The desire for health and the promises of medicine.

The varieties of meaning in which we use the terms illness and health requires that we developed a conceptualization allowing us to maintain a unity between the differences. In fact, the experiences of health and illness are complex ones and they need to be understood in their different levels so that the need for help of patients and their desire for health is adequately faced. At its roots, the experience of illness is that of a threat posed to the unreflective credit given to life in good health. This threat has not only a biopsychosocial dimension, but a moral and symbolic one as well, and it is mainly at this level that illness represents a moral challenge. Contemporary culture seems to be at pains in suggesting a shared set of meanings enabling the patient to give an intersubjectively valid sense of illness, since the only kind of answer offered is a technical one. The symbolic dimension of the notions of health and illness call for a deeper cultural enterprise of looking for a credible sense of illness for our times.

The idea of physician as a bioethical topic.

The model of the physician as a caregiver and as a researcher has been given extensive attention in the bioethical debate. There has been a transition in the last decades from the traditional idea of a physician inserted in the hippocratic ethos to a more technical and contractarian model; we contend that the latter fails to capture the essential features of the clinical encounter, in that its presuppositions are abstract and lead to unintended results. Other models have been proposed (beneficence, covenant, care) which seem to better fit the reality of the clinical encounter. In the experimental setting there is a particularly illuminating example of the type of relationship which we find more convincing.

Health as an analogical concept.

This article examines the normative structure of the concept of health and tries to suggest an account of it in a phenomenological-hermeneutic framework. It is argued that the concept of health has a logical priority to illness, though the latter has an experiential priority. The fundamental feature of the concept of health as discussed in the literature is initially recognized in the notion of 'norm', in both the bio-statistical and normative-ideal sense. An analysis of this body of literature reveals some weaknesses in bio-statistical definitions of health as well as in those normative ones which endorse a value-relativity thesis. An approach based on the analogical structure of language is then advanced. In this framework, the notion of biological normativeness proposed by G. Canguilhem is connected with an analysis of the language of health through etymologies. It is argued that health can be characterized as an analogy of 'plenitude', which is the common ideal reference of the various health-concepts. The analogical structuring of language allows the recognition of different levels of meaning, and therefore of different kinds of normativeness (biological, mental, social, moral). Some hints of a theory of health deriving from this framework are then given.

The physician as caregiver and researcher.

The physician might happen to play a double role in the clinical setting when he is the caregiver as well as the researcher for a patient at the same time. The dynamics and the ethical profile of the two relationships caregiver-patient and researcher-subject are different, and conflicts might arise: while the main responsibility of the caregiver is directed towards the patient "here and now", the researcher has a primary responsibility for future patients, the scientific community and the society at large. It has been suggested that in the clinical setting the researcher, provided that all the requirements for the ethical conduct of an experimentation be respected, has an "autonomy-in-trust", i.e. a wide discretional space in the decision-making process. While agreeing with such a proposal to some extent, we suggest that a more active and deeper participation of subjects in the experimental process, through an ongoing consent and joint decision-making process, would help in overcoming many possible conflicts.