Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe this person. On (...) the other hand it certainly does not preclude an additional evaluation of the state of affairs as undesirable or bad. The basic scientific description and the evaluation are, however, two independent matters, according to this kind of theory. Other philosophers claim that the concept of health, together with the other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. A statement that he or she is healthy does not merely imply certain scientific facts regarding the person’s body or mind but implies also a (positive) evaluation of the person’s bodily and mental state. My task in this paper will be, first, to present the two principal rival types of theories and present what I take to be the main kind of reasoning by which we could assess these theories, and second, to present a deeper characterization of the principal rival theories of health and illness. (shrink)

Familiarity with Charles Darwin's treatise on evolution is essential to every well-educated individual. One of the most important books ever published--and a continuing source of controversy, a century and a half later--this classic of science is reproduced in a facsimile of the critically acclaimed first edition.

People confront their doctors with three modes of unhealth - disease, illness and sickness. Each is discussed, and the question is asked and answered as to why in this situation people wish to become patients.

The traditional contrast between naturalist and normativist disease concepts fails to capture the most salient features of the health concepts debate. By using health concepts as a window on background notions of medical science and ethics, I show how Christopher Boorse (an influential naturalist) and Lennart Nordenfelt (an influential normativist) actually share deep assumptions about the character of medicine. Their disease concepts attempt, in different ways, to shore up the same medical model. For both, health concepts function like demarcation criteria (...) in the philosophy of science: they mark off the jurisdiction of medical science, and protect it from an inappropriate intrusion of socioeconomic factors, which threaten the integrity of modern medicine. These views are challenged by new developments in healthcare such as managed care and total quality review. To frame the health concepts debate in a way that better captures the issues integral to these new developments, I advance a new way of reading the distinction between weak and strong normativists. Strong normativists are skeptical of the demarcation project, think facts and values cannot be disentangled, and hold that socioeconomic conditions unavoidably influence how pathology is understood. The new health concepts debate should be framed as one between weak and strong normativists, and it concerns how we should respond to the current developments in health care. (shrink)

by MICHEL FOUCAULT Everyone knows that in France there are few logicians but many historians of science; and that in the 'philosophical establishment' - whether teaching or research oriented - they have occupied a considerable position. But do we know precisely the importance that, in the course of these past fifteen or twenty years, up to the very frontiers of the establishment, a 'work' like that of Georges Canguilhem can have had for those very people who were separ ated from, (...) or challenged, the establishment? Yes, I know, there have been noisier theatres: psychoanalysis, Marxism, linguistics, ethnology. But let us not forget this fact which depends, as you will, on the sociology of French intellectual environments, the functioning of our university institutions or our system of cultural values: in all the political or scientific discussions of these strange sixty years past, the role of the 'philosophers' - I simply mean those who had received their university training in philosophy department- has been important: perhaps too important for the liking of certain people. And, directly or indirectly, all or almost all these philosophers have had to 'come to terms with' the teaching and books of Georges Canguilhem. From this, a paradox: this man, whose work is austere, intentionally and carefully limited to a particular domain in the history of science, which in any case does not pass for a spectacular discipline, has somehow found him self present in discussions where he himself took care never to figure. (shrink)