Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and (...) asymptomatic; positive and symptomatic; negative; and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

THE ARTICLE DEMONSTRATES FOR SOMATIC MEDICINE AS WELL AS PSYCHIATRY AND PSYCHOTHERAPY THAT THE CONCEPT OF DISEASE IS AT LEAST PARTIALLY DEPENDENT ON IDEOLOGICAL CONSIDERATIONS. THE PAPER SURVEYS REPRESENTATIVE VIEWS AND EXPLORES THE BEARING OF THE CONCEPTS OF NORMS, FUNCTIONS, VALUES ON THE SPECIFICATION OF DISEASE.

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, (...) and curing disease are core aims, but also to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates (a) what is meant by these claims (b) what their implications are, and (c) whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, (...) and curing disease are core aims, but also to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates what is meant by these claims, what their implications are, and whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

The paper first defines palliative treatment and distinguishes it from symptomatic treatment. Then, the palliative situation is delineated as inseparably linked to the finitude of human life. Given the objectives of palliative treatment — responding to symptoms, damage to the patients' self-image, and the proximity of death — a subjective concept of disease is described, that is regarded as the focus of palliative treatment. The essence of the concept of disease is analysed as the patient's experience (...) with a tendency of reduction of her or his vitality. Palliative medicine is shown not to be symptom-oriented, but disease — directed as other domains of medicine. Implications and practical consequences, especially the status of objective findings, of this concept are discussed and therapeutic opportunities in the palliative situation reconsidered. (shrink)

By contrasting Hippocratic and nineteenth century theories of disease, this paper describes important conceptual changes that have taken place in the history of medicine. Disease concepts are presented as causal networks that represent the relations among the symptoms, causes, and treatment of a disease. The transition to the germ theory of disease produced dramatic conceptual changes as the result of a radically new view of disease causation. An analogy between disease and fermentation was important (...) for two of the main developers of the germ theory of disease, Pasteur and Lister. Attention to the development of germ concepts shows the need for a referential account of conceptual change to complement a representational account. (shrink)

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals some important (...) differences between functional explanations in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one (...) ‘normativist’ label ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages. (shrink)

Publisher: Philosophical Library Publication date: 1953 Subjects: Medicine Medical / Diseases Medical / General Medical / Diseases Medical / Microbiology Science / Life Sciences / Biology / Microbiology Notes: This is an OCR reprint. There may be typos or missing text. There are no illustrations or indexes. When you buy the General Books edition of this book you get free trial access to Million-Books.com where you can select from more than a million books for free. You can also preview the (...) book there. (shrink)

The concept of disease has been the subject ofa vast, vivid and versatile debate. Categoriessuch as ``realist'', ``nominalist'', ``ontologist'',``physiologist'', ``normativist'' and``descriptivist'' have been applied to classifydisease concepts. These categories refer tounderlying theoretical frameworks of thedebate. The objective of this review is toanalyse these frameworks. It is argued that thecategories applied in the debate refer toprofound philosophical issues, and that thecomplexity of the debate reflects thecomplexity of the concept itself: disease is acomplex concept, and does not (...) easily lenditself to definition. (shrink)

The terms "health", "disease" and "illness" are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the 'disease' concept is illusory. The health/ (...) class='Hi'>disease distinction is irrelevant for most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease. (shrink)

As human beings we sometimes in one way or another become sick, and therefore go for treatment depending on our choice of treatment (religious perspective or Western medical treatment). Although African traditional religion is not against a Western medical way of treatment or healing process, its followers believe that there are some diseases that Western medicine cannot treat, and therefore need spiritual attention, as it is sometimes practiced in churches. This article discusses the African traditional view regarding disease, causes (...) of disease, how disease is diagnosed and treated, with a special focus on Ghana. The article also describes the role of the diviner or the African traditional priest or what others may term as ‘herbalists’. The advantages and disadvantages of the African traditional healing process are considered. The article concludes by discussing African traditional healing in the context of a contemporary health care discourse, as well as a proposal for dialogue between traditional healers, Western medical practitioners, the government of Ghana, and the governments of various countries where this issue may be applicable, to build a consensus in addressing health issues. (shrink)

THIS PAPER IS A COMMENTARY ON LUDWIK FLECK'S ESSAY ON THE CONNECTION BETWEEN WHAT HE CALLS "THOUGHT-STYLES" AND SCIENTIFIC AND MEDICAL CONCEPTS. THE IDEA OF A "THOUGHT-STYLE" APPLIED TO CONCEPTS OF DISEASE IS THAT THEY ARE NOT ONLY VALUE-LADEN IN THE SENSE OF INCLUDING NORMATIVE DIMENSIONS. THEY ALSO EMBRACE BROAD SOCIAL FACTORS, AS WELL. I ARGUE THAT THOUGHT-STYLES SHOULD BE UNDERSTOOD TO BE "OPEN-TEXTURED," ADMITTING A PLURALITY OF VALUE CONSIDERATIONS TO CONCEPTS OF DISEASE.

The terms health, disease and illness are frequently used in clinical medicine. This has misled philosophers into believing that these concepts are important for clinical thinking and decision making. For instance, it is held that decisions about whether or not to treat someone or whether to relieve someone of moral responsibility depend on whether the person has a disease. In this paper it is argued that the crucial role of the disease concept is illusory. The health/ (...) class='Hi'>disease distinction is irrelevant for most decisions and represents a conceptual straightjacket. Sophisticated and mature clinical decision making requires that we free ourselves from the concept of disease. (shrink)

The concept of disease has been the subject of a vast, vivid and versatile debate. Categories, such as "realist", "nominalist", "ontologist", "physiologist", "normativist" and "descriptivist", have been applied to classify disease concepts. These categories refer to underlying theoretical frameworks of the debate. The objective of this review is to analyze these frameworks. It is argued that the categories applied in the debate refer to profound philosophical issues, and that the complexity of the debate reflects the complexity of (...) the concept itself: disease is a complex concept, and does not easily lend itself to definition. (shrink)

Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper deals with the (...) question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (shrink)

Russell Powell and Eric Scarffe1 are pluralists about disease. They offer their thickly normative account to meet the needs of doctors, but they allow that a different concept of disease might work better for zoologists. In this commentary, I grant that Powell and Scarffe’s thickly normative evaluation of biological dysfunction works well in many medicinal contexts. Powell and Scarffe respond effectively to eliminativists—we should retain the concept of disease. But the paper’s pluralism and focus on (...) the specific needs of institutions should permit us to eliminate the notion of disease from domains for which the historical grounding of their selected effects account of function are contrary to therapeutic goals. One such domain is mental health. I found Powell and Scarffe’s rejection of Boorse’s dispositional account of biological function persuasive—the selected effects account of function is a superior fit for biologists’ use of the term. But the historical nature of this concept is, at best, a distraction from the task of morally evaluating the many ways in which …. (shrink)

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused on the task (...) of delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be? (shrink)

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified (...) claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)

In the discussion of such social questions as "how should alcoholics be treated by society?" and "what kind of people are responsible in the face of the law?", is "disease" a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance 'alcoholism should be classified as a disease' we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases (...) and, therefore, we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden. (shrink)

Although it is now generally acknowledged that new biomedical technologies often produce new definitions and sometimes even new concepts of disease, this observation is rarely used in research that anticipates potential ethical issues in emerging technologies. This article argues that it is useful to start with an analysis of implied concepts of disease when anticipating ethical issues of biomedical technologies. It shows, moreover, that it is possible to do so at an early stage, i.e. when a technology is (...) only just emerging. The specific case analysed here is that of ‘molecular medicine’. This group of emerging technologies combines a ‘cascade model’ of disease processes with a ‘personal pattern’ model of bodily functioning. Whereas the ethical implications of the first are partly familiar from earlier—albeit controversial—forms of preventive and predictive medicine, those of the second are quite novel and potentially far-reaching. (shrink)

This paper attempts to address the general question whether information technologies, as applied in the area of medicine and health care, have or are likely to change fundamental concepts regarding disease and health. After a short excursion into the domain of medical informatics I provide a brief overview of some of the current theories of what a disease is from a more philosophical perspective, i.e., the "value free" and "value laden" view of disease. Next, I consider at (...) some length, whether health care informatics is currently modifying fundamental concepts of disease. To this question I will answer largely in the negative. (shrink)

In the discussion of such social questions as how should alcoholics be treated by society? and what kind of people are responsible in the face of the law?, is disease a value-free or value-laden notion, a natural or a normative one? It seems, for example, that by the utterance alcoholism should be classified as a disease we mean something like the following: the condition called alcoholism is similar in morally relevant respects to conditions that we uncontroversially label diseases, (...) and therefore we have a moral obligation to consider alcoholism a disease. So there are grounds to think that, in the discussion of social questions, our concept of disease is strongly value-laden. However, it does not follow that the medical concept of disease is likewise value-laden. In this paper I distinguish between the medical and social concepts of disease, arguing that the naturalist-normativist debate is concerned with the former, but not the latter. Therefore, we need not settle the naturalist-normativist debate in order to conclude that the social concept of disease is value-laden. (shrink)

The concept of disease is deeply rooted in medical practice, and one can hardly conceive of caring for patients without this tool. Nevertheless, under this seemingly uncontroversial idea there are some highly polemical axioms that we usually take for granted, even though they often lead us to some uncomfortable inconsistencies and contradictions. Some of the conceptual issues derived from our traditional view of disease, which condition the way we conceive and practice medicine, include:We conceive of disease (...) as a real entity that affects a previously healthy person, thus making him ill. The purpose of medicine is to identify and fight this entity. If it succeeds, the patient is cured; otherwise, the patient will .. (shrink)

This paper attempts to address the general questionwhether information technologies, as applied in thearea of medicine and health care, have or are likelyto change fundamental concepts regarding disease andhealth. After a short excursion into the domain ofmedical informatics I provide a brief overview of someof the current theories of what a disease is from amore philosophical perspective, i.e. the ``valuefree'' and ``value laden'' view of disease. Next, Iconsider at some length, whether health careinformatics is currently modifying fundamentalconcepts (...) of disease. To this question I will answerlargely in the negative, and I will provide the sketchof some arguments from current research programs inmedical informatics why I think this is the case. Thisargumentation is supported by a detailed account ofhow the disease profile for beriberi heart disease,used in one of the major medical informaticsdiagnostic programs, QMR (and its ancestorINTERNIST-1), was developed, and why at least thisprogram essentially follows received views oftraditional medicine.The one main exception to theconformity of this program to ``received'' views of adisease occurs when the program's designers need tofine-tune a disease definition. This fine-tuning is tocomport with the expert's perspective on the disease,including his or her epistemic values, as well as theprogram's other resources for diagnosing components ofa disease. (shrink)

This paper will begin with some very broad and general considerations about the kind of biological entities we are. This exercise is motivated by the belief that the view of what we—multicellular eukaryotic organisms—are that is widely assumed by biologists, medical scientists and the general public, is an extremely limited one. It cannot be assumed a priori that a more sophisticated view will make a major difference to the science or practice of medicine, and there are areas of medicine to (...) which it is probably largely irrelevant. However, in this case there are important implications for medicine, or so I shall argue. In particular, it enables us to appreciate fully the potential medical significance of some of the most exciting contemporary advances in general biology, in such fields as epigenetics, metagenomics, and systems biology; and part of this significance is that these advances have raised serious doubts about how we should understand the biological individuals that medicine is generally assumed to aim to treat. (shrink)

The clinical empiricism of Thomas Sydenham (1624–1689) and his definition of especie morbosae represented a substantial turn in the medicine of his time. This turn supposed the shift towards an ontological conception of diseases, from a qualitative to quantitative interpretation. Sydenham’s clinical proposal had a great influence on empiricism philosophical thinking, particularly in John Locke and his delimitation of knowledge. The dialogue between medicine and philosophy, set out by Sydenham-Locke, reactivates the problem of the clinical and theoretical foundations of medical (...) thought, as well as the limits of scientific knowledge. Similar to problem exposed in the Hippocratic treatise On ancient medicine, seventeenth-century medicine seeks its epistemological foundations and the solution to its difficulties in clinical experience, probability and analogy. The aim of this work is to show the Sydenham’s contribution to one of the great controversies between medicine and philosophy. (shrink)

Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. Drawing (...) on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms. (shrink)

Hilary Putnam's influential analysis of the 'division of linguistic labour' has a striking application in the area of doctor-patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals' explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like 'sickness' and 'illness' in ways that do not necessarily correspond to health professionals' understanding. Drawing (...) on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like 'sickness' or 'illness' does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms. (shrink)

It is now widely accepted that the concepts of “health” and “disease” in psychiatric and psychological contexts are value laden. In this article I argue that even in the realm of physical illness and disease (appendicitis, phenylketonuria, etc.), the concepts of “health”, “illness” and "disease” are value laden. I explore the four most common bases used to objectively ground the key concept “normal functioning”, namely, genetic structure, evolutionary fitness, non-premature death and absence of pain. I argue (...) that they all fail to adequately provide an objective grounding for the. concept “normal functioning” (health) and, hence, for “abnormal functioning” (illness, disease). The reason an objective grounding cannot be given is that physical “health”, “illness” and “disease” rest on widely shared values in addition to the condition of the organism. (shrink)

The concepts of health and disease play pivotal roles in medicine and the health professions This volume brings together the requisite literature for understanding current discussions and debates these concepts. The selections in the volume attempt to present a wide range of views concerning the nature of the concepts of health and issues using both historical and contemporary sources -- Back cover.

According to the ‘fact-plus-value’ model of pathology propounded by K. W. M. Fulford, ‘disease’ is a value term that ought to reflect a ‘balance of values’ stemming from patients and doctors and other ‘stakeholders’ in medical nosology. In the present article I take issue with his linguistic-analytical arguments for why pathological status must be relative to such a kind of medico-ethical normativity. Fulford is right to point out that Boorse and other naturalists are compelled to utilize evaluative terminology when (...) they characterize the nature of diseases and biological dysfunctions. But the relevant ‘biofunctional judgements’ are no less factual and empirical for that. While it is indeed evaluative to say that biological dysfunctions involve failures to execute naturally selected functions, such judgments are not bound to entail anything about what is good or bad for us, and what should be treated or not. In the last part of the paper I ruminate briefly on the relationship between ‘biological evaluationism’, on my construal, and descriptions of ‘causal biology’. As I note in my conclusion, a strict bioevaluative concept of disease can be valid for every species on earth, and thus be of particular usefulness in general biological contexts. (shrink)

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are (...) outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy. (shrink)

Examining the naturalist and normativist concepts of health and disease this article starts with analysing the view of C. Boorse. It rejects Boorse's account of health as species-typical functioning, giving a critique of his view based on evolutionary theory of contemporary biology. Then it gives a short overview of the normativist theories of health, which can be objectivist and subjectivist theories. Rejecting the objectivist theories as philosophically untenable, it turns to the subjectivist theories of Gert and Culver, and to (...) the view of Nordenfelt. These theories give quite a good subjectivist account of health and disease, but they do not pay enough attention to the notion of the environment, without which it is impossible to define health and disease. Starting with their definitions but introducing the notion of “reasonable social norms”, the article arrives at the following definition of health: The healthier a physical or mental characteristic, process, reaction is, the more it makes it possible for the individual to adapt to reasonable social norms without pain and suffering, and the longer, and happier a life it will be able to ensure him in that society. (shrink)