Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal.
Philos Ethics Humanit Med. 2020 Apr 16;15(1):3. doi: 10.1186/s13010-020-00087-2.
What is considered normal determines clinical practice in medicine and has implications at an individual level, doctor-patient relationship and health care policies. With the increase in medical information and technical abilities it is urgent to have a clear concept of normality in medicine so that crucial discussions can be held with unequivocal terms.The different meanings for normality were analyzed throughout the literature and grouped according to their relevance in the academic community in models, namely the Biostatistical Theory (BST), Health, Ideal, Process and Biological advantage. The BST is the most established naturalistic approach, however normal variability can arguably constitute a problem. Health is similar and raises the question of setting the boundaries of pathology. Normality as an Ideal is an useful tool but is naturally unrealistic. As a Process it is comprehensible but is hard to frame for practical purposes. If considered as a Biological Advantage, seems intuitive but abnormality should tend to disappear.After, three examples were presented to discuss these models. They were Anemia, Psychiatric diseases and Psychopathy. In the case of Anemia the BST was applied and the arbitrary boundaries but with social impact were exposed. Psychiatric diseases was discussed under the process of self-organization and non-suffering ideal. With Psychopathy the boundaries of biological advantage are questioned.This review appeals to the importance of redesigning of the concept of normality in medicine according to current times and stresses the importance of integrating concepts such as variability and autonomy.
常态的定义决定了医学临床实践，对个体层面、医患关系和医疗保健政策都有影响。随着医学信息和技术能力的增加，迫切需要对医学中的常态有一个明确的概念，以便能够用明确的术语进行关键性讨论。本文通过文献分析了常态的不同含义，并根据其在学术界的相关性分为模型，即生物统计学理论（BST）、健康、理想、过程和生物学优势。BST 是最成熟的自然主义方法，但正常的可变性可能构成一个问题。健康与之相似，并提出了确定病理学界限的问题。常态作为一种理想是一种有用的工具，但自然不切实际。作为一个过程，它是可以理解的，但很难为实际目的构建。如果被认为是一种生物学优势，似乎是直观的，但异常应该趋于消失。之后，本文提出了三个例子来讨论这些模型。它们是贫血、精神疾病和精神病。在贫血的情况下，应用了 BST，并揭示了任意的但具有社会影响的界限。精神疾病是在自我组织和不痛苦理想的过程中讨论的。对于精神病，生物学优势的界限受到质疑。
这篇综述呼吁根据当前时代重新设计医学中常态的概念，并强调了整合变异性和自主性等概念的重要性。
