• philosophical ethics

Educators who start a philosophy of medicine or medical ethics class with a philosophical discussion on the definition of basic concepts in medicine, such as health and disease, might relate to this anecdotal account. Students initially find the topic engaging because of the ubiquity of the concept of disease regulating not only their direct encounter with health-related contexts, for example, when veterans returning to school receive accommodations after being diagnosed with Post Traumatic Stress Disorder (PTSD), but also their social world, say, when they get in an argument with their classmates about whether vaccines cause or prevent diseases, or when they join the campus gym to improve their health. Yet their enthusiasm wanes when they read the seminal naturalist and normative accounts of disease. This happens not because such conceptual work does not have any philosophical sophistication and value but because the discussion seldom makes direct contact with the common uses of the disease concept in the medical, social, moral and institutional contexts in which the students are heavily embedded.

As the authors of ‘Rethinking ‘Disease’: A Fresh Diagnosis and a New Philosophical Treatment’ argue, the notion of disease central to the naturalist and normativist positions is conceptually insulated from its applications in various institutional settings in healthcare and also from its personal, social and economic contexts. This insularity largely stems from the fact that traditional conceptual analysis in philosophy assumes a lot more than it can show, including the assumption that concepts, such as disease, have necessary and sufficient conditions that exist independently of the world as we encounter it and are accessed through our intuitions. This is a problem, because the concept of disease plays a crucial role in medical epistemology, scientific research, and ethical and policy-related issues; a philosophical account of disease that does not directly engage …