INTRODUCTION

                “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 person’s resources.

                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 experimental studies.

                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 God’s gift to the World, which through the dominion of Christ has constituted occidental culture.

Giuseppe Rodolfo Brera

Rettore dell’Università 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 2000

1.        The person’s world is teleonomic.

Teleonomy is the person’s 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 individual subjectivity.

In terms of religious faith, this phenomenon is explained by God’s love for the  person, whom He created in His image.

The 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 person’s 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 for meaning

3.    The  worlds of body, mind and spirit exist as teleonomic interactions, and each is the equal value.

Thus for example the neurobiology of learning and behaviour, psychoneuroimmunology,  endocrinology are  interactive disciplines that demonstrate the

4.    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 coping.

5.    Spirituality is the person’s natural need for a harmonious, unitary  significance.  It is revealed in the individual’s 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 individual’s personal, subjective bi-directional relationship with the  Creator,  God, through body, mind and spirit. The  person’s 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 individual’s life on many levels and involves the work  of building protective factors to neutralize risk factors; it involves body, mind and spirit in the person’s teleonomy, as revealed in the possibilities and the quality of coping   in his/her lifestyle.

7.    The 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.

The relationship 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  person’s real dignity .

First and foremost  the dignity of the individual consists in the realization of the person’s liberty .

This possibility 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.

4.    Person-centred clinical method aims to individualize the person’s health resources, risks  and clinical syndromes as a cohesive body/mind/spirit personal teleonomic interaction. 

This method  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.

9.    Any clinical relation and research which does not take into account the interactions of the person’s three dimensional resources and his own teleonomy, must give incomplete and false results and can be dangerous for the individual’s health and medical science.

10. 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

this person’s individuality through his own symbolic world and  biology both in health and clinical

conditions, taking into account the individual’s age and within the  appropriate cultural and social

context.

Prevention, care and cure, must be studied as actions intended to help the individual patient’s  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)

11. To achieve methodological rigor, biomedical research and clinical work must include variables belonging to the person’s biological-psychological and spiritual worlds and consider them simultaneously.   

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 1999

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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