Medical Worldviews

A worldview or eine Weltanschauung, originally coined by Immanuel Kant (1724-1804) in the Critique of the Power of Judgment (2000), is a notion composed of beliefs that allow us to make sense of the world and to act in it.1 Although Kant used the term to account for the sense perception of the world, it has since then taken on a more expansive meaning. For example, the German philosopher, Wilhelm Dilthey (1833-1911), defined a worldview in terms of what is known about the world and how that knowledge is judged and responded to.2 Many contemporary definitions emphasize some facet of Dilthey’s definition. The most common definition takes a worldview to be an all-encompassing philosophy of life, composed of a personal or a social ideology. For example, Ninian Smart (2000) uses the notion of worldview to examine traditional beliefs and feelings associated with various world religions. Although he avoids defining the term, he does discuss parameters essential to a worldview, such as the mythical, emotional, and ethical.

Modern medicine is certainly part of a larger worldview that constitutes western culture. In this chapter, the metaphysical positions, along with the metaphysical presuppositions and ontological commitments, which ground the biomedical and humanistic or humane models, are discussed, before examining the other metaphysical issues concerning these models. The metaphysical positions or stances that a physician may take towards a patient and other medical entities include monism, dualism, or holism. Associated with these positions or stances are the metaphysical presuppositions of reductionism and emergentism, as well as the ontological commitments of physicalism or materialism and organicism (Table 1.1). I begin with metaphysics, analyzing the positions, presuppositions and commitments upon which medical knowledge and practice are founded; for they influence and constrain the ontological entities-such as bodies, persons, and drugs-and the metaphysical concepts-such as causation, disease, and health-that compose medical worldviews.