In decisions about inclusion (or exclusion) of health care services in the benefit package, different interpretations of notions like health, health risk, disease, quality of life or necessary care often remain implicit. Yet they can lead to different benefit package decisions. After a brief discussion of these concepts in definitions of the goals of medicine, the various value-judgements implicit in interpretations of key notions in health care are analysed and conclusions are drawn with regard to the composition of decision making (...) bodies at various levels. It is further argued that such a body needs to discuss the various interpretations of key-notions explicitly in the various phases of a priority-setting procedure so that more consistent choices can be made in health care priority setting. (shrink)

There is a widespread and largely unchallenged assumption within philosophy that the word ‘normal’ is ambiguous: i.e., that it can mean different things in different contexts. This assumption appears in work within topics as varied as the philosophy of biology, medicine, justification, causation, and more. In this paper I argue that we currently lack any independent reason for adopting such an assumption. The reason that would most likely be offered in its favour requires us to ignore an alternative and equally (...) plausible explanation for the seeming variety of different meanings that ‘normal’ is taken to have. Meanwhile, the well-known conjunction reduction test for ambiguity provides no evidence for the ambiguity of ‘normal’, and in fact suggests that maintaining this ambiguity claim is more difficult than has been initially supposed. Therefore, with the way things stand at present, it should not be assumed without argument that ‘normal’ is an ambiguous term. (shrink)

This paper explores usage of the concept ofabnormality in medical genetics and proposesdirectives for more careful usage of this concept.The conceptual difficulties are first explored, thena model is developed to assess actual usage, followedby analysis of a sample of genetic textbooks andgenetics literature. It appears that fact andvaluation are often intermingled, that referencestandards used to define 'genetic abnormalities' areoften not clear and that the concept of abnormality isoften used independent of the degree of certainty withwhich the altered genetype develops into (...) a (seriously)harmful phenotype. On the basis of these findings itis argued that more restraint and more careful use ofthe concept of genetic abnormality of medical geneticsis appropriate as well as more agreement on the use ofreference standards. (shrink)