The concept of disease in palliative medicine.

The paper first defines palliative treatment and distinguishes it from symptomatic treatment. Then, the palliative situation is delineated as inseparably linked to the finitude of human life. Given the objectives of palliative treatment--responding to symptoms, damage to the patients' self-image, and the proximity of death--a subjective concept of disease is described, that is regarded as the focus of palliative treatment. The essence of the concept of disease is analysed as the patient's experience with a tendency of reduction of her or his vitality. Palliative medicine is shown not to be symptom-oriented, but disease--directed as other domains of medicine. Implications and practical consequences, especially the status of objective findings, of this concept are discussed and therapeutic opportunities in the palliative situation reconsidered.