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Discourse ethics in practical medicine
  1. F Keller,
  2. G Allert,
  3. H Baitsch,
  4. G Sponholz,
  5. Ethics in Medicine Working Group at the University of Ulm
  1. Medical Faculty, University of Ulm, Germany
  1. Correspondence to:
 Dr F Keller
 Dvision of Nephrology, Medical Faculty, University Hospital, Robert Koch Strasse 8, D-89070 Ulm, Germany; frieder.keller{at}


Problems emerge in practical medicine because the binary ethics of the classic patient/doctor relationship has been replaced by multiagent interaction between those engaged in the process of diagnosis and treatment. New methods are required to deal with complex problems in every patient. Where and why the current practice can fail is illustrated with an example of an unspectacular routine case of cancer. The failure may result from basing the procedure on mechanistic methods or from the deficit and difficulty in communication. Whether rule based algorithms could have improved the treatment in the patient with cancer is discussed. How discourse ethics may fit better with the course of the case is described. Clinical Medicine follows a similar logic to that modelled by discursive ethics, ethics thinking should essentially contribute to the procedural logic of medical practice. Discourse ethics can be used as a procedural model that copes with the complexity and temporality of practical medicine. Applied discourse ethics can turn out to be both instrumental in mediating inherent conflicts and constitutive for value based problem solving in modern medical practice.

  • clinical medicine
  • rule based inference
  • discourse ethics
  • Juergen Habermas

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  • * Clinical medicine could be handled as the mapping of the whole scale of true premises (+x) or false premises (−x) into a decision (y) with veracity values between zero (y = ±0) and one (y = +1). Possible conclusions are all more or less “right”, more or less likely, but decisively so (0<y<1). For such mapping, any sigmoid or logistic function could be proposed, such as the following Fermi function: Decision (y) = 1/[1+exp(−Σ±Premise (xi))]. With often ambiguous premises (±Premise xi = 0), as for example in clinical medicine, an equivocal truth value is calculated (Decision y = 0.5). With any changing premise (xi), the veracity value of a decision can change (y). Thus, a multigranular or a temporal logic is less a problem of too complex mathematics than a problem of parameterising the real situation.

  • Competing interests: none declared.