Abstract

Address to the Second Annual Conference, European Society for Person Centred Healthcare: A key motivation for Boorse's biostatistical theory of health was to defend the objectivity of medical diagnosis. There are background assumptions at work here about the relationship between knowledge, truth, objectivity, science, value and reality that require urgent analysis in the context of the current debate about person-centred healthcare. The clearest illustration of these assumptions can be found in the debate about the reality of mental illness, where there has historically been a divide between those who accept that diagnosis is 'value-laden' and therefore accept a relativist/subjectivist account of mental illness, and those who feel the need to deny the value-laden nature of diagnosis to defend the reality of mental illness. However, more nuanced analyses note that all medical diagnosis is arguably value-laden & this does not imply that medical conditions are unreal. Instead of denying the value-laden nature of diagnosis, we need to adopt an alternative philosophical framework which requires us to make explicit, and to justify, the value-judgements implicit in diagnosis. Objections to this are considered from philosophy of science and political philosophy, and are seen to embody the same philosophical framework that needs to be revised.