Introducing the 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: hrucki@mail.ru

- Eimantas Peicius

Kaunas University; Sartu 29, Kaunas, LT-3042, Lithuania; E-mail: eimpei@takas.lt

Eubios Journal of Asian and International Bioethics 13 (2003), 15-19.


Abstract

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 SynThesis-mission.

Key words: philosophy of medicine, bioethics, individual's health, emergence, dialectics, personalism, wholism

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:

1. True 'Thesis-AntiThesis-SynThesis'-order.

2. Clear model of translation ideas into reality - of informational message emergence and transference, with its transforming (translation) from one code  (of the   '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 synthesis:

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 emergence;

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 mainstream concept.

Henceforth, Emergence-Discourse 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 Discourse.

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) SynThesis.

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 biomedicine?

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 and Disease".

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.

Finally, the 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.    

In conclusion 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.

Next, the 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 substance).

Finally, we 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 scientific framework.

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.

The 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 cosmist epistemology.

Now, entering 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 society (p.38).

On 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'.

Notions of 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.

Hence, Western '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.

On the 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.

Definition of 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.

The other 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.

These two 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:

Homo Sapiens animalis (HSA) - as a direct function of Biosphere.

Homo Sapiens sapiens (HSS) - as a direct function of Society.

Homo Sapiens cosmicus (HSC) - as a direct function of Process.

HSA 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).

To conclude 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.

The comparison 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.

Indeed, Jozsef 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).

The tenable 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'.

From the 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 ontogenesis.

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.

Therefore, 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).

Jozsef Kovacs 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 growth).

Indeed, while 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.

Noteworthy, 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.

Developing 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.

As it 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 the society.

In other 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.

In conclusion, 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)

Henceforth, 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 exists".

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 cosmological context.

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.

The principle 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.

Another Thesis 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 context then?

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?

Bio-social-individual model 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 rather impossible.

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.

Conclusion

Naturally, due 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.

References

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.

Khroutski, 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 )

Khroutski, K.S.: 2002, 'Epistemology of civilised man diseases', E-Logos  
(http://nb.vse.cz/kfil/elogos/epistemology/khrout1-02.htm)

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 & Bros.

Nordenfelt, L.: 1987, On the nature of health. An action-theoretic approach.  Dordrecht-Boston: D.Reidel Rublishing Company.

Nordenfelt, L.: 1993, 'Concepts of health and their consequences for health care', Theoretical Medicine 14 (4): pp. 277-285.

Parsons, T.: 1950, The Social System.  Glencoe: Free Press.

The Ottawa 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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