Emergence-Discourse Method to Philosophy of Medicine and Bioethics: In Search
for Rational Comprehension of Individual Health
- Konstantin S. Khroutski
Institute of Medical Education,
Novgorod State University after Yaroslav-the-Wise
Postal address: A/B 123, PO-25,
Novgorod the Great, 173025 Russia; E-mail:
- Eimantas Peicius
Kaunas University; Sartu 29, Kaunas,
LT-3042, Lithuania; E-mail: email@example.com
Eubios Journal of Asian and International Bioethics 13 (2003), 15-19.
In this paper
an attempt is undertaken to introduce a novel 'Emergence-Discourse' method
(EDM) in the field of contemporary biomedicine. The EDM-idea determines
initially the selection of a basic concept for the consideration (we have
chosen Jozsef Kovacs's "The concept of health and disease") and the
further interplay of Thesis (exhibiting paradigmatically novel theses in
criticising the basic concept), AntiThesis (in criticising now the
Thesis-propositions), and Synthesis (in criticising, in turn, the
AntiThesis-points). The chief EDM-design is 1) to reach the translation of the
postulates of a novel paradigm (to make them comprehensible) for the most
members of a scientific community; 2) to reach a new level of whole-organising
synthesis of heterogeneous philosophic and scientific truths. In our case, we
advance the theses of a novel Cosmist paradigm in biomedicine, which states
that man is as much a function of Biosphere (Nature) and Society as of Process
- cosmic autonomous one common entire universal evolutionary process of the
life on the Earth. Cosmist paradigm relies on the bases of philosophical
cosmology and ontology of Absolute (relative to all-embracing evolutionary
Process) Cosmist (of universal, functionally deliberate ascending ontogenesis
of any subject - living organism: biological, personal, and societal) Wholism
(with reference to the natural functional integration of any subject into one
common whole self-unfolding and evolutionary ascending Process). In this paper
we present only Thesis and AntiThesis. SynThesis is expected to appear in the
nearest future. Herein, the chief design is that a SynThesis-author should be
absolutely free from any EDM-team commitments - for the true realisation of the
philosophy of medicine, bioethics, individual's health, emergence, dialectics,
Introduction: 'Emergence-Discourse' method
The bio-(Living)-World is
universal. That is the natural
sciences' truth, which has the undeniable meaning at least since the year 1953
- since the discovery of DNA structure by Watson and Crick, which proves the
unity of all kinds of life on the Earth, and the genetic transmission of
psychic character by DNA molecules.
Hence, insofar as the world of life is universal, reasonably we have the
right to find parallels between the different levels of one universal (on the
Earth) life organisation. In this,
the process of protein synthesis is very much attractive for our
intentions. Extrapolating the
pattern of protein synthesis on the scientific discussion process, we have
arrived at the idea of 'Emergence Discourse'.
What is the essence of our
analogy? What we observe in the
process of protein synthesis? That is:
2. Clear model of translation ideas
into reality - of informational message emergence and transference, with its
transforming (translation) from one code
'central-nuclear' origin, incomprehensible for the most of 'organismic-cellular' structures) into
another form of the 'common organismic' language - now understandable for most structures of 'organism'
(cell, organ, body, man, societal body, scientific community, society, etc.)
3. Emergence of novelty - in the final appearance of 'active
enzyme' (a novel conceptual approach).
Indeed, we have, in the protein
1) First, the prime activation of
the gene (the certain functional
unit of heredity) - the Thesis (Idea) emergence;
2) Next, the transcription of
information from the gene's DNA into nucleic acids of the messenger RNA - the
sequence of the bases, which are entirely opposite (but complementary) to the primer DNA - the AntiThesis
3) Finally, attached to the
ribosome, the messenger RNA determines the process of translation - binding of
the amino acids to the growing polypeptide chain (in a strict sequence, according to a sequence of codons on
the messenger RNA molecule) up to the complete synthesis of the protein
molecule (enzyme) - the SynThesis emergence.
Hence, in the course of our biologic
analogy: AntiThesis (in
philosophic discourse between scientists) is the reflection of the Thesis
(primary code of a novel concept), which (AntiThesis) becomes now perceivable
for the structures of SynThesis organisation (within the special conditions of
'ribosome'); and, finally, Synthesis is the ultimate realisation of Thesis in the
common medium of the given 'organism' (of a scientific community, for example).
What is then 'Ribosome'? To our assumption, that is the
mainstream conceptual basis, which allows the translation of the Thesis (an incomprehensible paradigmatically
novel concept) from unintelligible form into the SynThesis - on the basis of
AntiThesis - a comprehensible whole concept, perceivable for the majority of
organism's (cell's, scientific community's, society's) structures (organelles,
scientists, men). Authors of this
exploration consider Jozsef Kovacs's
"The concept of health and disease" (Kovacs, 1998) to be precisely the needed 'ribosome' - powerful wholist
method is a device to transform (to transcribe and translate) the information
from the one language (of a novel paradigm) into another (of the currently
dominant paradigm) and, thus, - to
reach the Emergence of the novel intelligible information during the process of
Herein, it is important to note,
Emergence-Discourse method (EDM), at first sight, could resemble Popperian
falsificationism principle. However, it has substantial disparities, for, in
contrast, it serves not to the development or refutation (clarification and
deepening, or error elimination) of either thesis or antithesis, but precisely
realises a paradigmatically novel approach of explaining the phenomenon under
observation (we have human health).
In substance, the EDM in philosophy of medicine and health care provides
the conditions for fruitful interaction and integration of different paradigms
on the topic of human health - of novel approaches with the currently
dominant (normal) paradigms (the language of which is intelligible
for the majority of scientists). Thereby, to distinguish ourselves from
Popperian criticism, we use the capital letters in writing the words Thesis,
AntiThesis and SynThesis. It is expected that the EDM can establish a new mode
of the process of reasoning and extended interactive communication between
philosophers and scientists - leading to a new level of whole-organising
synthesis of heterogeneous philosophic and scientific truths. In contrast, Popperian criticism leads
in principal to the development either of thesis or of antithesis, but
never - to the emergence of higher
level (of organisation)
Naturally, the scientists involved
in the EDM ought to hold the common philosophic fundamentals. In our case, the both authors of this
article have the common wholistic background. At the same time, having a common background, we do not have
a common platform. That is a crucial point of the EDM - each of the
participants expresses distinctly different position in treating the object
under consideration. The latter,
to our belief, is the reliable guarantee of our ability to consider novel
approaches to the explanation of the phenomenon of individual's health -
individual (personal) wellbeing of the man.
What is the general design of a new
method aimed at the advancement of a novel paradigm in the field of
Primarily, a mainstream concept on
the topic must be chosen, which will serve as a core line of the entire
Emergence-Discourse. In our case,
as it was stated above - that is Jozsef Kovacs's "The Concept of Health
Next, a first author (Konstantin
Khroutski), carrier of a paradigmatically novel approach, represents the
Thesis - his criticising of
Kovacs's "The Concept of Health"
from his novel - cosmist - positions.
Further, the second author (Eimantas Peicius) performs a
significant role of AntiThesis, sequentially and accurately criticising the
first author's critical framework
- of paradigmatically novel theses and inferences, but now from the
standpoint of a mainstream
(normal) paradigm. In this, we follow Kuhn's notion (now common) of
paradigm as an accepted set of principles by which the world is viewed.
third participant (an author of SynThesis) comes on the stage and implements
the culminating function. We have decided that a SynThesis-writer should appear
in the future (in the final point of the whole work), thus acting independently
(being absolutely free from the EDM-team commitments), while realising the
SynThesis mission. It is proposed that he will reflect (likewise sequentially)
the critical theses but now of the 'second author' and, by this way, he will
involuntary start to support the critical points of the first author. In other
words, he will involuntary assume the position of the novel paradigm, and this
position can provide him with the necessary conditions to realise a
philosophical shift in normal viewing of individual's health. On the contrary,
if the proposed novel paradigm is unworthy, the 'third' author will complete
the destruction of the Thesis.
we highlight that every stage of the EDM-discourse (Thesis - Antithesis -
SynThesis) essentially has the essence of Emergence. Herein, we precisely mean
that "emergence" (in
philosophic thinking) is the rise of a system that cannot be predicted or
explained from antecedent conditions. EDM is the EMERGENCE-Discourse method. Indeed,
the first author criticises the chosen basic concept from the paradigmatically
novel stand and thus the results of his critique ever will be emergent, for
they principally cannot be predicted or explained from 'antecedent conditions'
- from the standpoint of any mainstream paradigm.
second author criticises (now, precisely from the mainstream positions) the
first author's criticism and, hence, the second author likewise will ever receive
the emergent result (for, he, in principle, critically reflects the emergent
expect that the third author, counteracting the criticism of a paradigmatically
novel approach, will try to shift the existing normal concepts. Reasonably, his
endeavours can fulfil a need for Emergence - the rise of a novel unpredictable
At any rate,
our basic aim is to uphold the high standard of philosophy - to prove its
principal independence from sociology and natural sciences and precisely its
guiding significance for the development of sciences (at present we obviously
have the contrary situation).
Thesis: From "medicalisation" to
"sociologisation" and further - to 'cosmologisation'
There is a
need, from the very beginning, to expose some basic elements of the cosmist
framework of references (cosmist paradigm). First of all, I am to shed some
light on the fundamental notion of "Process" (CEPLE) - cosmic evolutionary process
of the life on the Earth. Being a positive phenomenon itself,
Process has the meta-naturalist significance, underlying the entire living
phenomena of Earth's life evolution. It precisely has the essence of
all-embracing (absolute) universal and put in order (cosmic) and whole
(wholistic) one common self-unfolding and evolutionary ascending CEPLE. Process
all-embraces the all other processes (ontogeneses) of the all subjects (living
organisms: biological, personal and societal) of Earth's life, determining -
through their functional usefulness for CEPLE - healthy ontogenesis of any
living subject on the Earth.
substantial characteristics of Process and other cosmological fundamentals are
given in my previous works (Khroutski 2000, 2001, and especially in
"Introduction of the Cosmist Fundamentals" (EJAIB 12(1), January
2002). This paper also contains the characterisation of the deduced ontological
framework of Absolute Cosmist Wholism (ACW system) and of the principles of
into the critical course, I would like to start from the conclusive judgement
of Jozsef Kovacs - from his definition of health:
The healthier a physical or
mental characteristic, process, reaction is, the more it makes it possible for
the individual to adapt to reasonable social norms without pain and suffering,
and the longer, and happier a life it will be able to ensure him in that
the whole, taking the cosmist standpoint, from this definition clearly follows
the three most distinctive features of the Western cultural paradigm: the
so-called (by me) 'presentism', 'metaphysicism', and 'humane anthropocentrism'.
Western metaphysicism and presentism likewise were outlined in the
aforementioned paper. The third notion - of humane anthropocentrism - is
highlighted as another distinctive feature of current Western mentality. Humane
anthropocentrism principally relies on global bioethics; it implies the
separation of humanism and scientism: the ultimate significance of social level
of Earth's life evolution, and the right of man to pluralistically adapt
oneself - utmost satisfactorily - in the given societal surroundings and under
demands of the morals of the given society - the set of customs and rules
belonging to a given culture.
'humanistic' paradigm has the bio-social-individual essence. In this, 'individual' (a person) is
free (phenomenologically, existentially, spiritually, etc.), but exclusively
within the given society. He is
always ultimately a function of Society.
Thereby, this humane anthropocentric ("normal", in Kuhn's term) approach has the
essence of metaphysicism and presentism, insofar as it is substantially static,
ever dealing with the given present society, and always falling
(scientifically) under the causal or teleological determination.
contrary, cosmist approach (paradigm) establishes the need in a novel
alternative cultural trend of Cosmist Dialectics. Cosmist dialectics precisely
strives to comprehend and embrace the real world in its gradual ascending -
emergent - becoming. The term 'dialectics', herein, does not naturally relate
to logical disputation and have no commitments to either Hegelian dialectical
(historical) process, or Marxian critique of this process. Cosmist dialectics
precisely serves the present and emergent future wellbeing of any living
subject on the Earth: from a molecule - up to a human being, society, mankind.
the terms "emergent future", "cosmist", "cosmic",
etc. are placed in the EJAIB (January, 2002). In this line, the cosmist term
"society" has no political meaning but relates to any body,
community, structure, organisation, or functioning of society - body of people
having common ends of their organisation.
In the further
disclosing of the essence of cosmist thinking the notion of cosmist personalism
is presented. Originally, cosmist personalism has the bio-social-cosmist
essence. Man here is a Transcending-the-Society person. It means that he always
lives in Society, but he (macro-evolutionary) is free from the society. The
heart of the matter is that man (any other living subject) is ultimately a
function of Process (but not of Society; Man, Nature and Society are equal
elements of one common Process). Process, in turn, is a genuine objective
phenomenon - alike Society. Thus, "cosmist" paradigm has the
dialectic personalist (changeable, of evolutionary process, and primarily of
free subjective determination) substance.
Let us consider, in this course, for instance, a
historical figure of Aleksandr Solzhenitsyn, a novelist (Noble Priser, 1970).
He fearlessly transcended
the all societal constraints ('societies'): eight-year imprisonment, government
pressure and censorship, forcible deportation to the West (1974), and has
realised ultimately his cosmist assignment - informed the world about the techniques
of terror and resulting moral debasement in the USSR, and exposed the nature of
the Soviet system. Eventually, he
has returned (in the 1994) to his native land as a very respected citizen. His life ontogenesis can be fairly
considered as wellbeing (healthy) one. At any rate, up to day, in his 84,
Aleksandr Isayevich is in good spirits, enthusiastic, active, and creative.
well-known figure is Mikhail Lomonosov (1711-65). He was the son of a
fisherman. In spite of his peasant background ('society') he left his village
(in 1730, at the age of 19!) and got (on foot! covering the distance of more
than seven hundreds kilometres) to St.Petersburg, where he started his
education. Finally, he obtained an extraordinary broad education, received a lifetime
appointment to the Russian Academy of Sciences, and was recognised as an
outstanding scientist, scholar, and writer.
examples clearly show that man ultimately is a function of Process, but not
merely of biosphere or society. In other words, it is necessary to state three
distinct functional macro-orders of man's being:
animalis (HSA) - as a direct function of Biosphere.
sapiens (HSS) - as a direct function of Society.
cosmicus (HSC) - as a direct function of Process.
and HSS are the object (and subject) of numerous natural, human, and social
sectoral sciences, including philosophic anthropology, which originally treats
individuals as both creatures of their environment and creators of their own values,
and argues that human nature is complex and dynamic and is constantly able to
rediscover and re-create itself within the confines of its biology and culture.
At any rate,
both HSA and HSS ever are Bio-Social creatures, and never - Bio-Social-COSMIST ones.
In other words, Man here is ever a bio-organism, social actor, and a unique
person (in his adaptation to the society), but never a COSMIST actor of
executing his personal (functional, specific) assignment - contribution to the
wellbeing of one common Process (of course, man ever can exist and act
exclusively within society). Henceforth, cosmist approach challenges to replace
"being" (a basic concept that serves as a clear starting-point for
any serious metaphysicist) by "functioning" - as a more basic
concept, which points on the necessity of active evolution for every living
subject (chiefly, for a person).
this part of reasoning it would be relevant to present the cosmist definition
of individual's health: The individual's health refers to the successful
cosmist unity of adaptational and creative processes of the human organism and
personality. I likewise give its detailed characterisation in the EJAIB paper.
of the cosmist and Jozsef Kovacs's definitions of human health clearly
discloses the substantial distinction: The former treats individual's health as
a process, while the latter - as a state. This is quite naturally, for, cosmist
health is chiefly person-dependent health, while the other approach implies
mainly the society-dependent origin of health. In this, logically, life span of
man is always the ontogenesis (process) of the man's life, which is chiefly
observable, while the life span of a society is much more longer and scarcely
is observable for any scientific community.
Kovacs clearly states: "If the society, as a whole, is healthy, i.e. it
has reasonable social norms, then those individuals, who adapt well to this
society, are healthy, too." (p.37).
conclusion, which could follow from this statement, is that
"adaptation" is the ultimate end for man's health. It becomes
intelligible, then, why "reasonable social norms" play such a
conclusive role in Jozef Kovacs's framework of references to human health.
However, that is presentism of the first water, for, "reasonable social
norms" are eventually 'the given reasonable social norms' and, hence, -
'the given reasonable social norms of the given society'.
cosmist point of view, wellbeing (healthy) man is the one who succeeds as much
in his adaptation to the given environment as, likewise, - in (re)discovering
and realising the route (values and goals) of his functional ascending
integration into the successively higher emergent futures of his wellbeing
In this, it is
significant that Jozsef Kovacs's "man-made objects" have basically
the social essence ("scientific theories, religions, organisational forms,
etc."). On the contrary, cosmist 'man-made objects' have precisely the
personal essence: they are deliberately "man-made" effects and
results, which lead man to successful realisation of the man's micro- (of
actual adaptation - constructive creativity) and macro-evolutionary (of
ascending integration - cosmist creativity) life processes.
cosmist approach (paradigm) urgently intends (aiming at the end of rational
explanation of individual's health) to shift bioethical normativism from social
(objectivist and subjectivist) - to personalist (likewise objectivist and
subjectivist, of micro- and macro-evolutionary essence) level. Moreover, it
should be argued that exclusively personalist (cosmist) level of bioethics
aspires to be rational and to lead philosophy and science to universal
comprehension of individual's health and the integration of biomedical, social,
and human knowledge about human health (individual's wellbeing).
rejects the objectivist theories as philosophically untenable (p.36). However,
that is a significant point that cosmist approach harmoniously unites both
objectivist normativism with subjectivist normativism as much in social sphere
as in personal realm. At this point, objectivist normativism establishes the
values, which are conducive to man's successful adaptation and his ultimate
stable wellbeing on the given level (in the given society), while subjectivist
normativism deals with the disclosing of personally unique goals and values of
the man's wellbeing (micro- and macro-evolutionary; actual and of personality's
Jozsef Kovacs chiefly relies on the two basic notions: "adaptation"
and "environment", the cosmist approach involves as adaptation to the
environment (adaptational creativity is the central category in the cosmist
ontological framework; it serves to the realisation of micro-evolutionary
processes of man's wellbeing), as well as cosmist creativity - to the
macro-evolutionary ascending process of the man's wellbeing ontogenesis, of his
actively conducted personality growth, aimed at the man's ultimate
self-actualisation on the mature creative level of the wellbeing ontogenesis -
his direct functional contribution to Process's wellbeing.
man's 'mature creative level of wellbeing ontogenesis' has much in common with
Jozsef Kovacs's argument that "the more developed a society an individual
lives in, or the more advantageous social position he occupies, the more the
significance of biological adaptation decreases in his case" (p.37).
However, cosmist position treats this modern formed and free civilised man as a
person, who is just more close to reaching his creative level and executing
here his direct specific (functional) contribution to Process's wellbeing,
which is the meaning of man's life. The other crucial thesis, herein, is that,
ultimately, man's health (wellbeing) directly correlates with the extent of his
functional belongingness to Process. In other words, human health depends as
much on the society (and on the man's adaptational abilities) as (to a greater
extent, in my view) on the man's subjective ability and activity to
(re)discover (on the every ontogenetic macro-level) his basic functional
assignment realising it practically in observable results and effects - to be
eventually noticed and selected from his 'uterine' emergent future, and
executing it ultimately - on the mature creative macro-level of the man's
wellbeing ontogenesis - directly to Process's wellbeing.
further the cosmist topic, we wish to stress it once again that cosmist
approach aims 'at the end of rational explanation of individual's health'. What
are the warrants of this author's confidence? Firstly, there is a principle of
CosmoBiotypology, which establishes the functional identity (and thus the
universal meaning) of the three macro-levels of the man's (subject's)
integrated wellbeing: Of his subjective gratifying feelings and perceptions; of
his adequate position in the social (ecological) environment; and of his
biological constitution (biotype). The latter naturally serves to the
fulfilment of the man's cosmic (of Process) functional assignment. Thus, CosmoBiotypological
principle actually rationalise the entire cosmist approach and universalise
biomedical, social, and human knowledge. In other words, CosmoBiotypological
methodology aspires to unite rationally the man's subjective knowledge with the
objective knowledge about the man.
is well known, the central demand of modern philosophy is the autonomy of the
individual person. In the case of cosmist philosophy we precisely speak of 'the
FUNCTIONAL autonomy and responsibility of the person' (the latter has the
utmost pluralistic essence). On the contrary, morphologically (causally or
teleologically) man ever is a function of the given bioecological system and
words, cosmist approach strives to shift philosophy and science from bio-social-individual
(anthropocentric) level to the chiefly personalist (cosmist) level - of man's
direct responsibility for the discovery of his basic (ultimate, cosmist)
functionality, its evolution and ultimate realisation (directly to Process's
wellbeing) on the mature personal (creative) macro-level of the man's wellbeing
ontogenesis. Due to the cosmist approach, that is the sole rational way to the
man's wellbeing (healthy) ontogenesis.
it would be relevant to argue the following: Indeed, cosmist approach, at
present, has its specific peculiarities. However, to my firm belief, that is
not a rare avis. At least, Jozsef Kovacs's Concept itself and Lennart
Nordenfelt's well-known holistic welfare theory of health apparently are very
close to some crucial cosmist fundamentals. In this, I especially mean Kovacs's
stress on the point that "morality will always remain an inherent part of
defining health and disease, and the detailed specification of them will depend
on human wants and desires." (p.38). Likewise as Nordenfelt's
characteristic of health "as a person's ability to achieve his vital
goals, which is equivalent with his ability to realise his minimal happiness in
standard circumstances." (Nordenfelt, 1987, p.xi) can be treated as being consistent
with the cosmist fundamentals. Finally, I would like to refer to the position
of WHO, calling to a "change of attitudes and organisation of health
services, which refocuses on the total needs of the person as a whole
person." (WHO, 1992, p.6)
basing on Kovacs's terms of
"medicalisation" and "sociologisation" (p.35), it
can be claimed that along with the necessary further perfection of health care
medicalisation and sociologisation the time has come for its transcendence at
the stage of 'cosmologisation'.
AntiThesis: From medicalisation
to cosmologisation - from narrowness to marginality
Health is not universal. If playing
the dialectic emergence discourse, AntiThesis role is to disprove the Thesis.
The aim of this AntiThesis discourse is to raise the contradiction conceptually
and to criticise the main viewpoint, proposed in the Thesis.
The proposed Thesis tries to improve
that health (or ill-health) is the very outcome of our Weltanshauung or
overview of entity in general. Depending on how we behold this entity
(world/environment/facts-events [things happened around us], on how we imagine
our standpoint in this entity, on how we expose ourselves or how we come
emergent - we more or less become that. This idea supposes that our subjective,
personalised comprehension of reality mostly influence our physical, mental and
may be even social conditions, so impacts our health status quo as it is. If
so, it comes very paradoxical notion - that ontology shapes (or at least,
should impact) any kind of practice, including such result oriented practice as
medicine. The Thesis hence proposes extremely extensive angle of view, which is
specific only for ontology, theology or cosmology. But if watching so widely,
can we see any phenomena of reality more deeply?
This proposal also implicates that
we are not mere what we can measure, calculate and prove objectively, but
mostly what we embrace with our mind, what we feel or even imagine. According
to this, Thesis is grounded on very ontological and yet purely speculative
concept of Process. If being a positive
phenomenon itself, or phenomenon of reality should be proved not by the reason,
not by words, but by the experience itself. Of course, we may stare and
experience as well, that everything in this world is changing constantly - more
or less. The motion of stars and planets in the outer-space, shifts of seasons,
births and deaths of every living being, everyday changes of events and news -
why not to call it Process. But do we state by this notion something positive
and constructive in sense, for example for solving particular problems of
particular individuals. Can we argue that such approach would help us to answer
euthanasia dilemma for our patient? Such cosmist-ontological statements about
absolute functionality, integrity and subjectivity do not give us any
instrument for practical solution at all, especially ethical or social, or
political or even medical solution as well. So what, if Process continuous and
goes on to some unknown direction? What does it mean for me, for my family, for
my friends, who are ill now? Does it help them to feel better? Much more
important, does it help medical professionals and scientists? They will
probably, say: "We know that for a long time, we know even some aspects of this
process, but you - philosophers or whoever - know only that the process
Furthermore, how can we know, that
this process is really positive? If taken from a personal life perspective, my
health everyday becomes worse and the more I live the more I come close to end
of my personal process, to death. The whole life process is just preparation
for death [Seneca]. Is the death positive end of nature; is it the goal of an
emergent evolutionary process?
The origin of the Thesis of cosmic
evolutionary process of life on the Earth seems to refuse our immediate
phenomenological experience of life on the Earth. We can see in the life
process (on the Earth at least) that for reaching of subjective well-being, the
health as well, mostly living beings must to kill or just to harm other living
beings, if they want to survive or to keep themselves healthy and surviving in
general. Even a man is not able to escape the deny of the ontogenesis of living
biological process just because of the so-called based needs like nutrition,
hydration or safety. The proposed principle about cosmic origin of Process
seems in conflict with principle of the struggle for existence/life in
Darwinian theory of evolution of species. So the idea of ontogenesis and its
impact for human health in general is not the idea par excellence even in the
Hence even starting the
philosophical cosmic approach, here come some conceptual AntiThesis proposals:
The Thesis' original concepts of
absolutism and cosmism expose extremely broad viewpoint. This view goes beyond
our empirical knowledge about reality as such. This goes beyond the human
ability to embrace all process of all living beings in the whole reality, even
if applying the method of analogy. Even more, it based on the a priori
postulates, that the all reality components are organised as integrated and
"put in order"(cosmist). But why not to call it chaos, according to facts of
terrible diseases, such as AIDS?
We don't have
any scientific evidences about the ontogenesis between evolutionary
micro-processes of living beings on the Earth and the macro cosmological
process in the outer Universe. Despite some hypothesis and beliefs based on the
finding of Genetics, Molecular biology etc., in micro-cosmos as well as finding
of Physics and Astronomy in macro-cosmos, are we able to integrate all that
myriad of elements and their interactions even virtually? Furthermore, these
findings are occasional, not always valid and they can give us not more than
imaginations about the wholeness of Process, its purpose and its ontogenesis.
of universality is not to be the object of any constructive approach. The
concept of universality challenge by human mind, human knowledge and human
experience. Everything-ness the same as nothing-ness is impossible to be
verified. The only alternative is left then - to belief in universal functional
integration and in universal emergent evolutionism. Cosmist-universalistic
approach is much more close to the mystical teaching of Lao Tzu concept of Dao
(principle of universality wholeness of every component of reality), which
actually has no particular meaning and no particular significant role in the
traditional discourse of arguments and logical implications. Either you take it
in, or just escape as incomprehensible.
proposal is based on the personalist approach in sense that every human person
is an ultimate function of Process. What is the meaning of health in such
Let's say health is supposed to be a balance
between what a person wants and what he is able to do Actually it is an
understanding based on the expressions of "how do I feel". It means - "right
now I am just feeling no accessory influences from my own body and mind". Just
there is no pain, no disability, no suffering. I am simply not determined
physically, mentally, socially or spiritually. When a human organism is healthy
and functions in appropriate manner, the balance between wishes and abilities
is achieved. For example, normally you never feel the beating of healthy heart
and never think about it, because healthy heart seems like it does not exist.
Then the main criterion of such
interpretation of health refers to individual's inner state of being at the
present time according to self-experience. So the interpretation of health as a
value is taken depending on individual preferences. It is quite obvious that
such interpretation is a purely subjective one, hence very changeable and
dynamic. Basically it depends on the personal features and is far away from the
possibility of consensus. But how to recognise these feelings for those who
strive to help these persons?
So a man can transcend society only
in his own feelings, beliefs or imaginations, but it is never possible in the
interactions or relationships with others, especially while healing or curing
process is running. If following cosmist personalism model all relationships
between doctors and their patients should be grounded on the subjective
emergencies of personalities, particularly, trying to understand each other in
very intimate and probably in intuitive manner. Of course, so called biomedical
model of health is recognised as too narrow, but the cosmist model of health
seems to go to other marginality -
it takes over all-embracing reality and even more than that, as it was stated
earlier. Can we embrace, evaluate or make the object of research the wholeness
of personality as such?
transforming to bio-social-cosmist model leads to elimination of possibility of
consensus of common values in society, which is not escapable today even for
current Robinsons. The cosmist personalism excludes health as social value
interpretation, but for now it is very clear that the objective needs of the
society are more preferable than subjective personal needs. Hence not those
human organisms are the healthiest, who are capable of attaining the biological
"aims" of these organisms, but those who are capable of attaining the goals set
by the society (Kovacs, 1998). That's why so many endeavours are put now in the
public health control and health promotion to make people happy and healthy
despite their universal or purely personal functions in the Cosmos.
Contemporary societies are hardly able to treat every its members biological
and social well-being or to demand even more - it seems too idealistic and
According to famous psychologist and
philosopher A. Maslow (1959), "when people satisfy their basic needs, the
consciousness opens for the new, "higher" need". But to satisfy them might help
only well organised society where consensus of values is set on. So if a man
feels no hunger, if he feels safe and satisfied enough with lower needs, he may
go further up to self-realisation or self-actualisation. When realised his
potentialities, individual becomes very precious for society. But if only
physiological or emotional well-being is violated, individual's
self-realisation is stopped and he needs the social help to restore it.
Although self-realisation is an individual action, it is mostly tend to the
social integrity. So the individual and social interests are closely related
and society is very concerned with having healthy members, because being
healthy they might be more beneficial improving social needs.
Indeed, the notion of health is
probably the most challengeable for the Western kind of mind. The shift from
objectivity to subjectivity is increasing and changing understanding of health
as such. The current paradigm - Western mainstream biomedical (bioethical)
paradigm - is really too short as just disclosing of the causes of the
all-existing diseases and thus taking them all under the scientific control.
Medicalisation process has achieved almost its highest point of culmination and
by many authors was recognised importance for transforming it to broader realm
of sociologisation (Kovacs, 1998; Parsons, 1950; Nordenfelt, 1993). At least
the WHO document "Health for all in XXI century" recognised the need for
integration between various parties, including holistic approaches of health.
Anyway further shift to cosmologisation is a bound toward the land of
uncertainty of concepts and applications in the practice.
to the EDM-design, next the stage of SynThesis must follow. Indeed, during the
work, we initially were seeking for a SynThesis-author and had good
candidatures for this role. Eventually, however, we went away from this idea.
The point is that we are aiming at the end of genuine freedom of a
SynThesis-writer whoever he will be. In this order, we decided to leave the
Synthesis section of our paper open, and to introduce only the Thesis and
AntiThesis to the readership. That is the reliable guarantee, in our view, that
a SynThesis-author will be free from any obligations as a member of EDM-team
and, thus, - absolutely free in
his analysis and conclusions - of all - for the true realisation of the whole
Emergence-Discourse method in philosophy of medicine and health care.
Khroutski, K.S.: 2000, 'Individual
Health: New Definition and Ontological Background', Medical Ethics &
Bioethics (Bratislava) 7 (1-2), 14-17.
Khroutski, K.S.: 2001, 'Doctor of
Tomorrow - Physician, Psychologist, Philosopher: Towards the Cosmist-Hippocratic Ethics in
Biomedicine', E-Logos (http://nb.vse.cz/kfil/elogos/ethics/)
Khroutski, K.S.: 2001, 'Introducing
Philosophical Cosmology', World Future 57(3), pp. 201-212.
Khroutski, K.S.: 2001, 'The Doctor
of Tomorrow - Physician, Psychologist, Philosopher: Towards the
Cosmist-Hippocratic Ethics in Biomedicine', Appraisal 3(4), pp. 135-146.
K.S.: 2002, 'Towards the Bioethics of Individual's Health: Introduction of the
Cosmist Philosophical Fundamentals', Eubios Journal of Asian and International
Bioethics 12(1), pp.2-9. (E-access: http://eubios.info/ejaib121.htm
K.S.: 2002, 'Epistemology of civilised
man diseases', E-Logos
Kovacs, J.: 1998, 'The concept of
health and disease', Medicine, Health Care and Philosophy 1, pp.31-39.
Maslow, A.: 1959, New Knowledge in
Human Values. New York: Harper
L.: 1987, On the nature of health. An action-theoretic approach. Dordrecht-Boston: D.Reidel Rublishing
Nordenfelt, L.: 1993, 'Concepts of
health and their consequences for health care', Theoretical Medicine 14 (4):
Parsons, T.: 1950, The Social
System. Glencoe: Free Press.
Charter for Health Promotion: 1992, WHO Reg.Publ.Eur.Ser. 44, pp.1-7.
Veber, V.R. and Khroutski, K.S.:
2000, 'Health - a central ontological problem', ESPMH Conference, Krakow 2000 -
Abstracts, Medicine, Health Care and Philosophy. 3 (3): p.381.
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