the late 18th and early 19th century and its influence in the late 20th century.

The debate about the appropriate methodology of medical education has been (and still is) dominated by the opposing poles of teaching science versus teaching practical skills. I will argue that this conflict between scientific education and practical training has its roots in the underlying, more systematic question about the conceptual foundation of medicine: how far or in what respects can medicine be considered to be a science? By analyzing the epistemological status of medicine I will show that the internal aim (...) of medicine( promoting health through the prevention and treatment of disease ) differs from the internal aim of science ( the methodological and systematic acquisition of knowledge ). Therefore, medicine as a whole discipline should not be considered as a science. However, medicine can be conceptually and methodologically scientific in so much as it is based on scientific knowledge. There is evidence from cognitive science research that diagnostic reasoning not only relies on the application of scientific knowledge but also — especially in routine cases – on a process of pattern recognition, a reasoning strategy based on the memory of previously encountered patients. Hence, medical education must contain both: the imparting of scientific knowledge and the rich exposure to concrete cases during practical training. Hence, the question of teaching science vs. the apprentice model will not be either-or but rather both — but in which proportion? (shrink)

Richard Koch first made his appearance in the 1920s with works published on the foundations of medicine. These publications describe the character of medicine as an action and the status of medicine within the theory of science. One of his conclusions is that medicine is not a science in the original sense of the word, but a practical discipline. It serves a practical purpose: to heal the sick. All medical knowledge is oriented towards this purpose, which also defines the physician’s (...) role. One kind of knowledge is diagnosis, which is strictly understood in relation to therapy, and is at the core of medical thinking. Diagnosis is not the assignment of a term of a species to a patient’s disease: this would not do justice to the individuality of a clinical manifestation and would fail to provide a reason for individual therapy. Nevertheless, the terms assigned to diseases, although fictitious, are not useless, but assist in differentiating various phenomena. These conclusions carry ethical consequences. Because the task of helping the sick constitutes medicine, morals not only set ethical limits: medicine originates in a moral decision. If there are no diseases but only individual sick people, disease can not be defined as an abnormality. The individual benefit to the patient must not necessarily be the complete restoration of health. With its object being incalculable, medicine cannot guarantee its own success. Here the physician has to develop principles that allow for the best possible response to the challenges faced in varying situations of conduct. (shrink)

Sadegh-zadeh [23] has proposed a theory of the relativity of medical diagnosis in terms of the time at which a diagnosis is accepted, the patient to whom the diagnosis applies, the physician who renders the diagnosis, the medical knowledge used, the diagnostic method applied, and the set of patient observations. Use of classical formal logic as the diagnostic method may result in three paradoxes: the paradoxes of consistency, completeness, and justifiable ignorance. These paradoxes may be resolved by the addition of (...) two non-classical operators, the certainty and effort operators, akin to the non-classical operators of modal logic. (shrink)

Medical ethics could be better understood if some basic theoretical aspects of practices in health care are analysed. By discussing the underlying ethical principles that govern medical practice, the student should also become familiar with the notion that medical ethics is much more than the external application of socially accepted moral standards. Professions in general and medicine in particular have internal values that command their moral virtuosity at the same time as their technical excellence. Three examples where clinical practice can (...) be clearly shown to require an ethical analysis are given: medical praxiology illustrates the motives, means and aims of physicians and patients; clinical decision-making as a practical syllogism that reaches prescriptive conclusions based on medical knowledge and the patient's wishes/intentions. Finally, diagnostics as an ethical bayesian approach is discussed, where the patient informedly decides the benefits and risks of further testing. (shrink)

Der Krankheitsbegriff ist sowohl ein Begriff der Lebenswelt als auch ein theoretischer Begriff der medizinischen Wissenschaft. Das Paper zeigt die wichtigsten Unterschiede auf. Im ersten Teil wird die Grundstruktur der Krankheitslehre anhand von 7 Prinzipien dargestellt. Im zweiten Teil werden einige besonders wichtige Unterschiede in Form von Frage und Antwort explizit erklärt. Prinzipien: Die Krankheitslehre hat das individuelle menschliche Leben unter dem Aspekt von Krankheit und Gesundheit zum Gegenstand. Die Krankheitslehre fasst Krankheiten als abgrenzbare Anteile eines individuellen Lebens auf. Jedes (...) krankhafte Phänomen ist entweder eine Krankheit oder deren Manifestation. Jede einzelne Krankheit ist ein Fall einer allgemeinen Art: einer Krankheitsentität. Krankheitsentitäten werden definiert durch eine Kombination von Erstursachen, Wirkbedingungen, Reaktionen und Folgen im Organismus, Verlaufsformen und Ausgängen. Krankheitsentitäten sind durch sie definierende pathologische Merkmale gekennzeichnet. Die Pathologizität von Merkmalen lässt sich durch ein System von Krankheitskriterien charakterisieren. Ein fraglich pathologischer Lebensvorgang kann durch Rekurs auf die Ätiopathologie der zugehörigen Krankheitsentität theoretisch eingeordnet werden. Fragen : Gibt es eine scharfe Grenze zwischen Gesundheit und Krankheit? Gibt es zwischen Gesundheit und Krankheit einen neutralen Bereich von Zuständen? Kann die Medizin eine positive Definition von Gesundheit angeben? Kann man Gesundheit mit vollständigem subjektivem Wohlbefinden gleichsetzen? Ist Krankheit etwas Unnatürliches? Können Menschen auch dann gesund sein, wenn sie eine Krankheit oder Behinderung haben? Ist jemand krank, bei dem ein Risikofaktor festgestellt wird? Dürfen gegen eine Krankheit nur Personen mit nachgewiesener Erkrankung behandelt werden? Ist Krankheit immer ein Übel? Welche normativen Implikationen hat der wissenschaftliche Krankheitsbegriff? (shrink)

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person’s health. This study investigates how advancements in science (...) and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics. (shrink)

Als Vorstellung eines vom Wissen der Medizin abweichenden Behandlungsfalls können Fallberichte darauf Einfluss haben, welche Maßnahmen zukünftig als medizinisch indiziert gelten. Die öffentliche Präsentation der getroffenen Handlungen und Empfehlungen liegt in der Regel ausschließlich in der Hand ärztlicher Autor*innen – Betroffene kommen hingegen kaum zu Wort. Während in der klinischen Patientenversorgung bereits hohes Gewicht auf Patientenperspektiven und -erzählungen gelegt wird, scheinen sich diese Entwicklungen im Fallbericht als Form wissenschaftlicher Kommunikation so (noch) nicht widerzuspiegeln. Vor diesem Hintergrund wird im Folgenden aus (...) gattungstheoretischer Perspektive untersucht, welche Rolle Patientenperspektiven und -erzählungen nicht nur – wie in der bisherigen Forschung vor allem untersucht – im Bereich des Klinischen, sondern gerade auch des Kasuistischen und den damit verbundenen Fragen klinischer Indikationsreflexion und -empfehlung zukommen sollten. Dabei wird nicht zuletzt argumentiert, dass (Patienten-)Narrationen analog zu Indikationsstellungen gerade ein Moment des Ungesicherten und Singulären betonen, das für die Textsorte des Fallberichts und daraus abgeleiteten Indikationsüberlegungen von spezifischem Wert ist. (shrink)