Marco Buzzoni

The often-emphasized tension between the singularity of the patient and technical–scientific reproducibility in medicine cannot be resolved without a discussion of the epistemological and methodological status of the human sciences. On the one hand, the rules concerning human action are analogous to the scientific laws of nature. They are de facto sufficiently stable to allow predictions and explanations similar to those of experimental sciences. From this point of view, it is only a trivial truth, but still a methodological irrelevancy, that the patient and the doctor–patient relationship represent an ontologically irreproducible reality. On the other hand, however, one can never exclude that one can fail in the application of "laws" of the human sciences to the individual patient, for such laws are by no means wholly separated from a patient's personal-hermeneutic mediation, and can at any time be revoked by becoming aware of them. This requires a synergistic collaboration of clinical and statistical methods, and shows a methodologically relevant sense in which one cannot disregard the singularity of the patient. The reason for the crucial role of the patient's singularity in medicine is every individual patient's capacity to revoke, in principle, routines and quasi-automatisms, even though the personal mediation by the patient's consciousness de facto changes them in such a small degree that predictions and explanations modeled in experimental science remain possible.

All the powerful influences exertedby the subjective-interpersonal dimension onthe organic or technical-functional dimensionof sickness and health do not make anintersubjective test concerning medicaltherapeutic results impossible. Theseinfluences are not arbitrary; on the contrary,they obey laws that are de facto sufficientlystable to allow predictions and explanationssimilar to those of experimental sciences.While, in this respect, the rules concerninghuman action are analogous to the scientificlaws of nature, they can at any time be revokedby becoming aware of them. Law-like andreproducible regularities in the sciences ofman are by no means separated from a patient'spersonal-hermeneutic mediation. This makes itpossible for human beings to modify, improve orsometimes even entirely (or better almostentirely) suspend these psychological,sociological, ethnological, medical,regularities. For this reason the sciences ofman including medicine are under the obligationof constantly inspecting the continuingvalidity of the rules on which theirpredictions and explanations are based, namelyby indirect, statistical methods. Thisrequires a synergistic collaboration ofextra-clinical and clinical tests through whichmedicine can obtain a good level ofintersubjective testability.

The terms “perspectivism” and “perspectivalism” have been the focus of an intense philosophical discussion with important repercussions for the debate about the role of mechanisms in scientific explanations. However, leading exponents of the new mechanistic philosophy have conceded more than was necessary to the radically subjectivistic perspectivalism, and fell into the opposite error, by retaining not negligible residues of objectivistic views about mechanisms. In order to remove this vacillation between the subjective-cultural and the objective-natural sides of mechanisms, we shall raise the question about theory-ladenness over again and interpret it in its connection with the technical–experimental nature of scientific knowledge, as affirming the perspectival character of scientific knowledge: It is because of the character at once theory-laden and practice-laden, i.e. technique-laden, of our putting questions to nature that empirical reality must be investigated from particular perspectives: nature can be known scientifically only from a potentially infinite number of perspectives or theoretical points of view, concretely exemplified by mechanisms or experimental ‘machines’ that allow specific access to specific aspects of sensible reality.