Should medicine be defined as the enterprise in charge of the health problems of society? If so, then any problem (individual, public, social or political) that can be reformulated as a “health problem” could serve as a goal of medicine. If, on the other hand, medicine ⁀ or medicine proper ⁀ is defined in terms of some limited goal and limited means, then some medical professionals would find themselves working in other fields than medicine. It could be of some importance (...) to the patient to know whether the medical professional he meets is engaged in medical practice (aiming at the patient's health), research, public health or some other project which involves medical competence. Obviously, some of these enterprises may have conflicting goals. This paper will analyse various candidates for being a model of medicine, discuss some of the consequences, and argue for a limited view of medical practice. (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)

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)

What's wrong with designer children, bionic athletes, and genetic engineering.

The ongoing ‘enhancement’ debate pits critics of new self-shaping technologies against enthusiasts. One important thread of that debate concerns medicalization, the process whereby ‘non-medical’ problems become framed as ‘medical’ problems.In this paper I consider the charge of medicalization, which critics often level at new forms of technological self-shaping, and explain how that charge can illuminate – and obfuscate. Then, more briefly, I examine the charge of pharmacological Calvinism, which enthusiasts, in their support of technological self-shaping, often level at critics. And (...) I suggest how that charge, too, can illuminate and obfuscate.Exploring the broad charge of medicalization and the narrower counter charge of pharmacological Calvinism leads me to conclude that, as satisfying as it can be to level one of those charges at our intellectual opponents, and as tempting as it is to lie down and rest with our favorite insight, we need to gather the energy to have a conversation about the difference between good and bad forms of medicalization. Specifically, I suggest that if we consider the ‘medicalization of love,’ we can see why critics of and enthusiasts about technological self-shaping should want (and in some cases have already begun) to distinguish between good and bad forms of such medicalization. (shrink)

New and proposed medical technologies continually challenge our vision of what constitutes appropriate medical treatment. As scholars and consumers grapple with the meaning of innovation, one common critical theme to surface is that it constitutes undesirable medicalization. But we are embodied creatures who can often benefit from medical knowledge; in addition, rejection of medicalization may be in some cases based on an untenable appeal to nature. Harnessing the power of medicine for women’s welfare requires us to rethink the goals of (...) medicine as well as implement fundamental reforms. (shrink)

The prescription of growth hormone therapy for children who are not growth hormone deficient is one of the controversies in contemporary paediatric endocrinology. Is it morally appropriate to enhance the growth, by means of medical treatment, of a child wish idiopathic short stature? The medical, moral, and philosophical questions in this area are many. Data on the effects of human growth hormone (hGH) treatment will not on their own provide us with answers, as these effects have to be evaluated from (...) a normative perspective. In this article we consider hGH treatment for children of idiopathic short stature from three normative perspectives: the goals of medicine, the good of the patient, and the public good. We argue that the prevention of psychological and social problems due to short stature (and not merely the enhancement of growth) should be the ultimate goal of medical treatment and research. (shrink)

Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.

Cet ouvrage est la thèse de doctorat en médecine présentée en 1943 par Georges Canguilhem, augmentée, lors de sa réédition vingt ans plus tard, de réflexions philosophiques sur la signification du terme « normal » en médecine. La thèse débute par une étude historique sur l’identité des phénomènes normaux et pathologiques, dogme de la pensée médicale au XIXe siècle. La seconde partie est une étude systématique, sous la forme d’une analyse critique, des concepts de normal et de pathologique. Georges Canguilhem (...) (1904-1995), philosophe puis médecin, contribua à rénover l’épistémologie française. (shrink)

This article examines the normative structure of the concept of health and tries to suggest an account of it in a phenomenological-hermeneutic framework. It is argued that the concept of health has a logical priority to illness, though the latter has an experiential priority. The fundamental feature of the concept of health as discussed in the literature is initially recognized in the notion of ‘norm’, in both the bio-statistical and normative-ideal sense. An analysis of this body of literature reveals some (...) weaknesses in bio-statistical definitions of health as well as in those normative ones which endorse a value-relativity thesis. An approach based on the analogical structure of language is then advanced. In this framework, the notion of biological normativeness proposed by G. Canguilhem is connected with an analysis of the language of health through etymologies. It is argued that health can be characterized as an analogy of ‘plenitude’, which is the common ideal reference of the various health-concepts. The analogical structuring of language allows the recognition of different levels of meaning, and therefore of different kinds of normativeness (biological, mental, social, moral). Some hints of a theory of health deriving from this framework are then given. Keywords: analogy, health, hermeneutics, norm, plenitude CiteULike Connotea Del.icio.us What's this? (shrink)