The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health (‘health’ is not defined as absence of disease (...) but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

Journal of Social Philosophy, EarlyView.

In 2012, the symposium "Christopher Boorse and the Philosophy of Medicine" was held at the University of Hamburg. The initial ideas presented at this event, which celebrated Chris's contribution to the development of what is now a vibrant area of research, especially to the theory of disease, form the core of the papers published in this issue. Similarly to what Robert Nozick once said about John Rawls's work, it can be demanded that philosophers of medicine must now either work within (...) Boorse's theory or explain why not. It is simply the main contender in the so-called naturalist camp of contributions to the theory of disease. All of the papers in this issue address his approach in some respect, and all of them are friendly toward his theory up to a point. In this brief introduction, I try to extract common threads. In doing so, I focus on three issues that have the capacity to determine future debates. The first is the methodology of developing a theory of disease, especially what conceptual analysis amounts to and what it may achieve. The second is the issue of value-ladenness of the concepts of health and disease, a topic that has been at the forefront of the philosophical debate, but which -- to my mind -- has often been misunderstood. The third issue is the problem of the unity of medical terminology. We can ask whether there is only one core medical concept, be it "disease," "pathology," "disorder," "malady," or something else. Alternatively, we might propose different concepts for different purposes. (shrink)

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves (...) the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation. (shrink)

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. -/- The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the (...) lack of empathy, as some philosophers have proposed—but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. -/- As this volume demonstrates, philosophers will be better equipped to determine what they mean by “the moral point of view” when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy. (shrink)

This chapter introduces the main findings of the medical research on psychopathy as well as the most significant threads of the philosophical debates surrounding psychopathy. It also introduces the articles collected in this volume. The introduction focuses on issues in moral psychology and metaethics, such as moral motivation, moral responsibility, and moral understanding. It shows the difficulty in conceptualising psychopathy and in using psychopathy as a test case for philosophical theories.

The chapter starts from a specific interpretation of what it means to know the difference between right and wrong, which stems from Gilbert Ryle. To know the difference between right and wrong implies caring about morality. The author links Ryle’s ideas to the notion of being a moral person. Two different ideas found in moral philosophy are delineated, namely, the amoral person, that is, someone who rejects the demands of morality, and the morally incapacitated person, that is, someone who cannot (...) take those demands into account. Psychopaths are not amoral in the philosophers’ sense of the word, but are incapable of, or seriously deficient in, taking the moral point of view. (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)

Der libertäre Paternalismus befürwortet Eingriffe in die Entscheidungsfindung von Bürgern, ohne ihnen Optionen völlig nehmen zu wollen. Vielmehr soll die Lenkung des Willens durch Schubser geschehen. Im folgenden Beitrag möchte ich zeigen, dass der libertäre Paternalismus auf tönernen Füßen steht. Ich bediene mich dabei des polemischen Bilds von Quacksalbern. Dieses Bild passt zu meinem argumentativen Vorgehen, da ich erstens zeigen will, dass der libertäre Paternalismus falsche Diagnosen über vermeintliche Krankheiten der Willensbildung stellt, und zweitens, dass er die falsche Therapie empfiehlt. (...) Im ersten Teil des Artikels kritisiere ich die Diagnose des libertären Paternalismus, wonach Menschen in ihrer Entscheidungsfindung systematisch fehlschlagen. Die Auswirkungen der zugrundeliegenden psychologischen Forschung werden missinterpretiert und damit vielen menschlichen Entscheidungen eine Art Defekt zugeschrieben. Der zweite Teil des Beitrags hinterfragt die Therapie des libertären Paternalismus. Für entsprechende Interventionen in die Wahlarchitektonik muss Wissen erlangt werden über die Richtung, in welche die Menschen jeweils geschubst werden sollten. Die hier genannte epistemische Aufgabe kann mit den theoretischen Mitteln des libertären Paternalismus nicht gelöst werden. (shrink)

Decision-making capacity or mental competence is one of the most intensively discussed concepts in contemporary bioethics and medical ethics. In this paper I argue that anorexia nervosa, an eating disorder primarily afflicting adolescent girls and young women, seriously challenges what I label the traditional account of decision-making capacity. In light of these results, it may in addition be necessary to rethink a certain popular type of paternalistic argumentation that grounds the justification of compulsory treatment, for example of anorexic persons who (...) refuse treatment, on a lack of decision-making capacity. (shrink)

Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure (...) of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard. (shrink)

In this paper, I want to discuss the relation between ambivalence and the unity of the self. I will raise the question whether a person can be both ambivalent about his own will and nevertheless be wholehearted. Since Harry Frankfurt’s theory is my main point of reference, I briefly introduce his account of the will and the reasons for his opposition towards ambivalence in the first section. In the second section, I analyse different interpretations of ambivalence. In the third section, (...) I provide a narrative account of a diachronic integration of the self that allows for the integration of volitional ambivalence. Finally, I scrutinise different meanings of the unity of the self, since disintegration, not ambivalence, seems to be bad for us. I conclude that persons can indeed be wholeheartedly ambivalent. (shrink)

In diesem Artikel wird argumentiert, dass die Philosophie nicht über passende Methoden verfügt, reale politische Probleme angemessen zu analysieren. So sind die tatsächlich vorzufindenden Empfehlungen zur Lösung solcher Fragen meist trivial oder unterkomplex. Es wird geraten, zuerst geeignete Instrumentarien der angewandten bzw. konkreten Ethik zu entwickeln, bevor sich PhilosophInnen zu solch komplexen Fragen wie die der Flüchtlingspolitik äußern.

The paper contrasts Lennart Nordenfelt’s normative theory of health with the naturalists’ point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse’s analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health and a positive conception of health. An objection (...) against Nordenfelt’s account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt’s conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt’s is in danger of supporting medicalization. In conclusion, although Nordenfelt’s theory is not altogether rejected and even seen in congruence with Boorse’s account, it is claimed that the naturalistic framework should obtain conceptual priority. (shrink)

In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational (...) alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I conclude that Rawlsian Justice as Fairness is bad for the environment. (shrink)

Does the reference to a mental realm in using the notion of mental disorder lead to a dilemma that consists in either implying a Cartesian account of the mind-body relation or in the need to give up a notion of mental disorder in its own right? Many psychiatrists seem to believe that denying substance dualism requires a purely neurophysiological stance for explaining mental disorder. However, this conviction is based on a limited awareness of the philosophical debate on the mind-body problem. (...) This article discusses the reasonableness of the concept of mental disorder in relation to reductionist and eliminativist strategies in the philosophy of mind. It is concluded that we need a psychological level of explanation that cannot be reduced to neurophysiological findings in order to make sense of mental disorder. (shrink)

Alternative approaches in the discussion of distributive justice differ in their answers to the question 'equality of what'? In this essay I intend to ask instead 'why equality'? The article rejects several arguments in favour of distributive equality, mainly on the grounds that they confuse two different kinds of justice, namely 'formal' justice and distributive justice. The ideal of distributive equality is based on comparisons but equal respect does not necessarily involve relational considerations. Subsequently I will consider equality of opportunity (...) which appears on first sight to be the most promising account. However, I will point out that this approach is not convincing as an attempt to give everyone the chance to live a good life. Finally I will submit that only a theory of absolute needs is adequate. (shrink)

In this paper, I will focus on the role that findings of the empirical sciences might play in justifying normative claims in political philosophy. In the first section, I will describe how political theory has become a discipline divorced from empirical sciences, against a strong current in post-war political philosophy. I then argue that Rawls’s idea of reflective equilibrium, rightly interpreted, leads to a perspective on the matter of justification that takes seriously empirical findings regarding currently held normative beliefs of (...) people. I will finally outline some functions that empirical studies might have in political philosophy. (shrink)

Moral Theory and Theorizing in Healthcare Ethics Content Type Journal Article Category Editorial Pages 365-368 DOI 10.1007/s10677-011-9291-x Authors Mike McNamee, College of Human and Health Sciences, Swansea, SA28PP UK Thomas Schramme, Universität Hamburg, Philosophisches Seminar, Von-Melle-Park 6, 20146 Hamburg, Germany Journal Ethical Theory and Moral Practice Online ISSN 1572-8447 Print ISSN 1386-2820 Journal Volume Volume 14 Journal Issue Volume 14, Number 4.

The predicate 'natural' is often used in a normative fashion, especially in Bioethics. But that something is natural does not alone suffice to explain its value. In this essay, I want to fulfil mainly two tasks: Firstly, to differentiate between several usages of the concept of naturalness and scrutinize whether they may serve a function in ethics; secondly, to argue for the value of naturalness in certain respects. The value of the natural lies firstly in its significance for human well-being: (...) specific natural functions form necessary elements and conditions of the ability to lead a good life. Secondly, the very feature of the natural, its being purposeless, which implies that we cannot read our aims out of nature, serves as the basis of its eudaimonistic value. (shrink)

ZusammenfassungDer Beitrag beschäftigt sich mit der Frage, ob eine Behinderung immer als Form von Leid betrachtet werden muss. Mit Hilfe einer Unterscheidung zwischen absoluten und komparativen Einschränkungen des Wohls wird aufgezeigt, dass die bloße Tatsache einer vorliegenden medizinischen Schädigung nicht hinreicht, ein Urteil über das absolute Wohl einer Person zu treffen. Es werden verschiedene Argumente geprüft, warum Behinderung dennoch generell negativ bewertet werden sollte. Diese werden zurückgewiesen. Abschließend wird eine Überlegung eingeführt, wonach gleichwohl bestimmte Formen der Behinderung als objektive Beeinträchtigungen (...) des Wohls zu gelten haben, nämlich dann, wenn basale Fähigkeiten betroffen sind. (shrink)