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 effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the definition and (...) boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)

This paper provides a philosophical analysis of the ontology of impairment, in part social and in part not. The analysis is based on the division between two categories of facts concerning the world we live in: “brute” and institutional facts. Brute facts are those that require no human institution for their existence. To state a brute fact requires naturally the institution of language, but the fact stated is not the same as the statement of it. For example, regardless of any (...) human institution or opinion, the presence of an extra chromosome 21 is a brute fact, and despite of people’s constructions or deconstructions, this fact remains. As for the lives of people with extra chromosome 21, the social reality and human institutions enter the picture. The social and moral status of these people is never a matter of brute fact. (shrink)

The book challenges the values of much of contemporary bioethics and health care policy by confronting their failure to secure the moral norms they seek to apply.

This paper continues a discussion concerning the distinction between disability and handicap initiated in this volume by Steven D. Edwards. Edwards argues that the reasons advanced by the WHO for this distinction in its International Classification of Impairments, Disabilities and Handicaps (ICIDH) are not valid. Edwards also criticizes my own quite different grounds for distinguishing between the two concepts. His general conclusion is that the distinction is superfluous. In this paper I claim that Edwards's reasoning is invalid. I present five (...) arguments for my case, viz., the arguments from: a) practical necessity, b) cost-effectiveness, c) clinical practice, d) the subject's vital goals, and e) the universal presence of some basic action. My own conclusion thus is that there is a need within health care for a distinction between disabilities and handicaps. I also indicate that there may be a need for further distinctions along the dimension of action-generation which is presented in the paper. (shrink)

This paper discusses the distinction between disability and handicap as it is proposed by the World Health Organization (WHO) in their publication International Classification of Impairments, Disabilities and Handicaps (WHO, 1993 (first published, 1980)). Following criticism of this an attempt to salvage the distinction by Nordenfelt (1993, 1983) is discussed. It is argued that neither the WHO nor Nordenfelt are successful in their attempts to preserve the distinction between disability and handicap in a theoretically wellmotivated manner. Contrary to the WHO, (...) it is argued that what they term ‘disabilities’ and ‘handicaps’ both have external causes. And contrary to Nordenfelt's position it is shown that “basic actions” do not provide a firm theoretical foundation for the concept of disability. Moreover, the criticisms of these two sets of views reveal that attempts to describe the phenomenon of disablement which focus on the individual suffer from a serious methodological shortcoming. (shrink)

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items (...) that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability. (shrink)