Mnoge biološke funkcije dopuštaju stupnjevanje. Na primjer, lučenje određenog hormona u organizmu može biti na višoj ili nižoj razini, u usporedbi s istim organizmom drugom prilikom ili u usporedbi s drugim organizmima. Koje razine funkcioniranja predstavljaju slučajeve disfunkcije; gdje da povučemo crtu? To je kvantitativni problem za teorije disfunkcije i bolesti. Cilj mi je braniti verziju bioloških teorija disfunkcije kako bih se uhvatio u koštac s ovim problemom. Međutim, također ću dopustiti da evaluativna razmatranja uđu u teoriju bolesti. Moj argument (...) se temelji na razlikovanju između biološke i kliničke perspektive. Prema mom mišljenju, bolest je ograničena na slučajeve koji spadaju u granice bioloških disfunkcija. Odgovor na kvantitativni problem ne zahtijeva proizvoljne odluke ili društveno vrijednosne sudove. Stoga se zalažem za nearbitrarnu metodu koja se temelji na činjenicama kako bi se riješio kvantitativni problem. Ipak, nisu sve biološke disfunkcije instance bolesti. Dodavanje kliničke perspektive omogućuje nam da spriječimo potencijalnu preveliku uključenost biološke perspektive, zato što postavlja dodatna ograničenja za određivanje granica bolesti. (shrink)

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions (...) are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire. (shrink)

Discussions concerning whether there is a natural right to health care may occur in various forms, resulting in policy recommendations for how to implement any such right in a given society. But health care policies may be judged by international standards including the UN Universal Declaration of Human Rights. The rights enumerated in the UDHR are grounded in traditions of moral theory, a philosophical analysis of which is necessary in order to adjudicate the value of specific policies designed to enshrine (...) rights such as a right to health care. We begin with an overview of the drafting of the UDHR and highlight the primary influence of natural law theory in validating the rights contained therein. We then provide an explication of natural law theory by reference to the writings of Thomas Aquinas, as well as elucidate the complementary “capabilities approach” of Martha Nussbaum. We conclude that a right to health care ought to be guaranteed by the state. (shrink)

The leading models of disability struggle to fully encompass all aspects of “disability.” This difficulty arises, the author argues, because the models fundamentally misunderstand the nature of disability. Current theoretical approaches to disability can be understood as “nounal,” in that they understand disability as a thing that is caused or embodied. In contrast, this paper presents an adverbial perspective on disability, which shows that disability is experienced as a personally irremediable impediment to daily-living tasks or goals-like-ours. The picture theory of (...) disability technically constitutes a species of relational approach because its analysis references the interplay between an individual and their environment; it differs from other relational accounts, however, by interpreting disability as a certain kind of negative experience—rather than a function of that relationship. This purely descriptive theory makes no normative claims about disability and operates as both a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. When disability is reframed in this way, the theory offers a particularist perspective which shows if, when, where, and how disability is experienced. (shrink)

Die wachsende Nachfrage nach Anti-Aging-Medizin wirft die Frage auf, welche medizinischen Leistungen ein solidarisches Gesundheitssystem tragen sollte. Die deutsche Entscheidungspraxis beruft sich auf den Begriff der Krankheit. Im Blick auf Anti-Aging wäre demnach 1) zu klären, was der Krankheitsbegriff bedeutet, 2) zu prüfen, ob das Altern sich unter diesen Begriff subsumieren lässt, um 3) abzuleiten, inwieweit Anti-Aging-Maßnahmen zur Verfügung zu stellen sind. Dieses Prozedere führt jedoch zu keinem brauchbaren Ergebnis. Unter Berufung auf den Krankheitsbegriff allein ist der Umfang solidarischer Gesundheitsversorgung (...) nicht zu bestimmen. Allerdings lässt sich durch Reflexion auftretender Probleme ein gangbarer Entscheidungsweg aufzeigen. Er sieht eine faire Verständigung über die Frage vor, wie wir alt werden wollen. (shrink)

Die wachsende Nachfrage nach Anti-Aging-Medizin wirft die Frage auf, welche medizinischen Leistungen ein solidarisches Gesundheitssystem tragen sollte. Die deutsche Entscheidungspraxis beruft sich auf den Begriff der Krankheit. Im Blick auf Anti-Aging wäre demnach 1) zu klären, was der Krankheitsbegriff bedeutet, 2) zu prüfen, ob das Altern sich unter diesen Begriff subsumieren lässt, um 3) abzuleiten, inwieweit Anti-Aging-Maßnahmen zur Verfügung zu stellen sind. Dieses Prozedere führt jedoch zu keinem brauchbaren Ergebnis. Unter Berufung auf den Krankheitsbegriff allein ist der Umfang solidarischer Gesundheitsversorgung (...) nicht zu bestimmen. Allerdings lässt sich durch Reflexion auftretender Probleme ein gangbarer Entscheidungsweg aufzeigen. Er sieht eine faire Verständigung über die Frage vor, wie wir alt werden wollen. (shrink)

This essay defends the controversial and indeed counterintuitive claim that there is a good argument to be made from a Lockean perspective for government action to guarantee access to health care. The essay maintains that this argument is in some regards more robust than the well-known argument in defense of universal health care spelled out by Norman Daniels, which this essay also examines in some detail. Locke's view that government should protect people's lives, property, and freedom–where freedom is understood as (...) independence and self-determination–justifies government action to ensure access to health care, because (roughly), just as individuals cannot protect themselves from crime and foreign invasion, so individuals are unable to provide for their own health care. Defense from disease is as important as defense from crime, and–although this is arguable–government action to guarantee access to health care does not itself undermine freedom. (shrink)

Justin Garson has recently argued that proper functions are proximal activities of traits selected by phylogenetic or ontogenetic selection processes, and that traits are dysfunctional only if they cannot perform their proper functions for constitutional reasons. We partially agree with Garson, but reject the view that functions are proximal activities, as well as his account of dysfunctions. Instead, we propose our own theory that biological functions are selected dispositions and that a trait is dysfunctional in virtue of not having the (...) dispositions for which it was selected. This account can explain both defects (or dysfunctions in Garson’s sense) and dysfunctions due to environmental factors. Moreover, it offers a neat way to explain the graduality of dysfunction. (shrink)

The first National Health Service (NHS) was introduced in the United Kingdom providing free universal health care (UHC) at the point of use. Within decades, increasing European countries adopted the same intervention to improve the health of citizens on the entire life span. Today, several reasons put at risk (1) empirically, the sustainability and fairness of these systems, (2) theoretically, the same consistency of solidarity, as vulnerable patients struggle most to receive essential care. Preserving solidarity from the pressure of modern (...) medicine and society needs to identify a fair and sustainable type of coverage at the same time. This paper aims (1) to describe the short circuit of solidarity in European NHSs; (2) to discuss alternative versions of UHC and support redistributive neo-universalism; (3) to promote the role of medical humanities in implementing this solution. (shrink)

This paper contains a brief comparative analysis of some philosophical and scientific discourses on human and animal health and welfare, focusing mainly on the welfare of sentient animals. The paper sets forth two kinds of proposals for the analysis of animal welfare which do not appear in the contemporary philosophical discussion of human welfare, viz. the coping theory of welfare and the theory of welfare in terms of natural behaviour. These proposals are scrutinized in the light of some similar theories (...) dealing with human health and quality of life. My conclusion is that the coping theory and the natural behaviour theory are not in themselves adequate for the characterization of welfare, either for humans or for sentient animals. I contend, finally, that, in the light of the previous discussion, there are good arguments for a particular set of analyses of both animal and human welfare, viz. the ones that are based on the notions of preference satisfaction and positive subjective experiences. (shrink)

In this article, I side with those who argue that the debate about the definition of “disease” should be reoriented from the question “what is disease” to the question of what it should be. However, I ground my argument on the rejection of the naturalist approach to define disease and the adoption of a normativist approach, according to which the concept of disease is normative and value-laden. Based on this normativist approach, I defend two main theses: (1) that conceptual analysis (...) is not the right method to define disease and that conceptual engineering should be the preferred method and (2) that the method of conceptual engineering should be implemented following the principles of Alexandrova’s account of social objectivity in the context of the definition of disease. (shrink)

In this paper I will argue that Aristotelian accounts of disease cannot provide us with an adequate descriptive account of our concept of disease. In other words, they fail to classify conditions as either diseases, or non-diseases, in a way that is consistent with commonplace intuitions. This being said, Aristotelian accounts of disease are not worthless. Aristotelian approaches cannot offer a decent descriptive account of our concept of disease, but they do offer resources for improving on the ways in which (...) we think about the harms that afflict human beings. While they cannot offer an account of ‘disease' they can offer an account of ‘harm'—and this it turns out, is ultimately of greater importance. (shrink)

In considering the debate about the meaning of ‘disease’, the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of ‘disease’ be assessed according to Hare’s (1997) taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their inter-relationships. Most (...) importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts. (shrink)

In this paper, I respond to commentaries on my book “Are Mental Disorders Brain Disorders?”. The topics I discuss are: accounts of function and dysfunction, constraints on the relationship between processes at the level of the brain and the mind, externalism in psychiatry, implications for moral responsibility and the question whether my account is a form of conceptual engineering. I defend my account and argue that the key criterion for whether mental disorders are brain disorders is whether we can map (...) dysfunctional psychological processes onto specific differences in brain function. I also acknowledge that my commentators have identified points where my account needs further development. (shrink)

In an important and timely book, Anneli Jefferson outlines a view according to which a given mental disorder is a brain disorder if it is a (harmful) mental dysfunction realised by a brain dysfunction. Prima facie, Jefferson’s book is a study in the metaphysics of dysfunction: how does mental dysfunction relate to brain dysfunction, and what does this imply for the status of mental disorders and brain disorders? In what follows, I shall argue that Jefferson’s contribution to this debate is (...) better understood as a conceptual explication of how psychiatrists, some philosophers, scientists and clinicians in the field (broadly construed) think of the label ‘brain disorder’. I infer this on the basis that Jefferson’s thesis would not follow from any serious, well-worked out theory of proper function. Despite initial appearances, Jefferson’s book about brain dysfunction is not about function at all. (shrink)

Despite their shared origins, medicine and dentistry are not always two sides of the same coin. There is a long history in medical philosophy of defining disease and various medical models have come into existence. Hitherto, little philosophical and phenomenological work has been done considering dental caries and periodontitis as examples of disease and illness. A philosophical methodology is employed to explore how we might define dental caries and periodontitis using classical medical models of disease – the naturalistic and normativist. (...) We identify shared threads and highlight how the features of these highly prevalent dental diseases prevent them fitting in either definition. The article describes phenomenology and the current thought around the phenomenology of illness, exploring how and why these dental illnesses might integrate into a phenomenological model. We discover that there are some features particular to dental caries and periodontitis: ubiquity, preventability and hyper-monitorablility. Understanding the differences that these dental diseases have compared to many other classically studied diseases leads us to ethical questions concerning how we might manage those who have symptoms and seek treatment. As dental caries and periodontitis are common, preventable and hyper-monitorable, it is suggested that these features affect the phenomenology of these illnesses. For example, if we experience dental illness when we have consciously made decisions that have led to it, do we experience them differently to those rarer illnesses that we cannot expect? Other diseases share these features are discussed. This paper highlights the central differences between the classical philosophical notion of disease in medicine and the dental examples of caries and periodontitis. It suggests that a philosophical method of conceptualising medical illness - phenomenology - should not be applied to these dental illnesses without thought. A phenomenological analysis of any dental illness is yet to be done and this paper highlights why a separate strand of phenomenology should be explored, instead of employing those that are extant. The article concludes with suggestions for further research into the nascent field of the phenomenology of dental illness and aims to act as a springboard to expose the dental sphere to this philosophical method of analysis. (shrink)

We characterize a type of functional explanation that addresses why a homologous trait originating deep in the evolutionary history of a group remains widespread and largely unchanged across the group’s lineages. We argue that biologists regularly provide this type of explanation when they attribute conserved functions to phenotypic and genetic traits. The concept of conserved function applies broadly to many biological domains, and we illustrate its importance using examples of molecular sequence alignments at the intersection of evolution and cell biology. (...) We use these examples to show how the study of conserved functions can integrate knowledge of a trait’s causal effects on fitness and its history of natural selection without invoking adaptation. We also show how conserved function provides a novel basis for addressing objections against evolutionary functions raised by Robert Cummins. (shrink)

Through hypothetical scenarios, this paper analyses whether machine learning (ML) could resolve one of the main shortcomings present in Christopher Boorse’s Biostatistical Theory of health (BST). In doing so, it foregrounds the boundaries and challenges of employing ML in formulating a naturalist (i.e., prima facie value-free) definition of health. The paper argues that a sweeping dataist approach cannot fully make the BST truly naturalistic, as prior theories and values persist. It also points out that supervised learning introduces circularity, rendering it (...) incompatible with a naturalistic perspective. Additionally, it underscores the need for pre-existing auxiliary theories to assess results from unsupervised learning. It emphasizes the importance of understanding the epistemological entanglements between data and data processing methods to manage expectations about what data patterns can predict. In conclusion, the paper argues against delegating the final authority for defining complex concepts like health to AI systems, as it necessitates ethical judgment and capacities for deliberation that AI currently lacks. It also warns against granting creators and deployers of AI systems the discretionary authority to determine these definitions outside the wider social discussion, advocating for ongoing public engagement on normative notions. Failure to do so risks limiting individuals and collectives’ ability to shape a just digital future and diminishes their fundamental epistemic agency. (shrink)

The authors of the articles in this issue of The Journal of Medicine and Philosophy address a wide variety of topics, from definitions of disease to bioenhancement. Each author, however, draws out the importance of careful use of language. Over the years, philosophers of medicine and bioethicists have debated questions such as what qualifies something as a disease, whether disease language is evaluative, whether the term “person” encompasses more than just human beings, and what language ought to be used to (...) best convey complex information to patients. Among a great deal of disagreement on these topics, one thing emerges distinctly: that clarity and careful attention to language is paramount in medicine. The articles in this issue contribute to that conversation, presenting complex arguments and illustrative examples of why it is so important to use clear and well-defined terms in medicine, and of the reality-altering power that our language carries. (shrink)

The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mental illness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. On the other side (...) of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mental illness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)

In this paper, I discuss the question whether objective criteria could be provided for judging something to be a mental illness. I consider the two most prominent objectivist or naturalistic accounts of mental illness, evolutionary and bio-statistical account, which offer such a criterion by relying on the notion of biological function. According to such suggestions, illness is a condition in which there is dysfunciton in some feature of an organism. In this context, I consider different accounts for ascribing functions in (...) biologyand their relationship with the suggested accounts of illnesses. Special focus is placed on the objections according to which the ascription of functions, as envisaged in naturalistic accounts of illness, is incompatible with actual medical and psychiatric practice. I conclude that these objections are legitimate insofar we want to an account of illness that preserves the current practice of ascribing illness. However, the question remains, could a theory that tries to capture the actual medical practice be value-neutral, since our ordinary conception of illness is permeated with value judgments that indirectly enter into medical practice. In that respect, it seems that the requirement for pure objectivity is too strong and thus, it is not reasonable to expect that naturalistic accounts can satisfy it. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Infectious diseases figure prominently as (counter)examples in debates on how to conceptualize “disease.” But crucial epidemiological distinctions are often not heeded in the debate, and pathological and clinical perspectives focusing on individual patients are favored at the expense of perspectives from epidemiology focusing on populations. In clarifying epidemiological concepts, this paper highlights the distinct contributions infectious disease epidemiology can make to the conception of “disease,” and the fact that this is at least tacitly recognized by medical personnel and philosophers. Crucially, (...) infectious disease epidemiology can help elucidate how carrying and transmitting infectious, communicable entities is a disease, even if the carriers themselves are not directly affected by symptoms detrimental to them. (shrink)

The dual role of microbial communities as either beneficial/functional or harmful/pathogenic involves two issues concerning causality in physiology and medicine, etiology of disease, and the notion of function in biology. Causal explanation formulated by the germ theory of disease and the Koch postulates connects the existence of a specifically identified microbe to disease by the isolation and identification of a pathogen from an organism with the disease and the successful infection of a healthy individual. Similarly, microbiome research in medicine centers (...) on taxonomic composition in correlation with physiological conditions and germ-free mice experimentations to establish causal connections. However, because the microbiome is an ecological community, it lacks the specificity of identification assumed in the germ theory. Furthermore, the ecological aspects within and between microbiomes such as background conditions, microbial interactions, and interdependence, are treated as confounding. Looking at ecological studies, the causal explanations are less specific regarding complex systems with their processes of interactions. This article makes the following two points: One is that microbiome causality in the host should be understood similarly to the microbiome causality in an ecosystem. The second is that if considering a microbiome’s causality in the host as an ecosystem, its etiological explanation needs to be revisited to include a heterogeneous and mutual notion of interactions. Finally, according to the second point, the notion of function in ecology with its relevant notion of causality should be considered accordingly. (shrink)

The terms “health promotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional public health work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination and health-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts are logically different, or if (...) they are just two extremes of one dimension. The central concepts, health promotion and disease prevention, are defined, and it is concluded that health promotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promote health without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promoting health. Finally, most health promoting interventions target basic health, not manifest health, and often also thereby reduce future disease. (shrink)

This book argues that a plausible account of emergence requires replacing the traditional assumption that what primarily exists are particular entities with generic processes. Traversing contemporary physics and issues of identity over time, it then proceeds to develop a metaphysical taxonomy of emergent entities and of the character of human life.

The prospect of germ-line genetic engineering, the ability to engineer genetic changes that can be passed on to subsequent generations, raises a wide range of moral and public policy questions. One of the most provocative questions is, simply put: Are there moral reasons that can be articulated in general secular terms for accepting human nature as we find it? Or, at least in terms of general secular moral restraints, may we reshape human nature better to meet our own interests, as (...) we define them? This question in turn raises the further question of whether human nature as it now exists has a moral standing akin to sacredness that can be understood in nonreligious terms. This essay will take as a given that it is not possible to show in general secular moral terms that human nature has a sanctity or special moral standing that should guide secular health-care policy. In addition, as this essay shows, it is not possible through appeals to considerations of authorizing consent or beneficence toward others to remedy this failure to establish a sanctity or special moral standing for human nature. Absent a religious or culturally normative understanding of human nature and given the availability of germline genetic engineering, there is a plurality of possibilities for refashioning our nature. The unavailability of substantive secular moral constraints on germ-line genetic engineering discloses a secularly licit plurality of possibilities for human nature. The likelihood that we will be able to refashion our human nature reveals how few general secular moral constraints there are to guide us. Paradoxically, the more we are able to reengineer our human nature, the less guidance is available. The plurality of possible conceptions of human well-being that can be pursued through germ-line genetic engineering challenges our self-understanding as humans. Given human freedom, and in the absence of taken-for-granted religious or cultural moral constraints, the likelihood of germ-line genetic engineering opens the possibility of human nature in the plural. (shrink)

The definitions of disease proffered by philosophers and medical actors typically require that a state of ill health be linked to some known bodily dysfunction before it is classified as a disease. I argue that such definitions of disease are not fully implementable in current medical discourse and practice. Adhering to the definitions would require that medical actors keep close track of the current state of knowledge on the causes and mechanisms of particular illnesses. Yet, unaddressed problems in medical terminology (...) can make this difficult to do. I show that unrecognized misuse of “heterogeneous,” “biomarker,” and other important health terms—which I call index terms—can misrepresent the current empirical evidence on illness pathophysiology, such that unvalidated illness constructs become mistaken for diseases. Thus, implementing common definitions of disease would require closing this “loophole” in medical discourse. I offer a simple rule that, if followed, could help do just that. (shrink)

According to the US National Institute on Aging and the Alzheimer’s Association (NIA-AA), Alzheimer’s disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AA’s conceptualisation of AD radically challenges past AD conceptualisations. This article offers ananalytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that of (...) AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as “biological-physiological” or “normative” conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation. (shrink)

Staggering advances in biotechnology within the past decade have given rise to pharmacological, surgical and prosthetic techniques capable of enhancing human functioning rather than merely treating or preventing disease. Bioenhancement technologies range from nootropics capable of enhancing cognitive abilities to distraction osteogenesis, a surgical technique capable of increasing height through limb lengthening. This paper examines whether the use of bioenhancements falls inside or outside the proper boundaries of healthcare, and if so, whether clinicians have professional responsibilities to administer bioenhancements to (...) patients. After explicating two theoretical approaches to the concept of health, one objectivist and the other constructivist, I contend that clinicians' corresponding professional responsibilities hinge on which philosophical account of health is endorsed, and illustrate how the lack of analytic clarity with respect to this concept can lead to defective positions on the place of bioenhancements in healthcare. With this conceptual framework in place, an account of health as a cluster concept that incorporates both constructivist and objectivist components is developed and defended. (shrink)

This article discusses the Tibetan notion of rlung, usually translated as: ‘wind’, but perhaps better understood as a close equivalent of pneuma in the Greek tradition, or qi in the Chinese tradition. The article focuses on the way rlung provides a useful prism through which concepts of health, illness and disease may be observed in a cross-cultural perspective. An analysis of syndromes linked with rlung in a Tibetan cultural context illuminates some of the ways in which culture determines particular syndromes. (...) The article raises a number of questions which are relevant for a more general multicultural approach to concepts of health, illness and disease.The article argues that notions of rlung/pneuma/wind/ qi constitute a particularly interesting area for an exploration of culture-bound syndromes, as they reside in the meeting point between material and non-material, physical and mental, as well as the psychological, spiritual and religious. They are hence fundamental for a more cross-cultural approach to the mind-body problem.The article also deals with the significance of history of medicine, particularly histories of medicine, which attempt to widen the scope of the traditional Eurocentric narrative of the history of medicine, in dealing with questions such as concepts of health and illness. Allowing alternative narratives—whether narratives of patients, other cultures or historical ones—can enhance our understanding of what health, illness and disease are. Discussing perceptions of the body as culturally defined is not only important from a philosophical or historical point of view, but also has important practical ramifications, which are particularly crucial in our global age. (shrink)

This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with natural balance. It (...) is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (shrink)

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

The time is near where ‘therapeutic’ bodily assistive devices, developed to mimic species-typical body structures in order to enable normative body functioning, will allow the wearer to outperform the species-typical body in various functions. Although such devices are developed for people that are seen to exhibit sub species-typical abilities, many ‘therapeutic enhancements’ might also be desired and used by people that exhibit species-typical body abilities. This paper presents the views of members of the World Federation of the Deaf on potential (...) beyond species-typical abilities enabling therapeutic assistive devices (i.e. related to hearing). Survey respondents showed support for the development and uptake of beyond normal hearing enabling devices. The views of survey respondents as clients affect hearing-enabling professions (such as audiologist and speech pathologists). The paper analyzes what guidance code of ethics of hearing enabling professions give in regards to beyond normal hearing enabling devices. This paper suggests that people labeled impaired and the professions that serve them should more involved in the enhancement discourse. (shrink)

The aim of the paper is to give an ontologically informed account of disease that can aid in the construction of disease ontologies. The paper begins by distinguishing cases of diseases from what are purely structural abnormalities, referred to as ‘disorders’. The paper then presents a causal model apt for the understanding of disease that distinguishes diseases from both their causes and their potential effects. The analysis of disease defended treats disease in terms of distortions of standard cellular network processes, (...) where those distortions are incapable of self remedy and produce biologically disadvantageous symptoms. (shrink)

Zusammenfassung Die informierte Einwilligung von Teilnehmer:innen gilt in vielen Fällen als Voraussetzung auch für die rein datenbasierte medizinische Forschung. In diesem Kontext wird ein Modell der breiten Einwilligung (_Broad Consent_) diskutiert. In Deutschland hat die Medizininformatik-Initiative einen konkreten Vorschlag für deutsche Kliniken ausgearbeitet, der eine Gültigkeit der Einwilligung für einen Zeitraum von 30 Jahren vorsieht. Der vorliegende Artikel diskutiert vor diesem Hintergrund die Frage, wie der Anspruch der Informiertheit in dieser zeitlichen Perspektive einzuordnen ist. Die Praxis der Einwilligung wird dabei (...) so verstanden, dass sie auf die Verwirklichung von Wohlergehen, persönlicher Souveränität und Vertrauen ausgerichtet ist. Eine anzunehmende Informationsasymmetrie zwischen Forschungsteilnehmenden, Forschenden, und datenspeichernden Institutionen wird dabei als spezifisches Kontextmerkmal herausgestellt. Um dieser Informationsasymmetrie in angemessener Weise zu begegnen, so die These, ist eine kontinuierliche Weitergabe von verständlich aufbereiteten Informationen an Forschungsteilnehmende notwendig, um die Wahrnehmung persönlicher Souveränität zu ermöglichen. (shrink)

ContextIn many cases, informed consent of participants is considered a prerequisite even for exclusively data-based medical research. In this context, a model of broad consent is being discussed. In Germany, the Medizininformatik-Initiative (Medical Informatics Initiative) has developed a proposal for broad consent for German hospitals which suggests a validity period of 30 years.Definition of the problemAgainst this background, the article discusses how the claim of consent beinginformedhas to be regarded in a temporal perspective. The practice of consent is here understood (...) to be oriented towards the realization of well-being, personal sovereignty, and trust. In the context of medical research, an asymmetry of access to information between research participants, researchers, and data-storing institutions has to be assumed.Argument and conclusionThe article argues that in order to appropriately address this information asymmetry, a continuous dissemination of comprehensibly prepared information to research participants is necessary to enable personal sovereignty. (shrink)

In this article, I address two objections developed by Kingma against Boorse’s bio-statistical theory of health, the objections that choice of reference classes renders the theory both circular and problematically value-laden. These objections not only apply to the bio-statistical theory of health but also to other naturalistic theories, like the dispositional theory of health. I present three rejoinders. First, I argue that the circularity objection arises from excessive methodological demands. Second, I argue that naturalists can resist the normativist claim that (...) health and pathology are differentiated on the basis of personal or cultural values. Finally, I show that it is possible to justify choices between rival theories of health without the interference of evaluative commitments. With these rejoinders, I conclude that the bio-statistical theory, as well as other naturalistic theories of health utilizing reference classes, is not undermined by Kingma’s arguments. (shrink)

A satisfactory account of the nature of health is important for a wide range of theoretical and practical reasons. No theory offered in the literature thus far has been able to meet all the desiderata for an adequate theory of health. This article introduces a new theory of health, according to which health is best defined in terms of dispositions at the level of the organism as a whole. After outlining the main features of the account and providing formal definitions (...) of ‘health’, ‘healthy’, and ‘healthier than’, I present the main strengths of the proposed account. I argue that the proposed dispositional theory accounts for all paradigm cases of health and pathology, that it circumvents a number of problems faced by rival theories, and that it makes for a naturalistic theory of health with a rigorous metaphysical underpinning. 1Introduction 2The Dispositional Account 3Further Specification of the Dispositional Account 3.1Reference classes 3.2Comparison classes 3.3Which dispositions? 4Advantages of the Dispositional view 5Three Objections and Replies 5.1Objection 1: Counter-examples 5.2Objection 2: Issues with holism 5.3Objection 3: Expediting medicalization 6Final Remarks. (shrink)

International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea (...) that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman’s central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria. (shrink)

John Searle has argued that functions owe their existence to the value that we put into life and survival. In this paper, I will provide a critique of Searle’s argument concerning the ontology of functions. I rely on a standard analysis of functional predicates as relating not only a biological entity, an activity that constitutes the function of this entity and a type of system but also a goal state. A functional attribution without specification of such a goal state has (...) no truth-value. But if completed with a goal state, functional attributions understood as four-place relations attain a truth-value. The truth conditions of all attributions of function involve a dependence claim of the goal state on the function bearer’s activity. The nature of this dependence may differ; I consider five different possibilities: causality, mechanistic constitution, mereology, supervenience and metaphysical grounding. If these dependency relations are objective, Searle’s central ontological thesis fails. What he ought to have said is that our valuing survival or other goal states may be the reason why biology seeks functional knowledge, but this has nothing to do with ontology. I will show further that Searle also raised an interesting challenge concerning the relationship of functional and causal truths, but it does not threaten the objectivity of functions either. At best, it could show that functional vocabulary is eliminable. However, I will show that functional vocabulary is not so eliminable. (shrink)

We are living through a demographic transition from a world in which there were lots of young people and very few older adults to one in which the numbers in these age groups are becoming more evenly balanced. One reason for this is that more of us are living into our seventies, eighties, nineties, and beyond. That is the good news. Unfortunately, the chance of developing chronic illnesses (including diabetes, arthritis, and dementia) is typically higher for people in these older (...) age groups than for those who are younger. Because we do not know how to cure these illnesses, many of us will spend at least some of this extra time with one or more chronic illness. While we are more likely than in the past to live into older age, we are likely to be living with illness when we get there. That raises a challenge: how should we respond to this change? (shrink)

Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two categories; (...) and what sorts of considerations could justify the location of that boundary. In exploring these questions, the papers draw on detailed clinical examples, provide theoretical critiques of existing approaches to disease definition, and offer new ways to conceptualize key features in debates about disease, including harm and biological dysfunction. (shrink)

Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)