Fifty years ago, in 1961, Feinstein published his first path-breaking articles leading to his seminal work Clinical Judgement and to the establishment of clinical epidemiology. Feinstein had an Aristotelian approach to scientific method: methods must be adapted to the material examined. Feinstein died 10 years ago and few years before his death he concluded that efforts to promote a person-oriented medicine had failed. He criticised medicine for not having recognized that only persons can suitably observe, evaluate and rate their own health status. Feinstein's position was-as in Clinical Judgement-methodological. He didn't espouse ethical principles. He pointed to methodological deficiencies in clinical epidemiology and evidence-based medicine. In this article we'll provide a framework for understanding and justifying Feinstein's call for a person-oriented medicine which recognizes patients as co-actors in clinical reasoning. It's argued that craftsmanship and practical wisdom are integrated in clinical judgement and reasoning and that clinical reasoning is not only about means to achieve the end, health. We do also reason and deliberate about ends. The 'defining end' of medicine (health) has continuously been negotiated and so been the object of deliberation. For centuries among professionals, in recent years among professionals and patients. These negotiations and deliberations lead to ongoing specifications of health as a 'guiding end', i.e. an end guiding clinical reasoning about what to do in particular situations. Feinstein's self-critical account to clinical epidemiology at the end of his professional career reflects the fact that patients during the last 30-40 years (i.e. in the period after the publication of Clinical Judgement) widely have been recognized as persons with rights to autonomy. Feinstein's lesson is, however, that espousing and recognizing ethical ideals is not enough. A change of clinical practice and its methods is necessary. His critique also implies that clinical epidemiology and evidence-based medicine as practiced haven't provided such a turn.

The authoritarian standpoint in medicine has been under challenge by various groups and researchers since the 1980s. The challenges have been ethical, political and medical, with patient movements at the forefront. Over the past decade, however, a deep challenge has been posed by evidence-based medicine (EBM), which has challenged the entire strategy of medical treatment from the point of view of a self-critical, anti-authoritarian and hereby also (it has been claimed) a more democratic medical practice. Previously, the challenges arose out of the patient rights perspective. EBM, by contrast, was taken to challenge the way doctors consider their medical practice as a whole. The present paper puts this claim of democratization into a historical context. Two dimensions of the democratization hypothesis are discussed and it is argued that they are insufficient to capture the substantial changes going on in the intersection between medical practice, biomedical science and citizens.

Betydningen af patientperspektivet fremhæves i adskillige sammenhænge i sundhedsvæsnet (i klinisk praksis, i sundhedspolitik m.m.) af bl.a. medicinske filosoffer og i humanistisk sundhedsforskning. Fra et epistemologisk perspektiv er det imidlertid ofte uklart, hvad der menes med ’patientens perspektiv’. I denne artikel argumenteres for, at vi må udfordre patientperspektiver forstået som præferencer og som spontane subjektive udtryk, hvis vi skal lykkes med en redegørelse for patientperspektivernes epistemologi. Dele af den humanistiske sundhedsforskning kan bidrage til at analysere, hvorledes patientperspektiver konstitueres som en vigtig kilde til viden, og den kan ligeledes udfordre antagelser og forståelser i praksiser.

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This article explores the concept of ‘pain’ and the relation between abstract, detached knowledge and patient experiences and ‘first person perspectives’. Pain can be handled as the correlate of a neurological finding (for example in a professional practice) and as an experience in a patient’s life. Sometimes patients articulate experiences impossible to link to an objective trace. In such situations it is often claimed that we are left with a choice between dealing with pain and suffering as abstract, detached public conceptions or as private inaccessible entities. In this paper I argue that this is an unappetizing choice, and that we can develop a better understanding of ‘first person perspectives’ if we look at them in the light of contexts, stories and practices regulated by public exemplars. Discourses for handling pain as a phenomenon in a person’s life exist, and it is an epistemological as well as a normative problem if such perspectives are not recognized. The argument is elaborated through a discussion of, amongst others, Martha Nussbaum, Marx Wartofsky, Amartya Sen, and Ludwig Wittgenstein.