Rizzi D A, Pedersen S A
Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Denmark.
Theor Med. 1992 Sep;13(3):233-54. doi: 10.1007/BF00489201.
One of the cornerstones of modern medicine is the search for what causes diseases to develop. A conception of multifactorial disease causes has emerged over the years. Theories of disease causation, however, have not quite been developed in accordance with this view. It is the purpose of this paper to provide a fundamental explication of aspects of causation relevant for discussing causes of disease. The first part of the analysis will discuss discrimination between singular and general causality. Singular causality, as in the specific patient, is a relation between a concrete sequence of causally linked events. General causation, e.g. as in disease etiology, means various categories of causal relations between event types. The paper introduces the concept of a reference case serving as a source for causal inference, reaching beyond the concept of general causality. The second part of the analysis provides exemplification of a theory of causation suitable for discussing singular causation. The chain of events that induce a disease state can be identified as effective causal complexes, each complex composed of non-redundant components, which separately contribute to the effect of the complex, without the individual component being necessary or sufficient in itself to produce the effect. In the third part of the analysis the theory is elaborated further. Causes, defined as non-redundant components, can furthermore be differentiated according to their avoidability, according to theories about human error or by the potential of eradication. Multifactorial models of disease creates a need for systematic approaches to causal factors. The paper proposes a taxonomical terminology that serves this purpose.
现代医学的基石之一是探寻疾病发生的原因。多年来，已形成了多因素致病原因的概念。然而，疾病因果关系理论的发展与这一观点并不完全契合。本文旨在对与讨论疾病病因相关的因果关系方面进行基本阐释。分析的第一部分将讨论单称因果关系和一般因果关系的区别。单称因果关系，如在特定患者中，是一系列因果相连事件的具体序列之间的关系。一般因果关系，例如在疾病病因学中，是事件类型之间不同类别的因果关系。本文引入了作为因果推断来源的参考病例概念，超越了一般因果关系的概念。分析的第二部分举例说明了一种适用于讨论单称因果关系的因果关系理论。引发疾病状态的事件链可被确定为有效的因果复合体，每个复合体由非冗余成分组成，这些成分分别对复合体的效果有贡献，而单个成分本身并非产生该效果所必需或充分的条件。在分析的第三部分，该理论得到进一步阐述。根据关于人为错误的理论或根除的可能性，定义为非冗余成分的原因还可根据其可避免性进行区分。疾病的多因素模型产生了对因果因素采取系统方法的需求。本文提出了一种用于此目的的分类术语。
