Reconceptualizing the ethics of diagnosis: a Foucauldian framework.

Diagnosis is a central step in the medical process. It is integrated between anamnesis, examination and therapy and is the pivotal node in the medical process. Without diagnosis - that is, the identification and understanding of a condition - causal therapy cannot be initiated, medical therapies would be arbitrary []. Diagnosis, therefore, serves as both a crossroads and a turning point in medical processes. Emerging from suffering and investigation, it represents the recognition of an illness and, at best, allows for a reversal of its course. Ideally, a correct diagnosis leads to a therapy that cures the condition. At a minimum, the purpose of diagnosing is to alleviate suffering. Whether it is a tentative diagnosis, a confirmed diagnosis, or a differential diagnosis, it lays the foundation for determining therapeutic indications and provides orientation. However, diagnosis is not merely a decisive step in the medical process in the sense of a causal basis of biomedical procedures. It also opens up another dimension, one that cannot be fully captured or defined by biomedical categories alone. This dimension pertains to the social aspects embedded in diagnoses when applied to individuals. The social impact of diagnoses affects individuals in their daily lives and self-perception. This social and psychological dimension has long been a subject of sociology and ethical research, as diagnoses can exert power over individuals and influence medical processes such as therapy compliance. This becomes apparent, for example, when a diagnosis associated with social stigma leads individuals to reject it, causing them to refuse therapy or avoid seeking help altogether [, ]. As early as 1844, Harrison pointed to the influence diagnoses can have on patients with his remark: []. Diagnoses harbor a tension that continues to engage social medicine and ethical research today. Jutel articulated it as follows: