Person - centred medicine represents a new epistemologic orientation
for medical science. The components of the paradigm derive firstly from an
acknowledgement of the impact of Christianity on the History of
medicine, secondly from kairological introspection, which, starting from phenomenological
and anthropo-analytical premises, provides evidence of teleonomy in human nature,
thirdly from the indeterminate relation between biological reactions and the quality of
coping, the epistemological foundation of the interactivity shown by
biological research, and finally from the emergence in the epistemological field of
a new concept of health based on quality of life and the individual persons
Person-centred medicine is a new medical concept based on the acknowledgement of the fact
that valuing and giving value to human life from conception to natural
death is the ultimate justification of medical knowledge. The individual
human being can never be the tool of science or of economic or political interests, laws,
ideologies, theories or religious dogma.
The basis of this philosophy, of which I had the honour and the responsibility of
being maieuta, rests on a theoretical synthesis between the quality of knowledge derived
from experimental research and that derived from humanistic clinical research.
This approach has already been extensively
evaluated in the postgraduate medical courses of the Ambrosiana University in Milan and
has been validated by the extraordinary improvements in the quality of medical
profession.The Manifesto represents the Epistemological programme of the Ambrosiana
University Milan Medical School Scuola Normale Superiore di Medicina
Person-centred medicine aims to modify the bio-molecular reductionist approach to medical
science in favour of an integration which makes doctors, nurses and patients true
protagonists of the health scenario.
In science and education, The person-centred paradigm represents a challenge
to develop research and education methods based, not on conjectures, but on the
interactionism and on the teleonomic theory, which is founded on the relativity of
biological reactions to the quality of coping as has been confirmed by numerous
In the second millennium jubilee of the birth of Jesus Christ, we affirm our hope that
Person centred medicine may complement the values of Hypocratic
medicine by the concept of the sanctity of human life and the individual human being
as Gods gift to the World, which through the dominion of Christ has constituted
Giuseppe Rodolfo Brera
Rettore dellUniversità Ambrosiana
Direttore della Scuola Medica di
Milano, Scuola Normale Superiore di Medicina
Coordinator of the International Committee
for the Youth Charter (ICYC)
Dei Gratia, per Iesum Christum, Anno Domini
1. The persons world is teleonomic.
is the persons conscious or unconscious natural tendency to interpret and
establish his human nature as an experienced reality consisting of truth, love and beauty.
A cohesive human
nature reveals itself during and after adolescence, through the development of logical,
affective and noethic structures. Such development underlies a growing awareness of self
in relation to questions about truth, love and beauty posed by the newly developed ego.
The self appears finalized the realization of an objective sense of personal and
In terms of
religious faith, this phenomenon is explained by Gods love for the person,
whom He created in His image.
anthropological fundaments of history of medicine are deeply linked to the Christian
religion and theology because of its foundation on Jesus Christ, the Son of God, a
person of divine nature, necessary «kairos» for personal individual, subjective
salvation from death and suffering.
In this light the
persons life, curing and be cured, suffering and recovering, assume holy
meaning. The pathos of the individual human being is determined
by the relationship between limits and possibilities of fulfilling his own
nature in the reality of a free and responsible subjectivity. Suffering and joy may become a «kairos» (opportune time) for discovering
his own individual true nature of person .
2. A person
is an individual subject to be considered in its totality as a three dimensional
whole, body, mind and spirit, which stands in relation with other individuals
from conception to death
2.1 The body: the totality
of biological phenomena
2.2 The mind: the symbolic
world, perception and behaviour
2.3 The spirit: the quest
worlds of body, mind and spirit exist as teleonomic interactions, and each is the equal
Thus for example the neurobiology of learning
and behaviour, psychoneuroimmunology, endocrinology are interactive
disciplines that demonstrate the
Biological phenomena relate to the possibility and quality of coping with
internal and external life events.
This is explained
by the theory of the indeterminate relativity of biological phenomena to the quality of
is the persons natural need for a harmonious, unitary significance. It
is revealed in the individuals explicit or unconscious symbolic, affective and
emotional World, whenever and wherever body, mind and spirit find their
unity, lack of coherence, or conflict. Religion is the individuals personal,
subjective bi-directional relationship with the Creator, God, through body,
mind and spirit. The persons spirituality and religion (where they exist)
interact with body and mind bi-directionally.
6. In the
light of modern scientific knowledge Health means the thriving of the individuals
life on many levels and involves the work of building protective factors to
neutralize risk factors; it involves body, mind and spirit in the persons teleonomy,
as revealed in the possibilities and the quality of coping in his/her
mission of medical science is to care for, to cure and to study the sick person from
conception to natural death, and the prevention of diseases, thus
providing possibilities for individuals to develop health.
In responding to the
personal demands of truth, love and beauty, the human being perceives his own
human dignity as a real human person.
This perception is
decisive for the quality of coping and of decisive importance for the biological
processes necessary for recovering from illness.
between the health professional and patients can be an opportune time
(kairos), a time-space through which the pathos of disease and suffering may be seen
as an opening for the discovery of the persons real dignity .
First and foremost
the dignity of the individual consists in the realization of the persons liberty .
of this applies both to patients and of health professionals. It is resides in the
mysterious opportunities offered by encounters between human beings.
The concept of
«existential counselor» as maieuta of human dignity cannot be divorced from the
role of health professional.
clinical method aims to individualize the persons health resources, risks and
clinical syndromes as a cohesive body/mind/spirit personal teleonomic interaction.
aims at caring for and curing the patient through a human
doctor-patient relationship centred on creating possibilities and resources. To
improve results and the quality of the health professions requires the
creation of an awareness of the irreducible dignity of the individual as
a human being created and loved by God.
Any clinical relation and research which does not take into account the
interactions of the persons three dimensional resources and his own teleonomy, must
give incomplete and false results and can be dangerous for the individuals health
and medical science.
Person-centred medical education must empower students to
learn the ethical possibilities and limits of the medical profession, the
epistemological fundamentals of medical science, theories and studies
relating to healthy and sick persons within their cultures and social contexts.
The aim of such
studies is to enable one to relate to the healthy and to the sick person, viewing
persons individuality through his own symbolic world and biology both in
health and clinical
taking into account the individuals age and within the appropriate cultural
Prevention, care and cure, must be studied as actions
intended to help the individual patients potential and resources
to grow, thus permitting him to realize the awareness of his own meaning as a
free and responsible individual and providing defences against immediate threats to
the survival of mind and body and against the collapse of personal defence.
(Resource Evidence Learning)
achieve methodological rigor, biomedical research and clinical work must include variables
belonging to the persons biological-psychological and spiritual worlds and consider
The original version of this Manifesto was presented on October 22 at the
Conference Assisi 99: Health and prevention in adolescence, Assisi, Italy, October 22-24
Written in Milan, at the Ambrosiana
University on December 7, 1999 by the Rector Prof. Giuseppe R. Brera.
Presented on January 29, 2000
at «Ospedale San Giuseppe», on the occasion of the
opening ceremony of the Academic Year 1999 - 2000 , Milano, Italy, Europe
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