Perhaps the greatest irony of all where medicine is concerned is that in its normative dimension it was once clear-headed and advanced, but is now backward and confused, while in its scientific dimension medicine was once backward and confused, but is now relatively more advanced.
In fact, the normative dimension of medicine is now hardly recogized at all. Not one doctor in a thousand could even guess what that dimension would look like, and even that one would almost certainly be wrong.
In its origins, at least in Ancient Greece, medicine adopted the elimination of illness and dysfunction as a goal. There were any number of urgently practical matters to deal with in this light, such as setting broken bones, and dealing with plagues. On the other hand, in addition to goals such as these, Chinese medicine also consistently kept other medical goals in mind. The Taoists, for example, sought physical immortality, and adopted the concept of "chi" — or "energy" — as central to their thinking. On their view, medicine was concerned not only with the elimination of illness and dysfunction, but also, and at least equally, with enhancement of vitality and quality and quantity of life. In other words, Chinese medicine was far more broadly normative than western medicine has ever been.
For many thousands of years, medical practice often did more harm than good. During this period, medicine hadn't yet been established on a firm scientific foundation, and assorted superstitions held sway. Until Galileo, science itself could hardly have been said to exist. While other Renaissance figures began to work out a more rationalistic approach (including, interestingly enough, Rene Descartes), it was only late in the 19th century that a more robustly scientific medical discipline began to be established. From that point forward, the relevance of biology to medicine became increasingly better understood and effectively applied.
Yet this desperately needed scientific approach came at a terrible price: science is concerned exclusively with the factual, and medicine, as a science, knows nothing whatsoever of norms — or of the desirable. Strictly speaking, even goals such as the elimination of disease fall outside of science proper. Accordingly, discussion of such extra-scientifc concepts as norms and goals fell under deep suspicion in the early era of both science generally, and medicine specifically. Biologists and psychologists, in particular, were keen to exorcize all talk of purpose, which implies goal-seeking. It was only later, with the emergence of disciplines such as cybernetics that a concept like "goal" could make a respectable reappearance. Yet most scientists, and even many philosophers, are still out to sea where norms and goals are concerned. And this has created a kind of vacuum of purpose in medicine.
Late in the 20th century, the normative dimension of medicine began to make a hesitant and rather confused re-appearance. A fuller understanding of the normative, and its integration with the scientific, hasn't yet been achieved. However, we believe that an integration of this kind provides, by far, the best orientation for medicine in the 21st century. Accordingly, essays exploring this orientation will be appearing shortly at Everything Progressive (primarily as one aspect of optimal self-management, or OSM).
The philosophical discipline of ethics should seek to clearly describe higher ceilings for both medical practice and for the discipline of psychology. Ethicists should adovcate, in particular, for the re-establishment of the extension of life as a primary research objective. (The assorted process of aging together constitute the leading causes of death, but don't appear as such in any table of leading causes.) Still, as desirable as that may be, this is nevertheless only a single, fragmentary objective and a more comprehensive, overarching framework remains in need of development. The Taoist concept of "chi" also needs re-examination in both a scientific perspective and as a key part of a guiding conceptual framework for medicine.
Everything else in life has its foundation in good health, making the achievement and maintenance of good, or far better still, optimal health, an objective of fundamental importance. Yet even this is a fragmentary objective. What is really called for is the total integration of medical ideals with optimal psychological function, both in the context of a theory of life purpose and a rational morality. In turn, this ideal makes most sense in the context of an optimally functioning society.
Everything Progressive is fully committed to the clarification and achievement of these goals, as will be more apparent in the months to come.
The Editor / Everything Progressive