Abstract
M.A.
Modern scientific medicine, in both its clinical method and its scientific practice, assumes a view of science, a view of reality (ontology) and, as a consequence, a biological anthropology which has far reaching implications for both scientific and clinical medical practice, as they determine to a large extent the meanings ascribed to the central concepts of medicine namely patient, health, disease and therapy. In this dissertation it is argued that these limited and inadequate meanings underlie the dissatisfaction with scientific medicine by the public and certain sections of the medical profession. The central thesis of the dissertation is that any attempt to transform the clinical method (in order to address the dissatisfactions with and limitations of the traditional clinical method) will have to be based on an alternative understanding of science, as well as an altternative understanding of reality and of the human person (consciousness). The assumption underlying the thesis is therefore that the present understandings of science, reality and the human person are not "self-evidently true" (although they may seem that way to the modern medical researcher and practitioner), but have a history influenced by contingent factors - a history which therefore could have been different. ,
The first chapter traces the historical roots of the relationship between modern medicine and modern science. This is followed by a conceptual model of positivist natural science and its medical equivalent, here referred to as biomedicine. The limitations of this approach to medicine are then outlined as well as attempts to redefine medical science (in order to relate it more adequately to the complex reality which is the ill person) by Engel (1988) and by Schwartz and Wiggins (1988). This section ends with an attempt to develop a more encompassing model of science based largely on the conceptual model of the natural sciences proposed by Radnitzky (1972) and of the human sciences by Mouton and Marais (1988). According to this model, scientific knowledge is a symbolic conceptual structure generated by a paradigm-mediated interaction between a community of researchers and their research domain. Because of the central role of paradigms in the generation of scientific knowledge, this model thus postulates an intimate link between the assumptions regarding the ultimate nature of the research domain, and the methodology which will be considered to provide valid knowledge of that domain - and thus to be scientific.