Abstract
The purpose of this article is to present a normative theory of the goals of medicine (a theory that tells us in what respects medicine should benefit the patient) that is both comprehensive and unified. A review of the relevant literature suggests that there are at least seven plausible goals that are irreducible to each other, namely to promote functioning, to maintain or restore normal structure and function, to promote quality of life, to save and prolong life, to help the patient to cope well with her condition, to improve the external conditions under which people live, and to promote the growth and development of children. However, it seems that all these goals need to be qualified in different ways, e.g. it does not seem reasonable to improve physiological function or functional ability unless this is expected to have positive effects on quality of life and/or length of life, or to improve the quality of life in any respect, or by any means. These qualifications all suggest that the proposed goals are, as goals, conceptually, and not just causally, related to one another, and that they should therefore not be regarded in isolation. Instead, we should think of the medical enterprise as having a multidimensional goal structure rather than a single goal. In order to depict clearly how the different goals are related to one another, a multidimensional model is constructed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Baker et al. (1994) Quality of Life in Epilepsy: The Liverpool Initiative. In: M.R. Trimble and W.E. Dodson (Eds.), Epilepsy and Quality of Life. New York: Raven Press.
Baker et al. (1998) Commission on Outcome Measurement in Epilepsy, 1994-1997: Final Report (ILAE Commission Report). Epilepsia 39(2), 213-231.
Boorse, C. (1977) Health as a Theoretical Concept. Philosophy of Science 44, 542-573.
Brock, D. (1993) Quality of Life Measures in Health Care and Medical Ethics. In: M. Nussbaum and A. Sen (Eds.), The Quality of Life. Oxford: Clarendon Press, pp. 95-132.
Brülde, B. (1998a) The Human Good. Gothenburg: Acta Universitatis Gothoburgensis.
Brülde, B. (1998b) Vad är hälsa? Några reflektioner kring hälsobegreppet. Gothenburg: Philosophical Communications, Green Series 58.
Brülde, B. (2000) On How to Define the Concept of Health: A Loose Comparative Approach. Accepted for publication in Medicine, Health Care and Philosophy.
Brülde, B. and Malmgren, H. (1998) Measuring Quality of Life — Some Philosophical Comments, Gothenburg: Philosophical Communications, Green Series 59.
Campbell, A.G.M. and McIntosh, N. (Eds.) (1998) Forfar and Arneil's Textbook of Pediatrics. Edinburgh: Churchill Livingstone.
Detels, R., Holland, W., McEwen, J. and Omenn, G. (Eds.) (1997) The Practice of Public Health, Oxford Textbook of Public Health. New York: Oxford UP.
Devinsky and Vickrey (1994) Quality of Life in Epilepsy: Recent Developments in the United States. In: M.R. Trímble and W.E. Dodson (Eds.), Epilepsy and Quality of Life. New York: Raven Press.
Devinsky, Vickrey, et. al. (1995) Development of the Quality of Life in Epilepsy Inventory. Epilepsia 36(11).
Fallowfield, L. (1994) An Overview of Quality of Life Measurements. In: M.R. Trimble, W.E. Dodson (Eds.), Epilepsy and Quality of Life. New York: Raven Press.
Griffin, J. (1986) Well-Being: Its Meaning, Mcasurement and Moral Importance. Oxford: Clarendon Press.
Johnson, S.B. (1984) Knowledge, Attitudes, and Behaviour: Correlates of Health in Childhood Diabetes. Clin Psychol Rev 4, 503-524.
Liss, P.E. (1996) On the Notion of a Goal: A Conceptual Platform for the Setting of Goals in Medicine. In: L. Nordenfelt and P.A. Tengland (Eds.), The Goals and Limits of Medicine, Stockholm: Almquist & Wiksell International.
Nelson, Behrman, Kliegman, Arvin (Eds.) (1996) Nelson Textbook of Pediatrics. Philadelphia: Saunders.
Nordenfelt, L. (1991) Livskvalitet och Hälsa. Teori och kritik. Stockholm: Almqvist & Wiskell.
Nordenfelt, L. (1995) On the Nature of Health. An Action-Theoretic Approach. Dordrecht: Kluwer.
Nordenfelt, L. and Tengland, P.A. (1998) Är det sjukvårdens uppgift att göra människor lyckliga? Läkartidningen 95, 868-870.
O'Donoghue, Duncan and Sander (1998) The subjective handicap of epilepsy: A new approach to measuring treatment outcome. Brain 121, 317-343.
Richt, B. (1991) Livskvalitetsmätningar — en positiv kritik. In: P.E. Liss and L. Nordenfelt (Eds.), Hälsa, Sjukdom, Livskvalitet. Linköping: Tema H.
Rosser et al. (1992) Index of Health Related Quality of Life. In: A. Hopkins (Eds.), Measures of the Quality of Life. London: Royal College of Physicians of London.
Statens Medicinsk-Etiska Råd (Ed.) (1990) Etiska deklarationer och riktlinjer för hälso-och sjukvården och det sociala området. Stockholm: Allmänna förl.
Stewart and Ware, Jr. (Eds.) (1992) Measuring Functioning and Well-Being, The Medical Outcomes Study Approach. Durham and London: Duke UP.
Sumner, L. W. (1996) Welfare, Happiness, and Ethics. Oxford: Clarendon Press.
The Goals of Medicine. Setting New Priorities. Special Supplement, Hastings Center Report, November-December 1996.
UNICEF (1990) The World Summit for Children. New York: UNICEF.
United Nations (1991) Convention on the Rights of the child. New York: United Nations.
Vickrey et. al. (1995) Outcome Assessment for Epilepsy Surgery: The Impact of Measuring Health-related Quality of Life. Annals of Neurology 37(2).
Vivier, P., Bernier, J. and Starfield, B. (1994) Current Approaches to Measuring Health Outcomes in Pediatric Research. Current Opinion in Pediatrics 6, 530-537.
WHO (1958) The first ten years of the World Health Organization. Geneva: WHO.
WHO (1984) Health for all by the year 2000. Geneva: WHO.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brülde, B. The Goals of Medicine. Towards a Unified Theory. Health Care Analysis 9, 1–13 (2001). https://doi.org/10.1023/A:1011385310274
Issue Date:
DOI: https://doi.org/10.1023/A:1011385310274