title: The rationale of value-laden medicine.
abstract: Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health-enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived-body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value-laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services.
authors.affiliation: Faculty of Medicine, University of Chile, Casilla 16168, Correo 9, Santiago, Chile. kottow@hotmail.com
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kottow
mesh_terms: D001675:Bioethics; D020811:Biomedical Technology; D003695:Delivery of Health Care; D006801:Humans; D010686:Philosophy, Medical; D012945:Social Values