An alternative view on the task of prognosis

摘要

Prognosis is central to clinical medical practice. In oncology, an accurate prognosis is a key requirement for making the right therapeutical decisions. Prognosis is even more important when medicine extends its predictive capacities using genetic data. Based on statistics and probability, indices, survival curves and prognostic scores are established. Intending to be an objective and neutral description of reality, this kind of prognosis and the corresponding practices of medical care however carry and imply a particular conception of human life and destiny. Medical Humanities can help to develop reflexivity regarding prognostic practices. This paper intends to clarify which particular assumptions are implied in the current way of doing prognosis in medicine, and highlights its advantages and limitations. Prognosis not only describes but also affects present and future patient experience. An alternative view on the task of prognosis is then developed with a broader understanding of the prognostic act. Based on a phenomenology of time, distinguishing between a quantitative chronological understanding of time (. chronos) and an experienced qualitative time (. kairos), the article contrasts a conception of the prognosis as forecast ('probabilistic prognosis') with a conception of prognosis as perspective ('hermeneutic prognosis'). In probabilistic prognosis, the future is seen as something that can be read from presently accessible signs, as something that we can anticipate within ranges of uncertainty. The patient's lifetime, which has been open toward the future, becomes closed through this kind of prognosis. In a hermeneutic conception of prognosis as a perspective on the future, which is thought of as an open space of possibilities, the future as not-yet is what can be envisioned without being known. A hermeneutic approach emphasizes the meanings of the experience of illness for the patient, helps to improve the practice of prognosis today, and offers caregivers and patients an opportunity for living better. ? 2012 Elsevier Ireland Ltd.