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‘Rethinking “Disease”: a fresh diagnosis and a new philosophical treatment’
  1. Russell Powell,
  2. Eric Scarffe
  1. Department of Philosophy, Boston University, Boston, Massachusetts, USA
  1. Correspondence to Dr Russell Powell, Department of Philosophy, Boston University, Boston, MA02215, USA; powell{at}


Despite several decades of debate, the concept of disease remains hotly contested. The debate is typically cast as one between naturalism and normativism, with a hybrid view that combines elements of each staked out in between. In light of a number of widely discussed problems with existing accounts, some theorists argue that the concept of disease is beyond repair and thus recommend eliminating it in a wide range of practical medical contexts. Any attempt to reframe the ‘disease’ discussion should answer the more basic sceptical challenge, and should include a meta-methodological critique guided by our pragmatic expectations of what the disease concept ought to do given that medical diagnosis is woven into a complex network of healthcare institutions. In this paper, we attempt such a reframing, arguing that while prevailing accounts do not suffer from the particular defects that prominent critics have identified, they do suffer from other deficits—and this leads us to propose an amended hybrid view that places objectivist approaches to disease on stronger theoretical footing, and satisfies the institutional-ethical desiderata of a concept of disease in human medicine. Nevertheless, we do not advocate a procrustean approach to ‘disease’. Instead, we recommend disease concept pluralism between medical and biological sciences to allow the concept to serve the different epistemic and institutional goals of these respective disciplines.

  • philosophy of medicine
  • political philosophy
  • philosophical ethics
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  • RP and ES contributed equally.

  • Contributors The authors contributed equally to this paper.

  • Funding Scarffe is grateful to the Social Sciences and Humanities Research Council of Canada for support of this research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been amended since it was first published online. The authors' affiliation was published with a typo. This has now been corrected.

  • Patient consent for publication Not required.

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