Medico-ethical versus biological evaluationism, and the concept of disease

Abstract

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.

How to Draw the Line Between Health and Disease? Start with Suffering

“…The relevant characterizing is however done at a useful level of explanation in empirical biology,…, nothing (medico-)ethical is necessarily implicit in bald bioevaluative practice. Being empirical in nature, questions of biological dysfunction can also yield to factual answers.» Moreover, «naturalists are quite capable of defining a concept of disease that only requires non-ethical evaluations of biological dysfunctions.»[ 51 ].…”

“…Accordingly, how persons function in their daily life, may be a more appropriate level for drawing the line between health and disease than the (micro-)level biological dysfunction. 2 As argued above, while many consider these and other types of functioning as value-laden concepts [ 35 ], I accept that others think that they are descriptive (and not normative) [ 51 , 55 ].…”

Human Enhancement: Enhancing Health or Harnessing Happiness?

“…There are of course other naturalistic conceptions of health (and disease) that may be less challenged by HE (Neander 1991, Schramme 2013, Lindstrøm 2012). Nonetheless, it is unclear whether HE challenges naturalistic conceptions of health.…”