Blurring boundaries or structural coupling? Revisiting the science-medicine interface through the analogy of politics...

Recent developments in cutting-edge medicine have inspired numerous analyses claiming the boundaries between scientific research and medical practice are blurring. This paper offers an alternative description of the dynamics at stake. Drawing on Luhmann's systems theory, it analyzes the relationship between medicine and biomedical science as a historically evolved pattern of structural coupling between two operationally closed functional systems. Methodologically, it employs systems comparison, using the well-developed systems theoretical description of the law-politics relationship as a template for examining analogies to the relation between medicine and science. Through a reconstruction of their center/periphery-differentiation, contingency formulae, structural coupling, and conditional programs, it shows that both constellations are marked by a distinctive arrangement of mutual externalization of legitimation. A historical account of the co-evolution of medicine and law further clarifies why medicine ultimately externalized the justification of its decision programs to science. Against this background, contemporary biomedical transformations are interpreted as signs of strain on established coupling mechanisms rather than as evidence of systemic fusion. The blurring boundaries debate thus appears as a symptom of intensified interdependence under conditions of scientific innovation to which the medical system is forced to react.