Beyond Cure: Care as Medicine's Constitutive End and the Limits of a Cure-Centered Account.

Cure occupies a prominent place among the goods of medicine, yet its limits raise a fundamental question about medicine's constitutive end. Chronic illness, disability, dementia, frailty, and dying reveal circumstances in which medicine retains substantial obligations despite the absence of cure. These cases invite renewed reflection on what medicine is fundamentally for. This article argues that care constitutes medicine's moral foundation and the broader framework within which cure derives its meaning and purpose. Drawing primarily on Edmund Pellegrino's philosophy of medicine, together with contemporary debates concerning medicine's constitutive aims and scholarship on suffering, vulnerability, and human dignity, the argument proceeds in five stages. First, it examines the relationship between care, cure, and the ends of medicine, situating the argument within competing accounts of medicine's defining aims. Second, it examines the influence of the curative ideal on modern conceptions of medical success. Third, it considers how chronic illness, disability, dementia, aging, and dying expose the limits of cure as an account of medicine's enduring obligations. Fourth, it argues that medical care constitutes a distinct moral practice arising from the fiduciary structure of the clinical encounter, in which professional knowledge and competence respond to patient vulnerability. Fifth, it considers the implications of this account for medicine increasingly shaped by artificial intelligence and digital technologies. The central claim is that medicine exists not because diseases require treatment but because persons seek help in matters concerning health, illness, suffering, and bodily vulnerability. Cure remains one of medicine's greatest goods, but it does not constitute medicine's ultimate end. Cure serves the good of the patient; care names medicine's enduring commitment to that good across changing clinical circumstances. This account preserves the importance of therapeutic intervention while explaining why medicine's obligations persist when cure is unavailable.