Dörner Klaus

D36 Good doctor. Textbook of the main position of a doctor / Transl. with him. AND I. Sapozhnikova with the participation of E.L. Gushansky. - M.: Aletheya, 2006. - 544 p. - (Humanistic psychiatry).

ISBN 5-98639-006-7

Klaus Dörner's book “The Good Doctor” is the first and only publication in Russia devoted to issues of medical ethics.

The author of this amazingly deep and piercingly kind book teaches the modern educated and progressive doctor to treat the patient not only as a carrier of the disease, but also as a suffering subject, with his own biography, psychology, reaction to the disease, a person looking for his place in society and family , for which it has lost its meaning and value. The book is addressed to both doctors, teachers and educators, as well as a wide range of readers.

UDC 616.89 BBK88.1

ISBN 3-7945-2250-8 Authorized translation of the 2nd

German language edition Dorner, Der gute Arzt © 2003 by Schattauer GmbH, Stuttgart - New York © Translation.

Sapozhnikova I.Ya., 2006 ISBN 5-98639-006-7 © Aletheya Publishing House, 2006

Preface to the second edition A large number of reviews, reader responses and discussions made it easier for me in the second edition of this book to correct some shortcomings and stylistic inaccuracies while maintaining the subject content and helped eliminate the difficulties of understanding that arose due to my fault. In addition, a detailed subject index will help “The Good Doctor” become a working tool in practice. The thoughtful changes made to the somewhat updated second edition of this book respond to Habermas's September 11, 2001, response to biotechnological development of medicine not only as a manifestation of postmodernism, but also generally characteristic of the new century. What I mean is that, along with vital needs, no less important, due to human self-determination, has acquired the need for a complex process of giving meaning to the Other and giving

PREFACE TO THE SECOND EDITION

connections to it. Based on these needs, new opportunities arise. I am referring to the dangers arising from these needs and the associated dangers not of optimizing the use of precision medical methods, but of maximizing the introduction into medicine market economy.

These methods, due to their high cost, are not only mechanisms for healing, but also means for deteriorating health, which some doctors refuse, since they are an uncontrolled source of evasion of responsibility, which, being elevated to the rank of “super-rational teaching”, represents an unsuitable system training and education.

Ultimately, this book can be called not only a guide to fundamental medical positions, but also a textbook on the most complete understanding of the activities of a doctor and medicine in general. The book proceeds from the fact that commonly used “rationality,” which reduces and “amputates” humanity, ignores as “unscientific” and “irrational” the concepts of “Alien” and “Other,” which, in addition to man himself, are included in the essence of the Self. I base my understanding of rationality as a type of activity in the close relationship of its various aspects, when activity manifests itself in passivity, science in philosophy, the theoretical in the ethical. It is obvious to me that perfect ethics and perfect rationality are speculatively compatible, and I hope this will become obvious to others.

I am pleased by the public recognition by readers that this book can be useful not only for doctors, but also for those who are called to “work with people” (forgive this still-current vile expression). First of all

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to distribute this book to caregivers, educators, educators, and teachers.

Hamburg, summer 2003

Klaus Dörner

Dedicated to Dorothea GOOD DOCTOR", worthy of a doctor, which is natural for any person and his lifestyle. No doctor can help but think about this. And this is what we know about each other. But it’s not customary to talk about this. If you nevertheless start talking about this, you find yourself the object of ridicule, most likely caused by the belief that “kindness” and a “good doctor” do not exist. Thus, it seems that beyond the concept “exists” there is something else that has meaning. Because the desire to possess this does not disappear anywhere, something that cannot be scientifically defined and unattainable, and, moreover, places not just high demands on the doctor, but super-demands.

That is, when a doctor tries every day to answer questions about how he can become a good doctor for each individual patient, for a specific other person, then he simultaneously works in practice and

INSTRUCTIONS FOR USE

philosophical planes, develops his basic position and philosophy of the essence of a doctor and medicine in general. And this is true, as already said, for every day of any doctor, even a student.

My attempt to help begins with the fact that I began to talk - although it is considered indecent - about the problem of the “good doctor” in order to make it more understandable, develop it and, perhaps, find a solution to it.

That is, when a doctor tries every day to answer questions about how he can become a good doctor for each individual patient, for a specific other person, then he simultaneously works in practice and

It can be said that the question of a good doctor involves working on his attitudes, his attitude, his motivation, his mode of action, his virtues and his character. I chose the concept of “basic position”. The main one is in a double sense: firstly, because this work is based on my own sensory and physical experience (and the senses can also be organs of virtue). Secondly, because during this work on myself I cannot do without basic, fundamental norms, which for me are final norms, if only because at the present time I need them as support when contrasting them with other norms (this refers to norms of care and responsibility as opposed to norms of self-determination and justice). Moreover, the science-like “average range principles” that are favored in ethical debates today are fraught with the danger of recognizing that there are “last” patients who pass through the cells of the network of these principles and therefore need to be protected by fundamental norms. This book is named by me

The book is structured quite simply. I start with self-care (Chapter I). (If such a beginning seems too complicated to someone, then he can start with the more descriptive subchapter I. 3 or with chapter II.) Due to the fact that caring for another person always includes an attitude towards this person, then all this goes in responsibility (Chapter II). In turn, responsibility turns me into a responding being, in connection with which the doctor is perceived by the patient as an Other (Chapter III), including - to cover everyone - the “last” patient (Chapter IV). And then we talk about the participation of a third party, since only in the presence of the patient’s relatives (relatives) the relationship between the doctor and the patient becomes full (Chapter V). And finally, the doctor depends on the community, because my world and the world of my patient also belong here (Chapter VI). Looking at relationships from the point of view of another person teaches me, as a doctor, ultimately self-restraint in all areas of practice (Chapter VII), and on the other hand, gives me moral liberation (Chapter VIII). This liberation results - for many, perhaps provocatively - into the inspiration of doctors and, on the one hand, gives them more courage in matters of service, and on the other, causes an increased consciousness of their authority.

That is, when a doctor tries every day to answer questions about how he can become a good doctor for each individual patient, for a specific other person, then he simultaneously works in practice and

Since, to the extent that doctors managed to turn from “demigods in white” into “wish fulfillers” and accordingly free themselves from responsibility, today it would behoove them to restore a high level of responsibility (up to the risk of demonstrating

his know-it-all). For this purpose, I propose the concept of materialism, which follows from the concept of care. The order of the chapters reflects, in increasing order, super-requirements, which, due to their impossibility, most suitable for orientation. I owe this course of my philosophical reflections to the Lithuanian-Jewish-French philosopher Emmanuel Levinas ( Emmanuel), Levinas family who was destroyed by the Nazis and whose works known now in many countries as “philosophy after Auschwitz." Given this historical turning point, I try to develop elements of “medicine after Gadamar” in my discussions. Often, Levinas's incomprehensible thoughts become clearer when you relate them repeatedly With in his image: expressive eyes on the defenseless face of another person that touch me, make me

give yourself at his disposal. and these, I believe, are the majority, I suggest simply skipping these “indigestible stones.” They will be easier to comprehend later by conscious repetition or by going from end to beginning.

Of course, the book also makes a contribution to the debate on ethics, drawing attention to the least visible, "inconsequential" points of view with the aim of strengthening them. We are talking here about a shift in emphasis: description instead of prescription, the culture of the doctor’s relationship instead of his decisiveness in action, situational experience instead of normative deduction, as well as thoughtful final justifications instead of average principles, the influence of power instead of anarchy, historical method instead of systemic and philosophical thinking instead of scientific.

But first of all, I would like to use my thoughts to support doctors in their daily grueling professional activity. Although I can vividly imagine how they sigh when reading my leisurely expositions, if at the same time I managed to make their basic position more mature and if they

That is, when a doctor tries every day to answer questions about how he can become a good doctor for each individual patient, for a specific other person, then he simultaneously works in practice and

added a little “kindness”, then one could agree that in the future they are most likely and most likely to take the right position in relation to patients and their loved ones at the right hour, minute or second, to find the right (and often this is one single) word . There is no more effective method of saving time! On this basis, all chapters begin with common words, in order, as far as possible, to end them with specific practical recommendations.

Who would I like to thank in closing?

First, the thousands of patients and their loved ones, all the medical professionals, including dentists, everyone I have met over the decades in inpatient and outpatient consultations: my main work has been with the mentally ill, but you won't hear about them here almost not a word. I thank the many students, especially the University of Witten-Hardecke, where I once again had the opportunity to be a member of a kind of academic community. Next, my father, a passionate practicing physician and obstetrician in Duisburg in the years 1933-1960, thanks to whom I saw the magical prospects that a doctor has or can have for general medicine.

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I also thank the Research Committee “Ethics in Health Care”, under the patronage of the Ministry of Science of North Rhine-Westphalia, the University of Bielefeld, to which I owe a considerable amount of my reflections. Finally, I am grateful to my granddaughter Dorothea, who was in a waking coma 14 days after birth due to a streptococcal infection and was with us for six and a half years. She taught me to understand what it means to be a doctor, what a family is and what it could be, what the senses have in common with virtues, and much more. You will meet Dorothea more than once on the pages of this book, which is dedicated specifically to her.

Hamburg, summer 2000

Taking care of yourself

A ghost haunts medicine. This is ethics. It is illusory because the sudden explosion of “fashion” for medical ethics is annoying.

After all, doctors have always wondered whether what they were doing was right or wrong, good or bad.

Finally, since 1980, centers, academies and institutes of medical ethics began to spring up out of the ground, specialized journals on ethics appeared, international documents on bioethics were developed, ethics commissions made their recommendations - I have to resist this boom in proposals for further training ethics. At the same time, a large number of textbooks on medical ethics appeared. In other words, I would like to make an attempt to state the same thing in a different way, in particular to prove that there are scientifically proven methods so that I can, through the application of rules, norms, principles having a certain range of action, decompose my medical position into individual elements,

I. Taking care of yourself subject them to double-checking and draw conclusions in accordance with the principles about the correctness of their actions. The most common list of principles should be mentioned here Prinziplismus Boshana ( Beauchamp)":

) and Childress (

Childress

respect for independence;

thoughtfulness of actions;

non-harm; justice. I try to make it clear that here, as in other sciences, different theoretical approaches are possible: the utilitarian approach, which deals with the happiness of the greatest number of people; deontological approach, referring to the law of moral duty proclaimed by Kant, for which the generalization, universalization of my actions is decisive; and finally, Habermas's discursive-ethical approach, which is modestly limited to procedural methods, that is, to the way in which it can be accepted are discussed with great public interest (genetic engineering, brain death as human death, euthanasia).

I self-care 15

the right choice in rare boundary situations that require the manifestation of all medical qualifications. The authors of textbooks and members of the created medical-ethical expert groups rarely miss the opportunity to refer to the fact that in the field of scientific medical ethics we here in Germany are hopelessly behind other countries, that our doctors, as a rule, go about their business without having any education in area of ​​ethics, which is absolutely unacceptable. Therefore, departments of medical ethics should be urgently established in all universities and institutes so that at least the next generation of doctors receives appropriate education in this field. And when I hear or read in the opinions of experts, mainly philosophers, lawyers and theologians, that this new item is very complex, and to comprehend it, you need to have a good understanding of theories of knowledge

, ontology, phenomenology, legal philosophy and theology, then I find myself completely confused. On the one hand, this all sounds logical and convincing, and there is no dispute that the application of methods for creating ethical judgments regarding medical problems can be extremely useful. On the other hand, I feel remorse 1 when I listen to the reproaches of these experts and ask myself whether I have such a bad conscience, or whether it simply represents a good basis for the flourishing of the modern ethical boom based on self-interest outside the practice of medicine. Will not my science, medicine, which is fundamentally correct, but if it goes too far wrong, be reduced to dehumanization?

UDC 616.89 BBK 88.1 D36
The publication of the book was supported by a grant from the Institute. Goethe
Dörner Klaus

D36 Citizen and Madness. On the social history and scientific sociology of psychiatry / Transl. with him. AND I. Sapozhnikova, ed. M.V. Umanskaya. - M.: Aletheya, 2006. - 544 p. — (Humanistic psychiatry). ISBN 5-98639-008-3

The book by one of the greatest German psychiatrists of the 20th century, Klaus Dörner, “Citizen and Madness” is devoted to the analysis of attitudes towards unreason and madness against the background of the formation of civil society in England, France and Germany and against the background of the formation of social and public institutions. The author presents an in-depth analysis of the natural scientific and philosophical doctrines underlying psychiatry and the classification of mental disorders.

The book is intended both for specialists in the field of sociology and psychiatry, as well as for readers interested in philosophy and history.

UDC 616.89 BBK 88.1
ISBN 3-434-46227-9 Klaus Ddrner, Burger und Irre

1995 by Europaische Verlagsanstalt, Hamburg Translation. Sapozhnikova I.Ya., 2006 ISBN 5-98639-008-3 Publishing house "Aletheya", 2006

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