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Philosophy, Medicine and Healthcare: Insights from the Italian Experience

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Abstract

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified—the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the ‘Postmodern’ Era—which can be seen, à la Foucault, as ‘fragments between philosophical fractures’. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care.

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Notes

  1. Glouberman shows how broad philosophical issues affect the way we conceive of health and illness, and how this has a profound impact on all areas of the health field, from government policies to how we look at our own health. “Our ideas about (1) order and disorder, (2) how we relate to the natural world, (3) how we know who we are, are so pervasive that it is hard for us to recognise how much they influence our thinking in general and about health and illness in particular. As they have changed dramatically over time to become richer and more complex, many of our ideas about health have followed” [24, p. 3]. According to Engels, philosophical ideas have a direct bearing on what are considered the proper boundaries of professional responsibility as well as the attitudes towards patients [17].

  2. [6, p. 24].

  3. [20].

  4. [22, p. 202].

  5. [20, p. 19].

  6. [37, p. 102].

  7. In this case beneficial treatment consisted of forcing the intruder out, by making the body inhospitable for the spirit through violence, torture and fasting, or by expelling the evil spirit through potions provoking vomit, or by removing the spirit by means of a hole made in the cranium.

  8. [28], passim.

  9. [37, pp. 2–3].

  10. [20, pp. 82–83].

  11. [24, p. 4].

  12. [21, p. 17].

  13. [47, p. 9].

  14. [48, Vol. I], passim.

  15. [45], passim.

  16. [9, p. 30].

  17. [33].

  18. [19], passim.

  19. [29], passim.

  20. [47, pp. 331–348].

  21. The experimental methodology extrapolates a body from its natural environment and puts it in an artificial controlled environment where tests are carried out.

  22. [25], passim.

  23. [28].

  24. [7, pp. 6–7].

  25. [24].

  26. [23], passim.

  27. [35, p. 6].

  28. [10, p. 15].

  29. [28].

  30. [18, p. 112].

  31. [35, p. 11].

  32. [18, p. 112].

  33. [14, pp. 44–45].

  34. [42].

  35. [12].

  36. Ronzani writes, with reference to the medieval hospital: “Infirmaries were usually located in humid and dark rooms, without other facilities apart from some primitive latrines. Only poor people were hospitalized, since affluent families used to cure their sick at home. In each room there were patients with clinical, surgical or infectious diseases: two, three or even four persons per bed. Quite rarely there was a separate room for acutely ill patients. Therefore, quite often patients with slight diseases, became affected by fatal infections after hospitalization. The mortality rate was very high, mainly among puerperants and the wounded. All services, from the more intimate to the more insalubrious, were provided within the same room. Sometimes corpses remained for a long time in the beds, close to other patients, before removal” [46, p. 22].

  37. [49, p.12].

  38. [31, pp. 164–165].

  39. [8].

  40. [41].

  41. [16].

  42. [30, p. 201].

  43. [34].

  44. [15, p. 99].

  45. [14].

  46. [26, p. 74].

  47. [27].

  48. [14].

  49. [32], passim.

  50. [40].

  51. [1, 2].

  52. [3].

  53. [11].

  54. [5].

  55. The market mechanism stimulates consumption in that it regulates transactions on the basis not of the use value—in other words the advantage obtainable in terms of health—but rather of the exchange value, namely the encounter between demand and supply. In addition, supply, by virtue of the specific peculiarity of the sector, is able to condition demand.

  56. It is interesting to note that at the same time the industry pushes toward the increase of parameters which define the legal thresholds for polluting factors.

  57. We refer not only to plastic surgery, but also to the reduction of sleep needs, the enhancement of memory or of physical strength.

  58. [50, pp. 36–37].

  59. [13, p. 220].

  60. [44, p. 183].

  61. [36].

  62. [39].

  63. This approach has been taken up by Mintzberg in his latest book, where “to manage” is defined “not just to walk a tightrope, but to move through a multidimensional space on all kinds of tightropes” (p. 192). An interesting quotation by Scott Fitzgerald is then reported (p. 193): “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function” [38, pp. 192–193].

  64. Mintzberg, ibidem.

  65. [3, pp. 22–32].

  66. Mintzberg, ibidem.

  67. [38, p. 191].

  68. [38, p. 186].

  69. “Many organizations, in health care and beyond, are just too big” [38, p. 172].

  70. As Mintzberg observes. “To manage nursing in a hospital seems natural enough. But what about managing nursing in two hospitals, a few miles apart, that have been magically merged on a sheet of paper?” [38, p. 165].

  71. [38, p. 192].

  72. [4].

Abbreviations

EBM:

Evidence based medicine

ICT:

Information and communication technologies

LHU:

Local health units

MBO:

Management by objectives

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  1. Università degli Studi di Salerno, Via Ponte don Melillo, 84084, Fisciano, SA, Italy

    Paola Adinolfi

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Adinolfi, P. Philosophy, Medicine and Healthcare: Insights from the Italian Experience. Health Care Anal 22, 223–244 (2014). https://doi.org/10.1007/s10728-012-0208-1

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