Illness and disease: an empirical-ethical viewpoint

Abstract

BackgroundThe concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates.Main textThree potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research.ConclusionThe combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected.

A matter of time: grappling with everyday ethical tensions at the confluence between policy and practice in a psychiatric unit

“…Our critical phenomenological lens allowed us to see how their efforts to recognise what mattered to patients (humanistic values) existed in tension with the goods associated with empirical-normative evidence (medical values) and/or equity (societal values). Thus, these everyday ethical tensions reflect what Seidlein and Salloch49 characterised as the unresolved philosophical and theoretical tensions between subjective experience (illness) and its related concepts in medicine (disease) and society (sickness) that, ultimately, exacerbate the gap between socio-empirical research and its implications for normative ethics. With the exception of one longitudinal study that differentiated between subjective and clinical time in relationship to conditional discharge,57 time is presented in mental health research as a singular, undifferentiated concept that, to our knowledge, has not been explicitly linked to how the phenomenon under examination is conceived (eg, illness, disease, sickness).…”

“…Akin to research that conceptualised time as a limited resource, everyday ethical tensions were often expressed in terms of ‘not having enough’ time. Yet, ethnographic attention to thick description, supported by a narrative-phenomenological conceptual framework, provided the level of detail needed to enter recent conversations in empirical ethics that seek to bridge the gap to normative arguments and recommendations 47–49…”

The Burnout Phenomenon: A Résumé After More Than 15,000 Scientific Publications

“…Seen in this way, burnout is a modern variant of lay models that have by no means lost their function due to the successes of medicine and psychotherapy (62,63), but rather develop dynamically, reflecting current scientific paradigms, and vice versa have a retroactive effect on-supposedly purely scientific-paradigms. In the context of the discussion about disorder and disease models (64)(65)(66), appropriate consideration of this dynamic aspect of the relevant terms would be important; The conceptualization of personalized medicine will foreseeably become even more complex as a result (67).…”

Sunset

“…Illness has been defined as a "subjectively interpreted undesirable state of health," 1 whereas disease is understood as an objective conclusion about a patient's health based on scientific reasoning. 2 One view of a patient-clinician encounter is that it should aim to dissolve distinctions between the subjectivity of illness and the objectivity of disease. To achieve this goal, a physician must diagnose and treat patients with compassion and motivate patients' understanding of their disease.…”