Theoretical Medicine

, Volume 13, Issue 3, pp 233–254 | Cite as

Causality in medicine: Towards a theory and terminology

  • Dominick A. Rizzi
  • Stig Andur Pedersen


One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease.

The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality.

The second part of the analysis provides exemplification of a theory of causation suitable for discussing singular causation. The chain of events that induce a disease state can be identified as effective causal complexes, each complex composed of nonredundant components, which separately contribute to the effect of the complex, without the individual component being necessary or sufficient in itself to produce the effect. In the third part of the analysis the theory is elaborated further. Causes, defined as nonredundant components, can furthermore be differentiated according to their avoidability, according to theories about human error or by the potential of eradication.

Multifactorial models of disease creates a need for systematic approaches to causal factors. The paper proposes a taxonomical terminology that serves this purpose.

Key words

causal reasoning causality disease etiology human error philosophy of medicine 


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  1. 1.
    Wulff HR, Andur Pedersen S, Rosenberg R. Philosophy of Medicine: An Introduction. Oxford: Blackwell Scientific Publications, 1986.Google Scholar
  2. 2.
    Kassirer JP. Diagnostic reasoning. Ann Intern Med 1989; 110: 893–900.Google Scholar
  3. 3.
    Wulff HR. Rational Diagnosis and Treatment. 2nd ed. Oxford: Blackwell Scientific Publications, 1981.Google Scholar
  4. 4.
    Kuipers B. Commonsense reasoning about causality: deriving behavior from structure. Artificial Intelligence 1984; 24: 169–203.Google Scholar
  5. 5.
    Murphy EA. The Logic of Medicine. Baltimore: The Johns Hopkins University Press, 1976.Google Scholar
  6. 6.
    Mackie JL. The Cement of the Universe. A Study of Causation. Oxford: Clarendon Press, 1974.Google Scholar
  7. 7.
    Andur Pedersen S, Rasmussen J. Causal and diagnostic reasoning in medicine and engineering. In: Andersen HB, Andur Pedersen S, Cacciabue C, Reason J, eds. Proceedings of the 2nd MOHAWC Workshop, Manchester, November 1990. Risø: Risø National Laboratory Press (in press).Google Scholar
  8. 8.
    Andur Pedersen S. Causal and Diagnostic Reasoning in Medicine. Roskilde: Institute of Mathematics, Roskilde University, 1990. (Tekster fra IMFUFA. Text no. 193).Google Scholar
  9. 9.
    Lindahl BIB. On weighting causes of death. An analysis of purposes and criteria of selection. In: Brändström A, Tedebrand L-G, eds. Society, Health and Population during the Demographic Transition. Stockholm: Almqvist and Wiksell International, 1988: 131–56.Google Scholar
  10. 10.
    Mackie JL. Causes and conditions. American Philosophical Quarterly 1965; ii: 245–64.Google Scholar
  11. 11.
    Lakoff G. Women, Fire and Dangerous Things. What Categories Reveal About the Mind. Chicago: The University of Chicago Press, 1987.Google Scholar
  12. 12.
    Rosch E. Principles of categorization. In: Rosch E, Lloud BB, eds. Cognition and Categorization. Hillside, NJ: Lawrence Erlbaum, 1978: 27–48.Google Scholar
  13. 13.
    Reason J. Human Error. Cambridge: Cambridge University Press, 1990.Google Scholar
  14. 14.
    Leplat J, Rasmussen J. Analysis of human errors in industrial incident and accidents for improvement of work safety. Accid Anal Prev 1984; 16: 77–88.Google Scholar
  15. 15.
    Rasmussen J. Human error and the problem of causality in analysis of accidents. Philosophical Transactions of the Royal Society of London 1990; B 327: 449–62.Google Scholar
  16. 16.
    Rasmussen J. Coping Safely with Complex Systems. (unpublished manuscript). (Invited paper for the annual meeting of the American Association for the Advancement of Science, Boston, February, 1988.)Google Scholar

Copyright information

© Kluwer Academic Publishers 1992

Authors and Affiliations

  • Dominick A. Rizzi
    • 1
  • Stig Andur Pedersen
    • 2
  1. 1.Unit of Medical Philosophy and Clinical TheoryUniversity of Copenhagen, PanuminstituttetCopenhagen NDenmark
  2. 2.Department of MathematicsRoskilde University CenterRoskildeDenmark

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