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Medicine, Health Care and Philosophy
Published in: Medicine, Health Care and Philosophy 1/2022

Open Access 01-03-2022 | Scientific Contribution

Health and disease as practical concepts: exploring function in context-specific definitions

Authors: Rik van der Linden, Maartje Schermer

Published in: Medicine, Health Care and Philosophy | Issue 1/2022

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Abstract

Despite the longstanding debate on definitions of health and disease concepts, and the multitude of accounts that have been developed, no consensus has been reached. This is problematic, as the way we define health and disease has far-reaching practical consequences. In recent contributions it is proposed to view health and disease as practical- and plural concepts. Instead of searching for a general definition, it is proposed to stipulate context-specific definitions. However, it is not clear how this should be realized. In this paper, we review recent contributions to the debate, and examine the importance of context-specific definitions. In particular, we explore the usefulness of analyzing the relation between the practical function of a definition and the context it is deployed in. We demonstrate that the variety of functions that health and disease concepts need to serve makes the formulation of monistic definitions not only problematic but also undesirable. We conclude that the analysis of the practical function in relation to the context is key when formulating context-specific definitions for health and disease. At last, we discuss challenges for the pluralist stance and make recommendations for future research.
Footnotes
1
Nordby’s argument is aimed at the semantic realism that appears to inform the quest for definitions of health and disease. While the semantic realist thinks that these concepts have real determinate extensions that a correct definition should capture, Nordby aims to argue that this assumption is false.
 
2
Plunkett defines a metalinguistic negotiation as a dispute that concerns a normative issue about what a concept should mean or how it should be used, but which is often perceived as a descriptive issue at first glance—resulting in a conversation in which speakers talk past each other.
 
3
This argument can be traced back to Schwartz’s 2004 paper on the ‘biological function’ debate, where he argued in similar spirit that it is not possible to arrive at an analytically true meaning of biological function—and hence, argued we should stop using conceptual analysis for this matter.
 
4
Sometimes the distinction between practical consequence and function is difficult to make. It seems unjustified to formulate a disease definition in a particular way just because it has some beneficial practical effect. However, when there are different legitimate definitions to choose from, looking at the consequences of choosing either one, seems justified (if not required).
 
5
The notion of ‘problematic situation’is derived from John Dewey’s Theory of Inquiry (1938, but see: Wright 2007), and is also employed by other pragmatist philosophers such as Philip Kitcher (2017).
 
6
Of course, it is open for discussion whether Schramme’s proposal to use the BST is the best option as it comes to function as gatekeeper for medicalization. Also, one could question the ‘objectivity’ of the BST (e.g., see Kingma 2007). However, these discussions would go beyond the scope of this paper.
 
7
Borowy notes, however, that in times of the Cold War, the WHO definition faded into the background, as the ‘social’ definition was associated with Communism (while the WHO was primarily funded by the USA). In those years, the broad WHO definition temporarily gave way to for a strong anti-disease movement, focusing primarily on the eradication of infectious diseases—as these were commonly viewed as a sign of backwardness.
 
8
‘General’ is used by Huber et al. as having a broader function, but is not general in the sense that it overarching, universally applicable, or monistic.
 
9
We thank an anonymous reviewer for pointing us to MacIntyre’s concept of ‘practice’, which distinguishes between internal goods and external goods. It seems worthwhile to explore if the assessment of motivational adequacy may benefit from this framework. For example, we could state that a morally good motivation must always improve aspects that we consider to be internal goods for medicine.
 
Literature
Bickenbach, Jerome. 2015. WHO’s definition of health: Philosophical analysis. In Handbook of the philosophy of medicine, ed. Thomas Schramme and Steven Edwards. Dordrecht: Springer Science.
Boorse, Christopher. 1977. Health as a theoretical concept. Philosophy of Science 44 (4): 542–573.CrossRef
Huber, Machteld, Johannes A. Knottnerus, Lawrence Green, Henriëtte van der Horst, Alejandro R. Jadad, Daan Kromhout, Brian Leonard, et al. 2011. How should we define health? British medical Journal 343 (7817): 235–37.
Nordenfelt, Lennart. 1993a. Quality of Life, Health and Happiness. Aldershot, United Kingdom: Avebury Ashgate Publishing Limited.
Nordenfelt, Lennart. 1995. On the nature of health: An action-theoretic approach. Dordrecht: Kluwer Academic Publisher.CrossRef
Schramme, Thomas. 2019. Just Enough Health: Theories of Health Justice. London and New York: Rowman and Littlefield.
Schwartz, Peter H. 2007. Decision and discovery in defining ‘disease.’ In Establishing Medical Reality, ed. Harold Kincaid and Jennifer McKitrick, 47–63. Dordrecht: Springer.CrossRef
Venkatapuram, Sridhar. 2011. Health justice. Cambridge, United Kingdom: Polity Press.
Wittgenstein, Ludwig. 1953. Philosophical Investigations. Oxford: Blackwell.
Wright, Hollis G. 2007. John Dewey’s view of situations, problems, means and ends. In Means, ends and medical care, ed. H.G. Wright. Vol. 92 of Philosophy and Medicine. Dordrecht: Springer.CrossRef
Metadata
Title
Health and disease as practical concepts: exploring function in context-specific definitions
Authors
Rik van der Linden
Maartje Schermer
Publication date
01-03-2022
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 1/2022
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-021-10058-9

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