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J Eval Clin Pract. 2013 Jun;19(3):497-500. doi: 10.1111/jep.12046.

Heidegger, Gestell and rehabilitation of the biomedical model.

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Department of Medicine, Toronto East General Hospital, University of Toronto, Toronto, ON, Canada.


The biomedical model is the foundation upon which current evaluations in clinical practice are based. In the quest for objective evidence to support clinical interventions, the patient is reduced to a number of technologically generated variables that serve as a surrogate for the patient herself. The biomedical model, as a reflection of Gestell or the essence of technology, carries with it the danger that it may overwhelm the practitioner's perspective so that other perspectives that may include the lived experience of the patient are actively suppressed. An ontology of the patient based on a Heideggerian exegesis is developed as a response to this concern. Morris has suggested that the most fundamental disturbance in the lived experience of the patient is an alteration in the patient's relationship to ecstatic temporality. In ecstatic temporality, the past, present and future are experienced as a unity in which the patient sees herself as her own possibility. Access to this experience is disturbed in illness; the future is no longer experienced as the patient's own possibility but rather as a series of predetermined external events that dictate the patient's affairs. By developing a biologically plausible model of ecstatic temporality, the lived experience of the patient does not have to be considered separate from the physical mechanisms involved in the disease state. As a consequence, the biomedical model cannot suppress the practitioner's humane perspective since the latter is explicitly brought under its purview.

[Indexed for MEDLINE]

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