Conceptions of Health

1
Conceptions of Health Disease

• ISD I E/H/HL
• Session 1
• April 14, 2003

2
Overview

• Since youre in the early days of the ISD course,
  its a good time to consider the concepts of
  disease health
• How should we conceive of them?
• The main question for this part of the session
  Are these descriptive or normative notions?
• i.e., is a value judgment made whenever judgments
  about health and disease are made or are these
  simply objective, value-free descriptions of a
  patient?

3
Some Examples

• Which of the following are examples of disease or
  ill health? Which are neither?
• AIDS
• Senility
• Extremely short stature
• SARS
• Colour blindness
• Starvation

4
Why Does Defining Health Disease, Matter?

• The basic concepts we work with often shape our
  thinking in ways we might not expect
• This idea will be explored at several points in
  the term
• 2. Significance for the scope of medicine
• Medicine is generally thought to be in the
  business of promoting health, curing disease,
  etc.
• Thus the limits of disease, health, etc. set the
  limits of medicine
• Consider, e.g., the debate about whether
  alcoholism is a disease

5
Two Examples

• Contrast
• Health is a state of complete physical, mental
  and social well-being and not merely the absence
  of disease or infirmity. (Preamble to the WHO
  Constitution)
• Health is a state of physical well-being
  (Daniel Callahan)
• Notice the huge difference in the scope of health
  care implied by the two definitions

6
The Relationship between Disease Health

• Are disease and health logical opposites? I.e.,
  is health just the absence of disease?
• This doesnt allow for degrees of healthiness
• Does being healthy really require the complete
  absence of disease?
• If so, well either need a fairly restrictive
  definition of disease or else no one will ever be
  healthy

7
Three Approaches to Defining Disease Health

• In terms of statistical normalcy/ abnormality
• In terms of proper biological functioning
• In normative terms

8
Normative vs. Non-normative Conceptions of
Disease Health

• Whats at stake in the argument about whether
  disease and health are normative concepts?
• Some claim that medicine cannot be objective
  unless its basic concepts are value-judgment free
• However, recall that some think value judgments
  can be objectively true or false
• If you accept that (at least some) value
  judgments are objectively correct, this usually
  limits your discomfort with the idea that health
  disease are normative concepts

9
Statistical Normalcy/Abnormality

• Healthy conditions are statistically normal
  conditions
• Diseases are statistically abnormal conditions
• Is this plausible?
• This idea is often appealed to, but clearly
  flawed
• Abnormal tallness is a disease?
• Unusual hair or eye colour constitutes a disease?

10
Proper Function

• health consists in our functioning in conformity
  with our natural design as determined by natural
  selection (66)
• If an organ loses the capacity to perform the
  function for which it was designed by evolution,
  the condition is indicative of disease (66)
• Is this plausible?

11
Problems with Proper Function

• The very idea seems to anthropomorphize
  evolution.
• Does it make sense to talk about function where
  theres no conscious designer?
• Notice this problem goes away if you accept the
  existence of God as active creator
• Even if we speak loosely about function, couldnt
  there be normal diseases?
• E.g., Consider that aging might be very useful
  from an evolutionary point of view
• Would this mean no diseases as a result of
  ordinary aging?

12
Normative Conceptions of Health Disease

• A normative conception claims it is impossible
  to decide whether a particular state of affairs
  represents health or disease without some
  reference to values (68)
• Culver Gert it is not dysfunction but the
  perceived evil associated with dysfunction that
  is at the heart of the meaning of disease. (69)
• Such a conception may also draw on ideas of
  function or abnormality, but it is value
  judgments that are claimed to be at the heart of
  judgments about disease or health
• Is this plausible?

13
So What?

• Most of the time, the fact that health disease
  are value-laden terms is not problematic since
  most of the time we agree about how to evaluate a
  particular condition
• E.g., heart problems bad
• Problems do arise, however, in some cases in
  which there are disagreements about how we should
  evaluate a particular condition
• E.g., deafness
• homosexuality
• p.m.s.

14
The Point

• None of this suggests that there is anything
  fundamentally wrong with the concepts of disease
  health
• It does suggest that it is a mistake to think the
  concepts are purely descriptive
• They have a normative element we should be aware
  of

15
A Further Question

• Even if we accept that the concept of disease has
  normative elements, it still remains for us to
  come up with a precise definition of disease
• Two Competing Conceptions of Disease
• Disease entity
• Focuses on the existence of a discrete, physical
  disease entity
• Clinical entity
• Conceives of disease in functional terms