Value and responsibility are two central concepts in philosophy and bioethics. The articles that comprise this issue of The Journal of Medicine and Philosophy engage topics of moral injury, madness, transhumanism, cognitive enhancement, and the woman’s responsibility to assist her fetus. Clearly diverse in matter, these subject articles univocally present fruitful ground for engagement with contemporary questions that impact society today. The ability to cure or to enhance, to treat or to terminate through advances in medical technology are all actions (...) that come with personal and social responsibility for their consequences. By approaching each article through the dual lens of value and responsibility, the reader is challenged to think seriously about the values we hold as human persons and the responsibility we take to pursue and protect these values. (shrink)

New technologies facilitate the enhancement of a wide range of human dispositions, capacities, or abilities. While it is argued that we need to set limits to human enhancement, it is unclear where we should find resources to set such limits. Traditional routes for setting limits, such as referring to nature, the therapy-enhancement distinction, and the health-disease distinction, turn out to have some shortcomings. However, upon closer scrutiny the concept of enhancement is based on vague conceptions of what is to be (...) enhanced. Explaining why it is better to become older, stronger, and more intelligent presupposes a clear conception of goodness, which is seldom provided. In particular, the qualitative better is frequently confused with the quantitative more. We may therefore not need “external” measures for setting its limits – they are available in the concept of enhancement itself. While there may be shortcomings in traditional sources of limit setting to human enhancement, such as nature, therapy, and disease, such approaches may not be necessary. The specification-of-betterment problem inherent in the conception of human enhancement itself provides means to restrict its unwarranted proliferation. We only need to demand clear, sustainable, obtainable goals for enhancement that are based on evidence, and not on lofty speculations, hypes, analogies, or weak associations. Human enhancements that specify what will become better, and provide adequate evidence, are good and should be pursued. Others should not be accepted. (shrink)

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

We defend a view of the distinction between the normal and the pathological according to which that distinction has an objective, biological component. We accept that there is a normative component to the concept of disease, especially as applied to human beings. Nevertheless, an organism cannot be in a pathological state unless something has gone wrong for that organism from a purely biological point of view. Biology, we argue, recognises two sources of biological normativity, which jointly generate four “ways of (...) going wrong” from a biological perspective. These findings show why previous attempts to provide objective criteria for pathology have fallen short: Biological science recognizes a broader range of ways in which living things can do better or worse than has previously been recognized in the philosophy of medicine. (shrink)

The ends of medicine are sometimes construed simply as promotion of health, treatment and prevention of disease, and alleviation of pain. Practitioners might agree that this simple formulation captures much of what medical practice is about. But while the ends of medicine may seem simple or even obvious, the essays in this issue demonstrate the wide variety of philosophical questions and issues associated with the ends of medicine. They raise questions about how to characterize terms like “health” and “disease”; whether (...) medicine’s goals should be extended to include enhancement beyond normal human function; and whether the ends of medicine are binding on those involved in health care outside of professional medicine, such as pharmaceutical companies. They also give philosophical attention to patient experiences, and so raise questions about whether current practices achieve the ends of medicine from the perspective of the patient. Together these essays demonstrate the important role played by a conception of medicine’s ends in a wide variety of issues and problems in the philosophy and ethics of medicine. (shrink)

There has been much debate about whether the concept of disease articulated in Boorse’s biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. I argue that value-ladenness does not threaten the scientific legitimacy of our disease-concept because the concept makes little difference to the formulation and testing of scientific hypotheses. Likewise, even (...) if our disease-concept is value-laden, this does not show it is morally impermissible. To determine its permissibility, we must regard it as a tool to structure social institutions. Seen in that way, whether our disease-concept is morally permissible is a consequentialist matter and depends exquisitely on unanswered empirical questions. (shrink)