Health and Illness, Misc

Insofar as value theory is relevant to the philosophy of medicine, two goods have dominated reflection: well-being and morality. This essay casts doubt on whether those values are sufficient to resolve an array of important debates about medical practice, maintaining that the value of what makes a life meaningful should play a much larger role. After first indicating how meaningfulness differs from happiness and rightness, the essay argues that meaningfulness cannot reasonably be ignored when thinking comprehensively about the proper aims (...) of medicine, the appropriate constraints on their pursuit, and the effective means by which to realize them. The essay’s goal is not to draw any firm conclusions about the suitable ends, constraints, and means of medical practice, but rather to show that, in order to arrive at any, one has to consider the category of life’s meaning, which should be much more prominent in the philosophy of medicine than it has been. (shrink)

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together with a further (...) seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective. (shrink)

ABSTRACT What kind of basic minimum do we owe to others? This paper defends a new procedure for answering this question. It argues that its minimally good life account has some advantages over the main alternatives and that neither the first-, nor third-, person perspective can help us to arrive at an adequate account. Rather, it employs the second-person perspective of free, reasonable, care. There might be other conditions for distributive justice, and morality certainly requires more than helping everyone to (...) secure a basic minimum. Still, if the minimally good life account is correct, and we owe everyone a basic minimum, we must ensure that everyone lives well enough. (shrink)

We live in tragic times. Millions are sheltering in place to avoid exacerbating the Coronavirus (COVID-19) pandemic. How should we respond to such tragedies? This paper argues that the human right to health can help us do so because it inspires human rights advocates, claimants, and those with responsibility for fulfilling the right to try hard to satisfy its claims. That is, the right should, and often does, give rise to what I call_ the virtue of creative resolve_. This resolve (...) embodies a fundamental commitment to finding creative solutions to what appear to be tragic dilemmas. Contra critics, we should not reject the right even if it cannot tell us how to ration scarce health resources. Rather, the right gives us a response to apparent tragedy in motivating us to search for ways of fulfilling everyone’s basic health needs. (shrink)

There are many different varieties of loneliness, with different causes, experiences, and impacts on our lives. We should distinguish them and appreciate that 'tackling' loneliness will mean different things for different kinds of loneliness.

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. (shrink)

In this paper I explore health and illness through the lens of enactivism, which is understood and developed as a bodily-based worldly-engaged phenomenology. Various health theories – biomedical, ability-based, biopsychosocial – are introduced and scrutinized from the point of view of enactivism and phenomenology. Health is ultimately argued to consist in a central world-disclosing aspect of what is called existential feelings, experienced by way of transparency and ease in carrying out important life projects. Health, in such a phenomenologically enacted understanding, (...) is an important and in many cases necessary part of leading a good life. Illness, on the other hand, by such a phenomenological view, consist in finding oneself at mercy of unhomelike existential feelings, such as bodily pains, nausea, extreme unmotivated tiredness, depression, chronic anxiety and delusion, which make it harder and, in some cases, impossible to flourish. In illness suffering the lived body hurts, resists, or, in other ways, alienates the activities of the ill person. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and (...) untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

This paper defends the hypothesis of a potential causal link between increased usage of hormonal contraceptives (HCs) and significant rises in instances of Autism Spectrum Disorders (ASDs) worldwide. It develops a background theory that supports this hypothesis through analysis of: observed correlations between increased usage of HCs and increased instances of ASDs; consistent evidence from independent studies linking “birth spacing” intervals and ASD-risk; evidence from studies on the effects of HCs on folate and B12 absorption; and hypotheses concerning disruptions to (...) mechanisms of delivery of folate and B12 during periods of in utero brain development. The proposed theory is then defended through discussion of how it may explain numerous puzzling correlations with increased instances of ASDs documented in certain demographics. (shrink)

A history of design changes for the eudiometer.

Geleneksel tıptaki büyük ilerlemelere rağmen tamamlayıcı ve alternatif tıp (TAT) uygulamaları hala yaygın olarak kullanılmaktadır. TAT, geleneksel tıbbın bir parçası olarak görülmeyen, çeşitli tıbbi ve sağlık sistemlerini ve ürünlerini içeren uygulamalardır. Bu derlemede kalp hastalıklarında sıklıkla kullanılan TAT yöntemleri, hasta ve hastalık üzerine etkilerinden bahsedilecektir.

I introduce the concept pathophobia, to capture the range of morally objectionable forms of treatment to which somatically ill persons are subjected. After distinguishing this concept from sanism and ableism, I argue that the moral wrongs of pathophobia are best analysed using a framework of vice ethics. To that end I describe five clusters of pathophobic vices and failings, illustrating each with examples from three influential illness narratives.

This book explores the central questions and themes lying at the heart of a vibrant area of philosophical inquiry. Aligning core issues in psychiatry with traditional philosophical areas, it presents a focused overview of the historical and contemporary problems dominating the philosophy of psychiatry. -/- Beginning with an introduction to research issues, it addresses what psychiatry is and distinguishes it from other areas of medical practice, other health care professions and psychology. With each section of the companion corresponding to a (...) philosophical subject, contributors systematically relate themes in philosophy of psychiatry to topics in philosophy of mind, phenomenology, philosophy of science, ethics, social and political philosophy, metaphysics, epistemology, and philosophy of medicine. Looking ahead to new research directions, chapters address recent issues including the metaphysics of mental disorders, gender and race in psychiatry and psychiatric ethics. -/- Featuring discussion questions, suggestions for further reading and an annotated bibliography, The Bloomsbury Companion to Philosophy of Psychiatry is an accessible survey of the debates and developments in the field suitable for undergraduates in philosophy and professional philosophers new to philosophy of psychiatry. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

This article offers an assessment of Henricus Regius’s (1598-1679) pre-Cartesian sources and their role in his appropriation of Descartes’s ideas, via two main questions: 1) Who was Regius, doctrinally speaking, before his exposure to Cartesianism? And 2) how did he use Descartes’s theories before his quarrel with Descartes himself in the mid-1640s? These questions are addressed by means of a textual analysis that concerns his theory of matter. In this article, I will show that 1) Regius started out with a (...) scientific program he had found in Ramism and the medical theories of Heurnius and Santorio. 2) On this basis, he developed a physiology encompassing Descartes’s theory of blood circulation and sensory perception. 3) Regius completed the resulting physiology with a theory of matter more developed than Descartes’s, and which he appropriated from Santorio, Basson, and Gorlaeus. (shrink)

The second chapter is devoted to the analysis of the first introduction of and quarrels over Cartesianism at the University of Utrecht, as determined by the teaching of a Cartesian natural philosophy and physiology by Henricus Regius. First, it is shown how his teaching gave rise to the querelle d’Utrecht (1641), in which two main issues were debated: the rejection of substantial forms, and the characterisation of man as ens per accidens. During the quarrel, questions were raised about the consistency (...) of the new philosophy with theology and – insofar as it raised the problem of the individuation of bodies and species by substantial forms – of the unity of man. Secondly, it is shown how Regius’s peculiar approach to natural philosophy (and physiology) led him to quarrel with Descartes himself in 1645–1648, with regard to two main questions: the nature of mind, and the method of natural philosophy, which Regius interprets in both cases from an empirical standpoint, as he maintains that the nature of mind may consist in matter (according to medical evidence), and that all knowledge has a sensory origin. Accordingly, he paved the way for ‘radical’ interpretations of Descartes which rejected his metaphysics, but also for an approach to a natural philosophy more open to the use of experience. In this chapter, I scrutinise the reasons behind Regius’s approach to physics and metaphysics by paying attention, on the one hand, to his quarrel with Descartes, and on the other to the sources of his methodology, which he largely borrows from medical authors. In conclusion, I show that Cartesianism, in the hands of Regius, might serve as the basis for medicine but could not yet become a full-fledged alternative to Aristotelianism. (shrink)

In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. -/- Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. Although blurred boundaries between the normal and the pathological are a recurrent theme in (...) many publications concerned with the classification of mental disorders, systematic approaches that take into account philosophical reflections on vagueness are rare. This book provides interdisciplinary discussions about vagueness in psychiatry by bringing together scholars from psychiatry, psychology, philosophy, history, and law. It draws together various lines of inquiry into the nature of gradations between mental health and disease and discusses the individual and societal consequences of dealing with blurred boundaries in medical practice, forensic psychiatry, and beyond. -/- Part I starts with an overview chapter that helps readers to navigate through the philosophy of vagueness and through the various debates surrounding demarcation problems in the classification and diagnosis of mental illness. Part II encompasses historical and recent philosophical positions on gradualist approaches to health and disease. Part III approaches the vagueness of present psychiatric classification systems, and the debates concerning their revisions by scrutinizing controversial categories, such as posttraumatic stress disorder, and the difficulties of day-to-day diagnostic and therapeutic practice. Part IV finally focuses on social, moral, and legal implications that arise when being mentally ill is a matter of degree. (shrink)

Many people report that reading first-person narratives of the experience of illness can be morally instructive or educative. But although they are ubiquitous and typically sincere, the precise nature of such educative experiences is puzzling—for those narratives typically lack the features that modern philosophers regard as constitutive of moral reason. I argue that such puzzlement should disappear, and the morally educative power of illness narratives explained, if one distinguishes two different styles of moral reason: an inferentialist style that generates the (...) puzzlement and an alternative exemplarist style that offers a compelling explanation of the morally educative power of pathographic literature. (shrink)

We survey several ways in which the structures and norms of medicine and healthcare can generate epistemic injustice.

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue (...) that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects. (shrink)

The myriad controversies embroiling the mental health field—heightened in the lead-up to the release of DSM-5 —merit a close analysis of the field and its epistemological underpinnings. By using DSM as a starting point, this paper develops to overview the entire mental health field. Beginning with a history of the field and its recent crises, the troubles of the past “external crisis” are compared to the contemporary “internal crisis.” In an effort to examine why crises have recurred, the internal dynamics (...) of the field are assessed: applying Kuhn’s paradigmatic framework, crises are appraised to situate the differences between the natural sciences and the mental health field. Next, a Foucauldian analysis examines the functioning of the field’s power over the body, which is disproportionate in comparison to its scientific grounding. This is followed by investigating the field’s combination of contested scientific grounding and significant power, through a Latourian consideration of the assumptions and meaning behind the mental health field’s deployment of science. This includes scrutinizing the history of the classification of Post-Traumatic Stress Disorder. The paper closes by assessing the field’s potential to address these issues effectively. (shrink)

Dementia will soon be ranked as the world’s largest economy. At present, it ranges from the 16th to 18th place, with countries such as Indonesia, the Netherlands, and Turkey. Dementia is not only a financial challenge, but also a philosophical one. It provokes a paradigm shift in the traditional view of healthcare and expands the classic concepts of human personhood and autonomy. A promising response to these challenges is the idea of cooperative solidarity. Cooperative solidarity, contrary to its ‘humanitarian’ version, (...) promotes spontaneous teamwork and individual initiative. It obliges us not only to help 'the suffering, the troubled and the disadvantaged’, but above all to support those who already do so for spontaneous moral or affective reasons. In the field of dementia study, solidary initiatives are described within the framework of supportive care. (shrink)

Patients suffering from advanced dementia present ethicists and caregivers with a difficult issue: we do not know how they feel or how they want to be treated, and they have no way of telling us. We do not know, therefore, whether we ought to prolong their lives by providing them with nutrition and hydration, or whether we should not provide them with food and water and let them die. Since providing food and water to patients is considered to be basic (...) care that is morally required, it is usually only the provision of nutrition and hydration by artificial means that is considered to require ethical justification. Building on what I call a virtue-based conception of autonomy, I argue that, at least for some patients suffering from advanced dementia, even providing food and liquid by hand is morally wrong. (shrink)

In, I argued that Boorse's biostatistical theory of health is unable to accommodate diseases that are the normal result of harmful environments. Hausman disagrees: if the BST compares normal dispositional function against the whole population or reference class, rather than against organisms in similar circumstances as I proposed, then my challenge can be avoided. In this paper, I argue that Hausman's response fails: his proposal cannot accommodate a series of common physiological processes, such as sleep and those involved in reproduction. (...) In the course of this argument, I also offer a detailed discussion of the concept of functional efficiency, and reveal a link between the problem of environments and that of reference classes. 1 Introduction2 Kingma on Boorse3 Hausman on Kingma4 Response to Hausman5 Three Possible Replies5.1 Reference classes5.2 Temporary pathologies5.3 Adequacy of function6 Concluding Discussion. (shrink)

This paper considers phenomenological descriptions of health in Gadamer, Heidegger, Merleau-Ponty, and Svenaeus. In these phenomenologies of health, health is understood as a tacit, background state that permits not only normal functioning but also philosophical reflection. Nietzsche’s model of health as a state of intensity that is intimately connected to illness and suffering is then offered as a rejoinder. Nietzsche’s model includes a more complex view of suffering and pain as integrally tied to health, and its language opens up the (...) possibility of many ‘healths,’ providing important theoretical support to phenomenological accounts of the diversity and complexity of health and illness. (shrink)

The last time you went to your doctor, you might have emerged feeling dissatisfied and disoriented. Nothing was clear after you left the office, and you don’t know whether it’s your fault or the doctor’s. While patients need to take control of the visit and set their agenda, the latest research shows that doctors and patients need to connect on a more emotional level as well. -/- In Talking to Your Doctor, readers will learn to: -/- •Talk to your doctor—and (...) get your doctor to talk to you • Remake the relationship with your doctor, and our health care system, on the basis of good communication •Make sure your visit with the doctor is productive and meets your needs •Help yourself and others avoid over-testing and over-treatment -/- Starting with the conversation can redress imbalances and put the relationship of doctor and patient, and eventually the entire health care system, back on a healthy footing. Using illuminating model dialogues, real transcripts from the clinic and hospital, resources for communication improvement, and a brief history of doctor-patient communication, the author helps readers develop strategies for obtaining better care from their doctors, from the minute they step into the exam room. (shrink)

It usually falls to an introduction such as this to explain the what and the why of the volume: what is contained in the contributions and why it is important. In this instance the two are more or less the same. What distinguishes “continental” approaches to bioethics and philosophy of medicine is precisely the reason why there is value in highlighting such approaches. Before elaborating on that rather vague contention, I would first like to say something briefly about how this (...) volume came about. In 2012 I organized, together with Havi Carel, a series of public seminars on the rather broad theme of “Medicine and Society.” These took place in Bristol (UK), with the generous financial support of the Royal Institute of Philosophy and an Early Career Researcher grant that I had received from the University of the West of England. Some of the contributions in this volume stem directly from those seminars, others are the result of conversations that began in those seminars and continued together with both the initial participants and colleagues whose perspectives I invited specifically for this volume. I am extremely grateful to all the contributors. (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable to (...) the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (shrink)

As Brillant-Savarin remarked in 1825 in his classic text Physiologie du Goût, “Tell me what you eat, and I will tell you who you are.” Philosophers and political theorists have only recently begun to pay attention to food as a critical domain of human activity and social justice. Too often these discussions treat food as a commodity and eating as a matter of individual choice. Policies that address the global obesity crisis by focusing on individual responsibility and medical interventions ignore (...) the dependency of human agency on a culture of possibilities. -/- The essays collected here address this lack in philosophy and political theory by appreciating food as an origin of human culture and a network of social relations. They show how an approach to the current global obesity epidemic through individual choice deflects the structural change that is necessary to create a culture of healthy eating. Analyzing the contemporary food crises of obesity, malnutrition, environmental degradation, and cultural displacement as global issues of public policy and social justice, these essays display the essential interconnections among issues of social inequity, animal rights, environmental ethics, and cultural identity. They call for new solidarities and new public policies to ensure the sustainable practices necessary to the production and distribution of wholesome and satisfying food. -/- Lévi-Strauss located the origin of ethics in table manners. By learning what and how to eat, humans learned respect for others, for the earth, and for the other forms of life that sustain human existence. Lévi-Strauss fears that in our time this “lesson in humility” coursing throughout the mythologies of “savage peoples” may have been forgotten, so that the world is treated as a thing to be appropriated and the extinction of species and cultures as an inevitable result of the ascendancy of global capital. This volume makes clear the need to change the way we eat, if we are to live on the earth together with what Lévi-Strauss calls “decency and discretion.”. (shrink)

To enable microbial colonisation of the gut mucosa, the intestinal immune system must not only react to danger signals but also recognize cues that indicate safety. Safety recognition, paradoxically, is mediated by the same environmental sensors that are involved in signalling danger. Indeed, in addition to their well established role in inducing inflammation in response to stress signals, pattern recognition receptors (PRRs) and a variety of metabolic sensors also promote gut-microbiota symbiosis by responding to "microbial symbiosis factors", "resolution-associated molecular patterns", (...) markers of energy extraction and other signals indicating the absence of pathogenic infection and tissue damage. Here we focus on how the paradoxical role of immune receptors and other environmental sensors define the microbiota signature of the individual. (shrink)

Dietary restriction (DR) famously extends lifespan and reduces fecundity across a diverse range of species. A prominent hypothesis suggests that these life‐history responses evolved as a survival‐enhancing strategy whereby resources are redirected from reproduction to somatic maintenance, enabling organisms to weather periods of resource scarcity. We argue that this hypothesis is inconsistent with recent evidence and at odds with the ecology of natural populations. We consider a wealth of molecular, medical, and evolutionary research, and conclude that the lifespan extension effect (...) of DR is likely to be a laboratory artifact: in contrast with captivity, most animals living in natural environments may fail to achieve lifespan extension under DR. What, then, is the evolutionary significance of the suite of responses that extend lifespan in the laboratory? We suggest that these responses represent a highly conserved nutrient recycling mechanism that enables organisms to maximize immediate reproductive output under conditions of resource scarcity. (shrink)

Psychiatry regularly comes under attack as a way of caring for and controlling the mentally ill. Originally published in 1986, this title explores the history and theory of psychiatry to illuminate current practice at the time, and shows why mental health services had developed in particular ways. The book was invaluable for all those who needed to understand the problems and processes behind current psychiatric practice at the time – sociologists and psychologists, psychiatrists and doctors, social workers, and health service (...) planners and administrators – and will still be of historical interest today. (shrink)

An invited editorial on the depiction of disease in art history which would then become the symbol of this redemptive philosophy.

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

This paper is on the problem of causal selection and comments on Collingwood's classic paper "The so-called idea of causation". It discusses the relevance of Collingwood’s control principle in contemporary life sciences and defends that it is not the ability to control, but the willingness to control that often biases us towards some rather than other causes of a phenomenon. Willingness to control is certainly only one principle that influences causal selection, but it is an important one. It shows how (...) norms make causes. (shrink)

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? (shrink)

We sketch a novel and improved version of Boorse’s biostatistical theory of functions. Roughly, our theory maintains that (i) functions are non-negligible contributions to survival or inclusive fitness (when a trait contributes to survival or inclusive fitness); (ii) situations appropriate for the performance of a function are typical situations in which a trait contributes to survival or inclusive fitness; (iii) appropriate rates of functioning are rates that make adequate contributions to survival or inclusive fitness (in situations appropriate for the performance (...) of that function); and (iv) dysfunction is the inability to perform a function at an appropriate rate in appropriate situations. Based on our theory, we sketch solutions to three problems that have afflicted Boorse’s theory of function, namely, Kingma’s ([2010]) problem of the situation-specificity of functions, the problem of multi-functional traits, and the problem of how to distinguish between appropriate and inappropriate rates of functioning. (shrink)

Childhood obesity has become a central concern in many countries and a range of policies have been implemented or proposed to address it. This co-authored book is the first to focus on the ethical and policy questions raised by childhood obesity and its prevention. -/- Throughout the book, the authors emphasize that childhood obesity is a multi-faceted phenomenon, and just one of many issues that parents, schools and societies face. They argue that it is important to acknowledge the resulting complexities (...) and not to think in terms "single-issue" policies. -/- After first reviewing some of the factual uncertainties about childhood obesity, the authors explore central ethical questions. What priority should be given to preventing obesity? To what extent are parents responsible? How should we think about questions of stigma and inequality? In the second part of the book, the authors consider key policy issues, including the concept of the 'obesogenic environment,' debates about taxation and marketing, and the role that schools can play in obesity prevention. -/- The authors argue that political debate is needed to decide the importance given to childhood obesity and how to divide responsibilities for action. These debates have no simple answers. Nonetheless, the authors argue that there are reasons for hope. There are a wide range of opportunities for action. Many of these options also promise wider social benefits. (shrink)

In this article, I argue that depression and suicide are natural kinds insofar as they are classes of abnormal behavior underwritten by sets of stable biological mechanisms. In particular, depression and suicide are neurobiological kinds characterized by disturbances in serotonin functioning that affect various brain areas (i.e., the amygdala, anterior cingulate, prefrontal cortex, and hippocampus). The significance of this argument is that the natural (biological) basis of depression and suicide allows for reliable projectable inferences (i.e., predictions) to be made about (...) individual members of a kind. In the context of assisted suicide, inferences about the decision-making capacity of depressed individuals seeking physician-assisted suicide are of special interest. I examine evidence that depression can hamper the decision-making capacity of individuals seeking assisted suicide and discuss some implications. (shrink)

English summary: Based on the famous essay by Georges Canguilhem on what is normal and pathological (originally published in 1943), extensive philosophical literature (mainly Anglo-Saxon) has attempted to define these concepts and analyze their status. The main discussion focuses on the following question: can you describe health and illness as natural phenomena or are they states that are determined by values? French text. French description: Depuis le celebre essai de Georges Canguilhem sur le normal et le pathologique publie initialement en (...) 1943 et dont l'un des objectifs etait la clarification des concepts de sante et de maladie, une litterature philosophique abondante, principalement anglo-saxonne, s'est attachee a definir ces concepts et a analyser leur statut. Le principal debat de ce domaine emergent de la philosophie de la medecine porte sur la question: peut-on decrire la sante et la maladie comme des phenomenes naturels ou s'agit-il d'etats qui sont determines par des valeurs? Tous les textes presentes dans ce volume ont participe de cette controverse. Ceux de la premiere section accordent une part importante a la composante biologique. Ceux de la seconde donnent le primat a la notion d'action. Ceux de la derniere section mettent en question l'utilite ou la possibilite meme de definir les deux concepts. (shrink)

Pain research is still dominated by biomedical perspectives and the need to articulate pain in ways other than those offered by evidence based medical models is pressing. Examining closely subjective experiences of pain, this book explores the way in which pain is situated, communicated and formed in a larger cultural and social context. Dimensions of Pain explores the lived experience of pain, and questions of identity and pain, from a range of different disciplinary perspectives within the humanities and social sciences. (...) Discussing the acuity and temporality of pain, its isolating impact, the embodied expression of pain, pain and sexuality, gender and ethnicity, it also includes a cluster of three chapters discusses the phenomenon and experience of labour pains. This volume revitalizes the study of pain, offering productive ways of carefully thinking through its different aspects and exploring the positive and enriching side of world-forming pain as well as its limiting aspects. It will be of interest to academics and students interested in pain from a range of backgrounds, including philosophy, sociology, nursing, midwifery, medicine and gender studies. (shrink)