The Concept of Disease

In the debate about the concept of disease the term is usually used in a broad sense, to include any non-healthy condition (such as injuries, poisoning, etc.) and interchangeably with ‘pathology’. The debate has focused on two main views, naturalism and normativism, and the issue of whether disease and health can be defined in a way that is value-neutral. Some recent work challenges the assumptions of this debate, such as that disease is a concept structured around necessary and sufficient conditions, and that philosophical analysis should focus on a biomedical notion of disease. Associated with this, other conceptual structures and alternative notions taking pragmatic, epidemiological, or public health perspectives have been put forward.

The naturalist position is represented by the biostatistical theory, developed by Christopher Boorse in several classic papers (1977; 1975; 1976) and defended against critiques in 1997 and 2014. Normativist views are developed by, for example, Canguilhem & Cohen 1978, Nordenfelt 1987, and Cooper 2002. Some argue that disease involves both descriptive and evaluative aspects, a position referred to as either a hybrid theory or as weak normativism, for example Wakefield 2014 and Ereshefsky 2009. Critiques of the traditional debate and alternative approaches are provided by Schwartz 2007 and Sadegh-Zadeh 2000.