Introduction to the Concept of Health in the book “In defense of an evolutionary concept of health (Ashgate Studies in Applied Ethics)”. Author: Mahesh Ananth 5th edition Ashgate Publisher October 2012 & Defining health and Disease in the Journal “Studies in History and Philosophy of Science Part C: Studies in history and Philosophy of Biological and Biomedical Sciences, Volume 40, Issue 3, September 2009 Author: Marc Ereshefsky Naturalism Normative Hybrid and alternative approach to the concept of health Even though the concept of health is indispensable to: (1) the practices of medicine, (2) the many debates surrounding public policy issues, and (3) The ethical concerns that loom over the decisions made by medical practitioners there is still a notable lack of consensus concerning the concept of health among scholars and healthcare professionals In spite of numerous efforts directed to the clarification of the concepts of health and disease, there is far from universal agreement about their nature (Lennart Nordenfelt, 1984) In fact the controversies are quite profound ((Lennart Nordenfelt, 1984) The Concept of Health Debate: Naturalists Versus Normativists 1. Health as a Natural Concept vs 2. Health as a Normative Concept The naturalists argue, that the concept of health is itself a value-free concept. For example, naturalists contend that whether a heart is healthy or diseased is an objective matter to be determined by relevant medical scientists. It is entirely a separate matter, they argue, whether or not such a condition is of value. The naturalist approach attempts initially to approach matters in a nonvalue-laden fashion. In particular, the notion of disease, the concept of disease, is defined without respect to the implications for the bearer— whether they be good or bad, happiness generating or or otherwise Essentially, a healthy state is taken to be one of proper functioning, that is to say, proper functioning for the species Home sapiens. Thus , a diseased state is taken to be one that, in some sense, interferes with this proper functioning. Thus, naturalists deny that values are part of the concept of health. Health essentially involves only the functional activities of organisms. In contrast, normativists argue that the concept of health is value-laden. First, they claim that, since science itself is littered with values, medical scientists (e.g., pathologists or physiologists) cannot escape incorporating values into their concepts. Second, normativists claim that the scope of the concept of health is ultimately tethered (tied) to diagnosis and treatment of patients within a cultural/social context. Defending the normativist position Talcott Parsons defined health as: “Health may be defined as the state of optimum capacity of an individual for the effective performance of the roles and tasks for which he has been socialized. It is thus defined with reference to the individual’s participation in the social system”. “It is also defined as relative to his “status” in the society, i.e. to differentiated type of role and corresponding task structure, e.g., by sex or age, and by level of education which he has attained and the like”. Thus, normativists, like Agich, Parsons, and Engelhardt, think that the idea of a value-free concept of health is fundamentally misguided because science is value-laden, or because the concept of health includes values associated with medical practice and the broader social environment in which people find themselves. A barrier to a generally accepted concept of health is this fundamental tension between normativists and naturalists. Normativists, who include societal concerns and goals within the scope of medicine, insist that norms are an ineliminable part of the concept of health while Normativists (Margolis 1976, Goosens 1980, Sedgewick 1982, Engelhardt 1986) believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Healthy states are those states we desire, and diseased states are those states we want to avoid. Naturalists, in contrast, restrict the scope of medicine to the somatic condition of the human body Their definitions attempt to highlight what is biologically natural and normal for humans. The hybrid definition of health, define, ‘health’ and ‘disease’ by combining aspects of naturalism and normativism. Their aim is to provide an account of health and disease that captures the virtues but not the vices of naturalism and normativism. For the hybrid theorist, disease only occurs when a state is both dysfunctional and disvalued. A condition is a disorder if and only if: (a) the condition causes some harm or deprivation of benefit to the person as judged by the standards of the person’s culture (the value criterion), and (b) the condition results in the inability of some internal mechanism to perform its natural function, wherein natural function is an effect that is part of the evolutionary explanation of the existence and structure of the mechanism (the explanatory criterion). (Wakefield 1992, p. 384) • One way, then, to understand the concept of health would be to start by following the course laid out by philosophers, because philosophers’ accounts of health often include claims about: (1) what we are as humans when we are thought to be healthy, (2) how we are able to come to be in a state of health, and (3) how we relate to the world when we are in a certain state of health. • An Alternative Approach state descriptions and normative claims State descriptions are descriptions of physiological or psychological states e.g. A measurement of the amount of calcium in a patient’s tissues is a state description. So as the description that a patient’s red blood cells are rupturing (is a state description); state descriptions are also free of functional claims. state descriptions do not explicitly employ such notions as natural and normal To avoid such controversies and assumptions, state descriptions make no claims about whether a physiological or psychological state is functional or dysfunctional. Normative claims are explicit value judgments concerning whether we value or disvalue a physiological or psychological state We often make overt value judgments when deciding which states to avoid, diminish, or promote. For example, we disvalue the rupturing of blood cells, we value having legs that can walk, When these value judgments are made explicit they fall under the heading ‘normative claims.’ reasons for using the distinction between state descriptions and normative claims: One reason is that using this distinction would help clarify discussions of controversial medical cases. Consider the case of deafness: In state descriptions and normative claim: both sides agree that deafness is a physiological state involving hearing, but they disagree over whether such a state should be valued or disvalued. Is it a disease? Simply put, whether an undesirable state is a medical state depends on how the division of labor is drawn in a society. According to the suggestion offered here, we avoid the use of ‘normal’ and ‘natural’ in state descriptions. We cannot get rid of bias in science, but we should try to eliminate it or highlight it whenever we see it.
