The question of the philosophical basis of medical science and medical practice is considered under three closely related themes: (i) the doctor-patient relationship, (ii) the structure of the medical-ethical discourse, and (iii) the problem of philosophical founding in relation to medical conduct. The doctor-patient relationship is regarded as a transformational relation. Acceptance of the illness of the patient, the construction of a complaint as a necessary condition — and not a description of an existing reality — as well as the establishment of a common interest are determinants of that relation. They are related to the dominant form of science and thought in medicine, namely application. This is typical for the Standard Medical-Ethical Discussion (SMED), its scope and its rationality. The third issue leads to the thesis that this particular rationality is not a sufficient ground for considering the medical discourse to be founded in philosophy.