Evolution and Normativity

Defining the concepts of health and disease has proved rather difficult and many philosophers of medicine have simply concluded that we would be better off giving up on such endeavors. I feel that this view is misguided mainly because it seems to rest on a rather inadequate understanding of how philosophers use biology to clarify medical concepts. While some philosophers appeal to biology so as to clarify what we mean by the concepts of health and disease, others attempt to use biology to develop a theory thathelps to explain what health and disease are. In this dissertation, I examine the work of an often overlooked philosopher of medicine, Georges Canguilhem, who sought to understand medical concepts by starting from the biological properties of variation and variability. In other words, in order to define health and disease, Canguilhem first tried to establish how what is normal can vary between organisms and even within the same organism due to the dynamic relation between the organism and its environment. Simply put: what is normal for one organism could be pathological for another and what is normal in one environment could become pathological in another. Consequently, variation and variability need to be included in our understanding of health and disease. Throughout this dissertation, I explore how Canguilhem goes about developing the implications of these biological properties for medical concepts and this allows me to distinguish his approach from some popular ones in philosophy of medicine, e.g. those trying to develop an objective biological approach (naturalism) and those appealingto evolutionary principles. I establish the plausibility of definingmedical concepts relative to individual organisms and their environments, while showing some of its potential limitations, especially when it comes to human social environments. Ultimately, a more nuanced understanding of how the inseparability of organisms and environments canhelp to clarify health and disease provides an interesting way to get past the apparent stalemate in philosophy of medicine and firmly establishes the relevance of Canguilhem’s philosophy.