Normality in medicine: a critical review

Area of Science:

• Medical Ethics
• Philosophy of Medicine
• Clinical Practice

Background:

• The concept of normality in medicine is fundamental to clinical practice, patient care, and health policy.
• Increasing medical knowledge necessitates a precise definition of normality for clear communication and ethical decision-making.

Purpose of the Study:

• To analyze and categorize existing models of medical normality.
• To discuss the implications and limitations of each model using clinical examples.
• To advocate for a revised concept of medical normality.

Main Methods:

• Literature review and analysis of different theoretical models of normality.
• Categorization of normality concepts into Biostatistical Theory (BST), Health, Ideal, Process, and Biological Advantage.
• Application of these models to case studies: Anemia, Psychiatric Diseases, and Psychopathy.

Main Results:

• The Biostatistical Theory (BST) is prevalent but struggles with normal variability.
• Normality as an Ideal is unrealistic, as a Process is impractical, and as a Biological Advantage raises questions about the persistence of abnormality.
• Case studies highlight the limitations of current models, particularly regarding arbitrary boundaries and the definition of pathology.

Conclusions:

• Existing models of medical normality have significant limitations.
• A re-evaluation and redesign of the concept of normality in medicine are essential.
• Future concepts should integrate principles of biological variability and patient autonomy.