Modern medicine is reaching the limits of a disease-centered paradigm when confronted by chronic disease, antimicrobial resistance, zoonotic risk, metabolic illness, mental distress, ecological degradation, climate vulnerability, social fragmentation, and widening inequity. These crises cannot be adequately understood as isolated biological malfunctions, nor as external “determinants” added around the individual body. They arise from historically conserved ways of living that have reshaped the relations among human beings, animals, plants, microbes, ecosystems, institutions, technologies, economies, and planetary systems.
This white paper develops a Maturana-informed account of natural drift as a conceptual foundation for rethinking medicine within the biosphere–anthroposphere unity. Rather than viewing evolution as adaptation to a pre-given environment, Maturana’s concept of natural drift emphasizes the historical conservation and transformation of organism–niche relations. Extended to human civilization, this insight suggests that societies drift according to the conversations, emotions, institutions, technologies, practices, and desires they conserve.
The paper argues that medicine must now be situated within this larger drift. Human civilization has become a planetary niche-making force, and its conserved patterns increasingly shape the health of persons, communities, animals, plants, microbes, ecosystems, and future generations. One Health provides the operational framework for recognizing the interdependence of human, animal, plant, microbial, ecosystem, and institutional health. The Field of Viability Framework provides the diagnostic grammar for assessing how constraints, margins, state, disturbance, perception, regulation, and options preserve or erode life-capacity.
The paper proposes that the future of medicine lies in becoming a reflective and practical discipline of life-coherent drift: rescuing the acutely ill, restoring organism–niche coherence, preventing the production of avoidable suffering, coordinating One Health action, and helping civilization consciously conserve the conditions in which life can continue to bring forth life. This does not displace acute biomedical care or make clinicians responsible for civilization as a whole; rather, it situates rescue, chronic care, public health, One Health, and policy guidance within a shared responsibility for conserving life-capacity.
