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through initiatives such as the “Initiative for measuring pain”
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in Germany or the
European Federation of IASP
R
Chapters who rally for the recognition of pain as a
measurable indication and disease. But this can also be a good field of application
for fuzzy set theory in future, perhaps more than the design and development of
medical experts systems should be.
As Wittgenstein points out in his
Philosophical Investigations
, the first person's
perspective (paradigmatically featured at the experience of pain) is not necessary
less 'objectively' than the only assumed 'objective' third person's perspective. The
patient's very subjective estimation of his own degree of (1.) pain, (2.) handicap
or (3.) needed enhancement is also supported by the facts - but only from the
very personal affected point of view. This point of reference is much closer to the
empirical data of the ill body than an observer ever can get (even if he is an medical
expert). Therefore no one, even not a physician, could perceive and decide as a
substitute for the patient's first person's perspective.
The neutral observer's or third person's perspective in medicine, strictly speak-
ing has the primacy only in the following case of a patient being (i) in the state of
unconsciousness, or (ii) having at least no sensation, or (iii) having lost his ability
to express sensations. That means, just in the case of a comatose patient (i) or in
that of a severely handicapped or person in the state of shock (ii) or in the case of
psychopathic person (iii) it will be required to decide exclusively from the external
view of the third person's perspective on the patient's illness and the best treatment.
These three cases have in common, that they point to three different ways of losing
the connection to the social sphere. In these three possible cases an individual is ac-
tually isolated and no mind connected with others or social embedded in the world.
In these cases, it needs the third person's perspective - precisely not as an 'objec-
tive' observer, but as a substitute for the first person's perspective, to represent the
patient's probable own point of view in medical interaction. (If the person's own
perspective is ignored, the interaction would be only an intervention.)
Hence, even in these cases the demand for the third person's view does not deny
the primacy of the first person's point of view.
Another point to mention is, how artificial and highly questionable it would be to
regard the physician as the embodied neutral observer. This might be a pre-assigned
ideal, but at the same time it is presumably the most misrepresenting image in the
dogmatism of institutional medicine. What the physician is doing in fact in every
day practice, is coping with patients, which means interacting with living persons
in individual situations. So each physician has to decide a lot of things in diagnosis
and therapy from his own subjective point of view - by using his ability of empathy
and intuition not as a vague, but as an experience based knowledge.
As a summary of our inquiry from an ethical point of view this paper wants
also to give some hints in order “to develop a philosophy of medicine that will be
tailored to the needs and interests of the patient” (§12.4), as Sadegh-Zadeh says.
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“Initiative Schmerz messen”, a task group of physicians, which developed a fuzzy scale
reading to make pain measureable individually - with a scale from 0 (no pain) to
10 (heaviest pain), see:
http://www.schmerzmessen.de/schmerz-messen/
