Abstract
Scientific knowledge is a symbolic system consisting of hypotheses, models and theories generated by means of a paradigm-mediated interaction between a scientific community and a research domain. Such a knowledge generating paradigm consists of already existing theories, as well as methodological and ontological beliefs or assumptions. In this article it is argued that the meaning ascribed to the central concepts of medical science(such as patient, disease, causality and therapy) are fundamentally determined by the 19th century logical positivist scientific paradigm. The ontological and methodological implications of the postmodern natural sciences (e.g. quantum physics) have not been applied to medical science. The 19th century ‘natural science paradigm’ therefore acts as a metatheory for both medical science and medical practice. However, the theoretical knowledge system generated by medical science acts as the theory for the practice of scientific clinical medicine which therefore functions with the same understanding of the central concepts such as patient, disease and disease causality, therapy etc. The limitations of this paradigmatic monism are illustrated by an analysis of the medical and societal response to the AIDS epidemic and it is concluded that medical science and practice, because of the complexity o f its research and practice domain, must accept in principle the possibility of paradigmatic pluralism (as in the social sciences) or should attempt to develop a holistic paradigm that will cope more adequately with its fields of research and practice.
Highlights
Scientific knowledge is a symbolic system generated by means o f a paradigmmediated interaction between a researcher or research group and an aspect of reality
In the explanatory framework o f the natural science paradigm, all events are explained in terms o f antecedent events organized in causal chains and networks which are characterizable in terms o f universal laws which make no reference to the causal efficaciousness of future events or higher levels of organization
The output o f the research activity o f medical science is a theoretical symbolic system which at the same time acts as the ‘theory’ for the ‘practice o f m edicine’
Summary
Scientific knowledge is a symbolic system generated by means o f a paradigmmediated interaction between a researcher or research group and an aspect of reality (the research domain). A paradigm change involves changes in the theoretical beliefs (‘know ledge’) o f a scientific community, but more importantly in the methodological beliefs and ontological assumptions This is what happened during the Enlighten ment when the neo-Aristotelian paradigm that dominated the intellectual life of the Middle Ages and formed the conceptual framework in terms o f which theorizing took place about the natural world (physical, biological), as well as the social and spiritual (religious) aspects of life, was slowly replaced by what is called the natural science paradigm. Because of the explanatory and predictive power o f the developing natural science paradigm it w as applied to the biological or life world on the assumption that the structure o f the life world was intrinsically the same as that o f the physical world and that the general principles o f the physical sciences were adequate to access this aspect o f reality as well. It is necessary to clarify the characteristics o f the natural science paradigm and to show how the acceptance o f this paradigm by medicine affected the m ajor concepts in medical science
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