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)

Jerome Wakefield’s harmful dysfunction analysis of medical disorder is an influential hybrid of naturalist and normative theories. In order to conclude that a condition is a disorder, according to the HDA, one must determine both that it results from a failure of a physical or psychological mechanism to perform its natural function and that it is harmful. In a recent issue of this journal, I argued that the HDA entails implausible judgments about which disorders there are and how they are (...) individuated. The same arguments apply to other views that incorporate a harm criterion. More recently, David G. Limbaugh has modified the HDA by providing a novel account of the way in which a disorder must be harmful. Here, I briefly review the relevant issues and then critically assess Limbaugh’s account. I argue in the end that Limbaugh’s revisions do not succeed in making accounts like the HDA more attractive. (shrink)

This paper criticizes Jerome Wakefield’s harmful dysfunction analysis of disorder by arguing that the conceptual linkage it establishes between the medical concepts of health and disorder and the prudential notions of well-being and harm makes the account inapplicable to nonsentient organisms, such as plants, fungi, and many invertebrate animals. Drawing on a previous formulation of this criticism by Christopher Boorse, and noting that Wakefield could avoid it if he adopted a partly biofunction-based account of interests like that often advocated in (...) the field of environmental ethics, I argue that integrating such an account of interests into the HDA would generate serious concerns. Specifically, it would make dysfunction sufficient for disorder and so reestablish between dysfunction and disorder precisely the kind of sufficiency relation that harm-requiring accounts of disorder strive to avoid; blur the line between the HDA’s dysfunction and harm components and, in so doing, deprive the HDA of its alleged main advantage over monistic dysfunction-based accounts of disorders like Boorse’s; and tie the HDA to an understanding of harm that is in itself problematic. I argue that these three concerns, and the dilemmas they generate, rob the HDA of much of its prima facie appeal, ultimately indicating that a satisfactory account of disorder should most likely eschew all references to prudential notions of well-being and harm. (shrink)

In this article, we use the theory of Information Ethics to argue that deceased people have a prima facie moral right to privacy in the context of health data research, and that this should be reflected in regulation and guidelines. After death, people are no longer biological subjects but continue to exist as informational entities which can still be harmed/damaged. We find that while the instrumental value of recognising post-mortem privacy lies in the preservation of the social contract for health (...) research, its intrinsic value is grounded in respect for the dignity of the post-mortem informational entity. However, existing guidance on post-mortem data protection is available only in the context of genetic studies. In comparing the characteristics of genetic data and other health-related data, we identify two features of DNA often given as arguments for this genetic exceptionalism: relationality and embodiment. We use these concepts to show that at the appropriate Level of Abstraction, there is no morally relevant distinction between posthumous genetic and other health data. Thus, genetic data should not automatically receive special moral status after death. Instead we make a plea for ‘contextual exceptionalism’. Our analysis concludes by reflecting on a real-world case and providing suggestions for contextual factors that researchers and oversight bodies should take into account when designing and evaluating research projects with health data from deceased subjects. (shrink)

The addiction literature is fraught with conceptual confusions, stalled debates, and an unfortunate lack of clear and careful attempts to delineate the phenomenon of addiction in a way that might lead to consensus. My dissertation has two overarching aims, one metaphysical and one practical. -/- The first aim is to defend an account of addiction as the systematic disposition to fail to control one’s desires to engage in certain types of behaviors. I defend the inclusion of desires and impaired control (...) in the definition, and I flesh out the notion of systematicity central to my dispositionalist framework. I engage the so-called ‘disease vs. choice’ debate, criticizing its presupposition that we are dealing here with a dichotomy and arguing that the movement towards a middle ground is the right track to take. I explain how the dispositionalist account can capture this middle ground and how it serves to expand upon existing views, in particular by filling in the metaphysical details. -/- The second aim is to show how the account I defend can help to unify the extant views and disciplinary perspectives in the literature. Both the dispositionalist aspect of my framework and the methodology adopted (applied ontology and systematic metaphysics) can move the literature towards both substantive and methodological unification. This will help to clear up conceptual confusions, resolve (or sometimes dissolve) apparently intractable disputes, situate different research perspectives with respect to each other, facilitate interdisciplinary dialogue, and help to frame important questions about addiction. Finally, I offer the beginnings of an ontology of addiction, which will provide a terminologically well-structured guide to the addiction literature in a way that will facilitate more effective and efficient communication and data management across disciplines. (shrink)