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)

Since its original publication in 1979, The Possibility of Naturalism has been one of the most influential works in contemporary philosophy of science and social science. It is a cornerstone of the critical realist position, which is now widely seen as offering a viable alternative to move positivism and postmodernism. This revised edition includes a new foreword.

Now acknowledged as a classic in the philosophy of science, A Realist Theory of Science is one of the very few books to transform not only our understanding of science, but that of the nature of the world it studies. The book has inspired the multi-disciplinary and international movement of thought known as critical realism. Re-issued with a new introduction.

The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of (...) practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order. (shrink)

The use of informed consent for surgery or research has been widely studied; however, its use in other areas of clinical practice has received less attention. This study investigates how doctors and nurses understand informed consent in relation to the prescription and administration of medicines in secondary care. It uses a qualitative analysis of semi-structured in-depth interviews with 19 doctors and 6 nurses recruited from various specialties in a teaching hospital. The results indicate a striking gap between official and actual (...) standards of practice. Providing information, assuring adherence and communication about potential treatment harms were raised as key issues instead of the principal goals of informed consent. Rather than simply treating these findings as support for a 'deficit' account of professionalism, the paper concludes that we need a richer and more grounded account of exactly when hospital medication decisions need to be subjected to the highest standards of informed consent. (shrink)

Advocates of “concordance” describe it as a new model of shared decision-making between physicians and patients based on a partnership of equals. “Concordance” is meant to make obsolete the notion of “compliance,” in which patients are seen as, ideally, following doctors’ orders. This essay offers a critical view of concordance, arguing that the literature itself on concordance, including materials at the web site of Medicines Partnership, the implementation arm in Great Britain of the concordance model, is full of contradiction; concordance, (...) in fact, harbors an ideology of compliance. The essay suggests that an improvement in patient medication use will more likely come from a frank consideration of the relation of compliance issues and commercial ones, and that a key question across domains is, “how are patients/health agents/consumers persuaded to acquire certain drugs and take them as directed?”. (shrink)

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (...) (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice. (shrink)

In this book by the award-winning author of Just Healthcare, Norman Daniels develops a comprehensive theory of justice for health that answers three key questions: what is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? Daniels' theory has implications for national and global health policy: can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or (...) meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? Just Health: Meeting Health Needs Fairly explores the many ways that social justice is good for the health of populations in developed and developing countries. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

Following on from Roy Bhaskarâe(tm)s first two books, A Realist Theory of Science and The Possibility of Naturalism, Scientific Realism and Human Emancipation, establishes the conception of social science as explanatoryâe"and thence emancipatoryâe"critique. Scientific Realism and Human Emancipation starts from an assessment of the impasse of contemporary accounts of science as stemming from an incomplete critique of positivism. It then proceeds to a systematic exposition of scientific realism in the form of transcendental realism, highlighting a conception of science as explanatory (...) of a structured, differentiated and changing world. Turning to the social domain, the book argues for a view of the social order as conditioned by, and emergent from, nature. Advocating a critical naturalism, the author shows how the transformational model of social activity together with the conception of social science as explanatory critique which it entails, resolves the divisions and dualisms besetting orthodox social and normative theory: between society and the individual, structure and agency, meaning and behavior, mind and body, reason and cause, fact and value, and theory and practice. The book then goes on to discuss the emancipatory implications of social science and sketches the nature of the depth investigation characteristically entailed. In the highly innovative third part of the book Roy Bhaskar completes his critique of positivism by developing a theory of philosophical discourse and ideology, on the basis of the transcendental realism and critical naturalism already developed, showing how positivism functions as a restrictive ideology of and for science and other social practices. (shrink)

The normal and the pathological are terms used for structures, activities, individual or collective situations proper to living beings and especially to man. The relation of a fact and a norm is its positive or negative value. Can the assessment of behaviours be reduced to noting a necessity? Is a living being's disease a fact similar to universal attraction? The author maintains that diseases are not merely predetermined effects, but are revealing of a normative regulation proper to living beings and (...) man. (shrink)

This inspirational book provides the philosophical backbone tocountless courses for health professionals. It poses twofundamental questions - "What is health?" and "How can more healthbe achieved?" - and answers them at a depth unmatched by any othertext in this field. David Seedhouse shows that these questions lieat the heart of health practice, and explains why all healthworkers should ponder them deeply. This second edition retains the freshness and enthusiasm of thefirst, while making the foundations theory and its practicalapplications clearer and (...) more accessible than ever. The bookincludes additional material and discussion, new case studies andrevised illustrations. * Describes and explores competing theories of health * Establishes a practical and ethical foundation for healthpromotion and education * Explains the foundations theory - a novel and comprehensive wayto understand health * Shows how the foundations theory might be used to create morehumane health services. (shrink)