Biological normativity: a new hope for naturalism

Medicine, Health Care, and Philosophy, 2021

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages.

Philosophical Papers, 2007

In considering the debate about the meaning of 'disease', the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of 'disease' be assessed according to taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their interrelationships. Most importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts.

Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 2010

This paper examines the most influential naturalist theory of health, Christopher Boorse's 'biostatistical theory' (BST). I argue that the BST is an unsuitable candidate for the rôle that Boorse has cast it to play, namely, to underpin medicine with a theoretical, value-free science of health and disease. Following the literature, I distinguish between ''real" changes and ''mere Cambridge changes" in terms of the difference between an individual's intrinsic and relational properties and argue that the framework of the BST essentially implies a Cambridge-change criterion. The examination reveals that this implicit criterion commits the BST to the troubling view that an individual could go from being diseased to healthy, or vice versa, without any physiological change in that individual. Two problems follow: (1) the current framework of the BST is ill-equipped to formally embrace Cambridge changes and (2) it is theoretically dubious. The arguments advanced here are not limited to the BST; I suggest they extend to any naturalist claim to underpin medical practice with a value-free theory of health and disease defined in terms of an evolutionary view of biological fitness.

Teorema, 2021

We situate the well-trodden debate about defining health and disease within the project of a metaphysics of science and its aim to work with and contribute to science. We make use of Guay and Pradeu’s ‘metaphysical box’ to reframe this debate, showing what is at stake in recent attempts to move beyond it, revealing unforeseen points of agreement and disagreement among new and old positions, and producing new questions that may lead to progress. We then discuss the implications of the two-way benefits between medicine and philosophy when the latter is driven and constrained by medical science.

History, Philosophy and Theory of the Life Sciences, 2016

Christopher Boorse, the leading naturalist philosopher of medicine, used to interpret illness as a practical concept that involves normative or evaluative elements, which have to do with the undesirability of medical conditions. Later he changed his mind and has since regarded illness as a value-neutral concept, just like disease. An illness, according to his most recent point of view, is a "systemic disease, affecting the organism as a whole". Yet, his account of illness is still fairly undeveloped. In my contribution I want to scrutinize the notion of illness from a naturalist point of view. I will first draw on Boorse's theory and point out problems with it. I will then discuss the crucial question about the logical relation between the concepts of disease and illness, especially by discussing Bill Fulford's "reverse view". A naturalist account of illness holds that the extension of the concept of illness is restricted by the scope of the concept of disease, hence that a condition qualifies as a putative illness only if it is a disease. I do agree with normativists, though, in claiming that the concept of illness is evaluative; it refers to pathological conditions that are bad for the affected person. Finally, I hint at a way as to how a distinctively naturalist theory of illness can draw on a naturalist theory of disease. We seem to gain knowledge about the basic elements of a good human life in virtue of developing a theory of basic biological functions. Hence, there is an interplay between value-neutral and evaluative points of view.

Nursing Philosophy, 2014

Philosophy of Science, 1977

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. This conception of health is as value-free as statements of biological function. The view that health is essentially valueladen, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed.

Science starts by using terms such as ‘temperature’ or ‘fish’ or ‘gene’ to preliminarily delimitate the extension of a phenomenon, and concludes by giving most of them a technical meaning based on an explanatory model. This transforma- tion of the meaning of the term is an essential part of its naturalization. Debating on the definition of ‘disease’, what most philosophers of medicine have examined is the pre-naturalized meaning of the term: for that reason they have focused on the task of delimiting disease and non-disease (health), mainly used conceptual analysis as a method of choice, and considered the nosological level of ‘disease judgments’ rather than the pathophysiological or psychopathological level of disease mechanisms, thus making them impervious to most scientific discoveries. By focusing instead on the naturalized concept of disease and following some suggestions by philosophers of biology and scientists in cutting-edge fields of biomedical research, they could gar- ner results from a comparison of the mechanisms of diseases. This would ultimately result in a general theory of disease linked with our most general theories on living beings, among them, systems biology and network medicine. Before undertaking such a task, preliminary questions arise: is it likely that there are biological features common to different types of disease? Is it a philosopher’s job to determine what they consist in? What use would such a general theoretical definition of disease be?