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The Limits of Medical Practice

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Abstract

Should medicine be defined as the enterprise in charge of the health problems of society? If so, then any problem (individual, public, social or political) that can be reformulated as a “health problem” could serve as a goal of medicine. If, on the other hand, medicine ⁀ or medicine proper ⁀ is defined in terms of some limited goal and limited means, then some medical professionals would find themselves working in other fields than medicine. It could be of some importance to the patient to know whether the medical professional he meets is engaged in medical practice (aiming at the patient's health), research, public health or some other project which involves medical competence. Obviously, some of these enterprises may have conflicting goals. This paper will analyse various candidates for being a model of medicine, discuss some of the consequences, and argue for a limited view of medical practice.

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REFERENCES

  1. See I. Nordin: “On The Rationality of Medicine” in L. Nordenfelt & P-A Tengland: The Goals and Limits of Medicine, Stockholm 1996, p. 55, for a short discussion of the fields within medicine.

  2. See L. Nordenfelt: “On Medicine and Other Species of Health Enhancement” in L. Nordenfelt & P-A Tengland: The Goals and Limits of Medicine, Stockholm 1996, p. 33, for a discussion of medicine and its relation to other health enhancement areas.

  3. This is of course the expression used by E. Pellegrino & D. Thomasma in their A Philosophical Basis of Medical Practice, Oxford 1981.

  4. For an overview, see P. Conrad: “Medicalization and Social Control” in Annual Review of Sociology, 1992; 18: 209.

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  5. For an explication of the concept in the technological context, see my “The rationality of technology”, Science Studies, vol. 2, p. 3.

  6. For an explication of this term, see P-E Liss: “On the Notion of a Goal”, in L. Nordenfelt & P-A Tengland: The Goals and Limits of Medicine, Stockholm, 1996, p. 13.

  7. Besides being an integrated part of the history of medicine, the focusing on the helpseeking individual may be of importance to the very meaning of “sickness”. Or as I. Zola explains in Socio-Medical Inquiries, Philadephia 1983, p. 56: “If sickness, judged by the prevalence of symptoms and signs, is, in fact, the rule rather than the exception in the ‘healthy’ population, then the individual's response to symptoms by seeking aid may be a more objective or operational definition of 'sickness’ than our usual clinical emphasis on the fact of symptoms and signs alone.”

  8. For a further elaboration of this concept, see L. Nordenfelt: On the Nature of Health, Dordrecht 1987, ch. 3.

  9. For a discussion of the need of, and possible conflicts between, different professional groups within medicine, see J. Bullington: “The Role of Different Professions in Defining the Goals of Medicine” in L. Nordenfelt & P-A Tengland:The Goals and Limits of Medicine, Stockholm 1996, p. 99.

  10. For a discussion of the domain of health promotion/prevention, see K. Tones: “The contribution of education to health promotion”, p. 24, and R. Downie: “Health promotion: conceptual issues and ethical issues”, p. 90, in P-E Liss & N. Nikku: Health Promotion and Prevention, Linköping/Uppsala, 1994.

  11. See for example G. Rosen: A History of Public Health, Baltimore/London, 1993.

  12. See for example I. Kennedy: The Unmasking of Medicine, London, 1983.

  13. The expression is taken from T. Szasz: The Therapeutic State, New York 1984.

  14. See for example L. Edelstein: Ancient Medicine, Baltimore 1967, p. 6.

  15. See R.H. Shryock: The Development of Modern Medicine, London 1948, pp. 246–247.

  16. This is clearly so when it comes to “compliance”, i.e. whether the patient follows the prescriptions of the doctor or not. See for example K. Zola: Socio-Medical Inquiries, Philadephia 1983, ch. 20.

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  1. Department of Health and Society, Linköping University, S-581 83, Linköping, Sweden

    Ingemar Nordin

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  1. Ingemar Nordin
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Nordin, I. The Limits of Medical Practice. Theor Med Bioeth 20, 105–123 (1999). https://doi.org/10.1023/A:1009988203813

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