The Patient
Abstract
As a science and practice of intervention and control, medicine is concerned
with cure and care, the promotion and protection of health, and the prevention
of maladies and human suffering. This wide-ranging task is
accomplished through medical practice and medical research, though no sharp
boundary between them can be drawn.
A widespread misconception about medicine has it that medicine is concerned
with illness and disease. However, the subject of medicine is the patient, i.e., Homo patiens, but not illness or disease, with the ends being directed toward the relief, prevention of human suffering, and saving human life. Accordingly, medicine
needs a theory of the patient first of all. Nosology and pathology as studies of
illness and disease may be viewed as elements of such a theory of the Homo
patiens. Seen from this perspective, clinical research and practice are to be
based on the question: What is a patient? That is, what characteristics distinguish
a patient from a non-patient? The present chapter is concerned with this question.
The inquiry into what a patient, i.e., Homo patiens, is, intersects with
anthropology that is concerned with the question of what is a human being?
This is the fundamental philosophical question of medicine because, as an
experimental and diagnostic-therapeutic discipline, it undertakes momentous
interventions in human life. It therefore needs an image of the human being
so as to ascertain whether medical interventions are in accord with, or contravene,
that image. For example, it is a legitimate question to ask whether
the transplantation of animal cells, tissues, and organs into humans, i.e.,
xenotransplantation, or whether the designing of offspring by genetic engineering,
is morally permissible. Since anthropology is basically a philosophical endeavor, medicine at its foundations turns out to intersect with philosophy.
We shall consider the patient as a bio-psycho-social agent who is suffering
or whose life is threatened by some occurrences inside or outside of her body,
usually called diseases, pathogenic environments, etc. Our aim is to understand
what these occurrences may look like and how they may be conceptualized,
systematized, recognized, causally analyzed, and controlled. Thus, our discussion consists of the following five sections: 7.1 The Suffering Individual; 7.2 The Bio-Psycho-Social Agent; 7.3 Health, Illness, and Disease; 7.4 Systems of Disease; 7.5 Etiology (= Science of Clinical Causation).