Addiction theorists have often utilized the metaphor of the blind men and the elephant to illustrate the complex nature of addiction and the varied methodological approaches to studying it. A common purported upshot is skeptical in nature: due to these complexities, it is not possible to offer a unifying account of addiction. I think that this is a mistake. The elephant is real–there is a _there_ there. Here, I defend a dispositionalist account of addiction as _the systematic disposition to fail (...) to control one’s desires to engage in certain types of behaviors_. I explain this position, defend the inclusion of desires and impaired control, and flesh out the notion of _systematicity_ central to my account. I then illustrate how my dispositionalist framework can unify the disparate and seemingly incompatible accounts of addiction (and their respective methodological approaches). I close with a brief plan to extend and implement my account. (shrink)

Jerome Wakefield criticizes my biostatistical analysis of the pathological—as statistically subnormal biological part-functional ability relative to species, sex, and age—for its lack of a harm clause. He first charges me with ignoring two general distinctions: biological versus medical pathology, and disease of a part versus disease of a whole organism. He then offers 10 counterexamples that, he says, are harmless dysfunctions but not medical disorders. Wakefield ends by arguing that we need a harm clause to explain American psychiatry’s 1973 decision (...) to declassify homosexuality. I reply, first, that his two distinctions are philosophic fantasies alien to medical usage, invented only to save his own harmful-dysfunction analysis (HDA) from a host of obvious counterexamples. In any case, they do not coincide with the harmless/harmful distinction. In reality, medicine admits countless chronic diseases that are, contrary to Wakefield, subclinical for most of their course, as well as many kinds of typically harmless skin pathology. As for his 10 counterexamples, no medical source he cites describes them as he does. I argue that none of his examples contradicts the biostatistical analysis: all either are not part-dysfunctions (situs inversus, incompetent sperm, normal-flora infection) or are indeed classified as medical disorders (donated kidney, Typhoid Mary’s carrier status, latent tuberculosis or HIV, cherry angiomas). And if Wakefield’s HDA fits psychiatry, the fact that it does not fit medicine casts doubt on psychiatry’s status as a medical specialty. (shrink)

Two sources of possible disagreement in bioethics may be associated with pessimism about what bioethics can achieve. First, pluralism implies that bioethics engages with interlocutors who hold divergent moral beliefs. Pessimists might believe that these disagreements significantly limit the extent to which bioethics can provide normatively robust guidance in relevant areas. Second, the interdisciplinary nature of bioethics suggests that interlocutors may hold divergent views on the nature of bioethics itself—particularly its practicality. Pessimists may suppose that interdisciplinary disagreements could frustrate the (...) goals of bioethics. In this article, I explore how wonder may alleviate the concerns of the first group of pessimists regarding problems associated with pluralism, provided that we are willing to accept some interdisciplinary frustrations. Then, I invite readers of this issue of The Journal of Medicine & Philosophy to test these intuitions by considering the role of wonder in these articles. (shrink)

How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). While we find that (...) people’s health and disorder judgments are driven by perceived dysfunction, we also find that health and disorder judgments are impacted differently by these factors. Health judgements are impacted by outcome and individual valuation, and disorder judgments are impacted by condition source. These results suggest that the folk concept of mental health is positive (i.e., mental health is more than the absence of mental disorder) and normativist (i.e., value judgments play a significant role in determining whether a condition counts as healthy), while the concept of mental disorder aligns with a naturalist perspective, at least to the extent that dysfunction plays an important role in categorizing a condition as a disorder. However, our finding that people’s dysfunction judgments are influenced by individual valuation and outcomes poses a strong challenge to naturalist accounts. To provide access to our supplementary data, an appendix has been included. (shrink)

In The Foundations of Bioethics, former senior editor of The Journal of Medicine and Philosophy H. Tristram Engelhardt, Jr. radically reassessed the nature and scope of bioethics, as well as the possibilities for this still-young field that he helped found, in light of the prevailing sociohistorical context, which he argued had been inadequately considered by bioethicists. This issue of The Journal of Medicine and Philosophy provides a snapshot of how bioethics is developing in the wake of Engelhardt’s critique. Topics covered (...) include the relation between rule of law and US healthcare policy, the relation between autonomy and consent, the role of rights in bioethical discourse, the debate between naturalism and normativism in the theory of disease, and the question of when human individuals begin to exist. Although no single theme explicitly unites them, the papers in this issue were produced within and are fruitfully read in terms of what Engelhardt influentially characterized as a morally pluralistic postmodernity subsisting amidst the ruins of tradition. In the conclusion, I introduce a further wrinkle into this Engelhardtian picture—namely, the looming danger of a more general epistemological pluralism effected by new technologies like Deepfakes. (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)

Michael Lamb’s recent book A Commonwealth of Hope presents an opportunity for bioethicists to engage in critical self-evaluation in order to consider anew why and how to engage difficult bioethical problems and questions with those who maintain diverse moral and metaphysical perspectives. Drawing on an account of the virtue of hope from Augustine of Hippo, Lamb develops a political theory in which hope provides common ground for political cooperation between diverse citizens of a commonwealth. The purpose of this introduction is (...) to sketch out a framework by which to assess and evaluate whether bioethics demonstrates hope. This article provides a summary description of Lamb’s presentation of Augustine’s virtue of hope and his concept of politics. Then it considers implications of Lamb’s politics of hope for bioethics, identifying three features of hopeful bioethics, with which bioethicists can engage in self-reflection and evaluation. (shrink)

The principle of respect for autonomy often dominates the bioethical discourse. Yet despite its prominence, the exact contours are not always well defined. Widespread disagreement about the nature of autonomy has led some to conclude that autonomy is hopelessly vague and therefore ought to be abandoned in contemporary bioethics. Despite calls to move beyond it, autonomy remains at the center of bioethical reflection. The challenge, then, if autonomy is to function as a bedrock of contemporary bioethics, is to define more (...) clearly the shape of autonomy, to mark more precisely its conceptual boundaries, and to delineate more carefully how best autonomy is put into practice in medical ethics. In this article, I raise questions about the ways autonomy is used in theory, as well as the ways that it is operationalized in practice. (shrink)

This paper presents the interpersonal variability of harm challenge to Jerome Wakefield’s harmful-dysfunction account (HDA) of disorder. This challenge stems from the seeming fact that what promotes well-being or is harmful to someone varies much more across individuals than what is intuitively healthy or disordered. This makes it at least prima facie difficult to see how judgments about health and disorder could, as harm-requiring accounts of disorder like the HDA maintain, be based on, or closely linked to, judgments about well-being (...) and harm. This interpersonal variability of harm challenge is made salient by the difficulty faced by harm-requiring accounts of disorder in dealing satisfactorily with cases of intuitively disordered conditions that seem harmless because they do not deprive the individuals that they affect of anything that they value (e.g., desired infertility). I argue that this challenge is made more serious for the HDA by some clarifications Wakefield has recently made on harm. In recent publications, Wakefield dissociates himself from the sheer cultural-relativist view of harm attributed to him by some critics based on his linkage of harm to social values, and adopts a more qualified social-values-based view of harm that leaves room for criticism of the values endorsed by members of a cultural group at a given time. I show how Wakefield’s qualified view makes it more difficult for the HDA to deal with the interpersonal variability of harm challenge, at least when applied to a Western cultural context where a high value is placed on autonomy and individual choice. (shrink)

Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions (...) about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment. (shrink)

The possibility of editing the genomes of human embryos has generated significant discussion and interest as a matter of science and ethics. While it holds significant promise to prevent or treat disease, research on and potential clinical applications of human embryo editing also raise ethical, regulatory, and safety concerns. This systematic review included 223 publications to identify the ethical arguments, reasons, and concerns that have been offered for and against the editing of human embryos using CRISPR-Cas9 technology. We identified six (...) major themes: risk/harm; potential benefit; oversight; informed consent; justice, equity, and other social considerations; and eugenics. We explore these themes and provide an overview and analysis of the critical points in the current literature. (shrink)