Medical nihilism is the view that we should have little confidence in the effectiveness of medical interventions. Jacob Stegenga argues persuasively that this is how we should see modern medicine, and suggests that medical research must be modified, clinical practice should be less aggressive, and regulatory standards should be enhanced.

Particular conceptions of reconciliation vary across a number of dimensions. As section 1 explains, the kind of relationship at issue in a specific context affects the type of improvement in relations that might be necessary in order to qualify as reconciliation. Reconciliation is widely taken to be a scalar concept. Section 2 discusses the spectrum of intensity along which kinds of improvement in relationships fall, and indicates why, in particular contexts, theorists often disagree about the point along this spectrum that (...) is morally or politically most significant. Section 3 provides an overview of the processes commonly cited as contributing to reconciliation. These processes are often controversial; those praised by some commentators as appropriate and constructive responses to past conflict are dismissed by others as undermining the moral or political conditions for just and peaceful relations. Section 4 concentrates on the relationship between reconciliation and justice. While some see these values as compatible and mutually supporting, others argue that, especially in the immediate wake of conflict, parties must often choose between reconciliation and justice. (shrink)

This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have (...) been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems. (shrink)

It is often claimed that irreducibly normative truths would have unacceptable metaphysical implications, and are incompatible with a scientific view of the world. The book argues, on the basis of a general account of the relevance of ontological questions, that this claim is mistaken. It is also a mistake to think that interpreting normative judgments as beliefs would make it impossible to explain their connection with action. An agent’s acceptance of a normative judgment can explain that agent’s subsequent action because (...) it is part of being a rational agent that such an agent’s beliefs about reasons normally, but not invariably, make a difference to the agent’s subsequent behavior. Because facts about reasons are not entities existing apart from us, there is no epistemological problem of how we can “be in touch with” such facts. There are serious worries about normative knowledge, but the problems involved are internal to the normative domain itself. The best solution to these problems would be an overall account of the domain of reasons in normative terms, supported by an argument from reflective equilibrium. But no existing account, constructivist, or based on desires or on an idea of rationality, is plausible, and no alternative is likely to succeed. Conclusions about reasons for action must rest on more piecemeal applications of the method of reflective equilibrium. (shrink)

This is a major work in moral philosophy, the long-awaited follow-up to Parfit's 1984 classic Reasons and Persons, a landmark of twentieth-century philosophy. Parfit now presents a powerful new treatment of reasons and a critical examination of the most prominent systematic moral theories, leading to his own ground-breaking conclusion.

Christopher Boorse's Bio Statistical Theory (BST) defines health as the absence of disease, and disease as the adverse departure from normal species functioning. This paper presents a two-pronged problem for this account. First I demonstrate that, in order to accurately account for dynamic physiological functions, Boorse's account of normal function needs to be modified to index functions against situations. I then demonstrate that if functions are indexed against situations, the BST can no longer account for diseases that result from specific (...) environmental factors. The BST is impaled on either horn of this dilemma and therefore must be dismissed. (shrink)

Moral Realism is a systematic defence of the idea that there are objective moral standards. Russ Shafer-Landau argues that there are moral principles that are true independently of what anyone, anywhere, happens to think of them. His central thesis, as well as the many novel supporting arguments used to defend it, will spark much controversy among those concerned with the foundations of ethics.

How should we define ‘health’ and ‘disease’? There are three main positions in the literature. Naturalists desire value-free definitions based on scientific theories. Normativists believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Hybrid theorists offer definitions containing both normativist and naturalist elements. This paper discusses the problems with these views and offers an alternative approach to the debate over ‘health’ and ‘disease’. Instead of trying to find the correct definitions of ‘health’ and ‘disease’ we should explicitly talk (...) about the considerations that are central in medical discussions, namely state descriptions and normative claims . This distinction avoids the problems facing the major approaches to defining ‘health’ and ‘disease’, and it more clearly captures what matters in medical discussions. (shrink)

In this paper we defend the view that the ordinary notions of cause and effect have a direct and essential connection with our ability to intervene in the world as agents.1 This is a well known but rather unpopular philosophical approach to causation, often called the manipulability theory. In the interests of brevity and accuracy, we prefer to call it the agency theory.2 Thus the central thesis of an agency account of causation is something like this: an event A is (...) a cause of a distinct event B just in case bringing about the occurrence of A would be an effective means by which a free agent could bring about the occurrence of B. In our view the unpopularity of the agency approach to causation may be traced to two factors. The first is a failure to appreciate certain distinctive advantages that this approach has over its various rivals. We have drawn attention to some of these advantages elsewhere, and we summarize below. However, the second and more important factor is the influence of a number of stock objections, objections that seem to have persuaded many philosophers that agency accounts face insuperable obstacles. In this paper we want to show that these objections have been vastly overrated. There are four main objections. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of “health” and “disease,” (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in (...) response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease. (shrink)

Time and cause present apparent asymmetries. What happens later depends on what happens earlier, and not the other way around. Effects depend on their causes, and not the other way around.

In responding to this debate, Ananth both surveys the existing literature, with special focus on the work of Christopher Boorse, and argues that a naturalistic ...