Svenaeus F
Department of Health and Society, University of Linköping, Sweden.
Theor Med Bioeth. 2000;21(2):171-89. doi: 10.1023/a:1009942926545.
In this article I scrutinize the question whether clinical medicine, in order to be considered a hermeneutical enterprise, must be thought of as a reading of different "texts." Three different proposals for a definition of the concept of text in medicine, suggested by other hermeneuticians, are discussed. All three proposals are shown to be unsatisfying in various ways. Instead of attempting to find a fourth definition of the concept of text suitable to a hermeneutics of medicine, I then try to show that the assumption that one needs to operate with the concept of text in order to develop a hermeneutics of medicine is false. Clinical interpretation can be shown to essentially consist in a dialogical hermeneutics, the pattern of which can be found in the philosophy of Hans-Georg Gadamer. This kind of hermeneutics is not a methodology of text reading, but an ontological, phenomenological hermeneutics in which understanding is a necessary feature of the being-together of human beings in the world. This being-together in and through language takes on a peculiar form in the clinical encounter, since the medical meeting is typically characterized by an asymmetrical enstrangement and has a specific goal--health for the patient--absent in other forms of hermeneutics. Central issues of Gadamer's philosophy, e.g. "fusion of horizons," are shown to fit the structure of clinical practice.
在本文中，我仔细审视了这样一个问题：临床医学若要被视为一种诠释学事业，是否必须被看作是对不同“文本”的解读。文中讨论了其他诠释学家提出的关于医学中“文本”概念定义的三种不同提议。结果表明，这三种提议都在不同方面存在不足。我并未试图去寻找适合医学诠释学的“文本”概念的第四种定义，而是试图表明，那种认为为了发展医学诠释学就需要运用“文本”概念的假设是错误的。临床诠释本质上可被证明是一种对话式诠释学，其模式可在汉斯 - 格奥尔格·伽达默尔的哲学中找到。这种诠释学并非文本阅读的方法论，而是一种本体论的、现象学的诠释学，在其中理解是人类在世界中共同存在的一个必要特征。在临床相遇中，这种通过语言的共同存在呈现出一种特殊形式，因为医患会面的典型特征是一种不对称的陌生感，并且有着一个在其他诠释学形式中不存在的特定目标——患者的健康。伽达默尔哲学的核心问题，比如“视域融合”，被证明与临床实践的结构相契合。
