HPS370 A Reflection on the Ontology of Health and Disease
A Reflection on the Ontology of Health and Disease
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A Reflection on the Ontology of Health and Disease
HPS370
It has been demonstrated that, in the field of philosophy of medicine, arriving at an adequate
definition of both “health” and “disease” is a contentious proposition. The value-free objective
approach (or objective naturalism), as proposed by Christopher Boorse for example, is an antiquated
point of view that cannot adequately account for the scope of medicine, both globally and historically
(Boorse, 542). As argued by Alex Broadbent, the concept of health is a notion that is naturalistic on
the basis of evolutionary biology, but the methods of classification behave like “secondary
properties”, a subjective approach, which accounts for the variation in ethnographic medical systems
(Broadbent, 127). I take issue with both positions. From a normative and phenomenological
interpretation, I argue that the ontological conception of health and disease are inadequately
supported by a naturalistic perspective.
First, I question the foundation of evolutionary biology that Broadbent uses to defend his
position. Jacob Stegenga debated Boorse’s stance by demonstrating the historical relativism of
disease classifications: for example, that homosexuality was once considered a medically diagnosable
disease (Stegenga, 33). Invoking the pessimistic meta-induction, we can challenge the historical
endurance of disease classifications. Thus, if Broadbent’s position depends on the theory of
evolution, we must accept that the ontology of the concepts of health and disease is supported by a
theory that is potentially falsifiable. I argue that a phenomenological, normative perspective offers an
ontology of health and disease that can encompass both socio-historical and naturalistic accounts for
the concepts of health and disease.
A promising concept proposed by medical anthropologists and featured by Stegenga, is to
distinguish the concepts of “disease” and “illness”. A phenomenological conception of “illness”
accounts for the subjective experience of an individual, while “disease” accounts for the biological
disorder (Stegenga, 41; Brown and Closser, 363). I argue that this distinction encapsulates the
accepted biological etiologies at a given time, while also acknowledging the complex variation of the
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human experience throughout the duration of the disease.
Stegenga further challenges the normative perspective by questioning whether the etiologies
of disease may become too broad, overflowing into social issues not readily addressed by medicine
(Stegenga, 24). To this question, I first have a normative claim: if medicine is concerned primarily
with cure, as proposed by Broadbent, shouldn’t medicine also be concerned with addressing the
genuine etiology of a disease, even if the cause overlaps with the realm of politics ? (Broadbent, 35).
If, for example, poor socioeconomic status is linked to the susceptibility of various diseases,
shouldn’t medicine aim to prioritize the root cause instead of “treating the symptoms”? (Bradley et.
al, 374).
Finally, my argument for the normative and phenomenological perspective synthesizes as a
re-interpretation of the ontology of health and disease. As stated by Broadbent, it’s a natural
inclination to interpret the concepts of health and disease as a biological truism, as an objectivity
(Broadbent 115). In defense of the phenomenological perspective, I argue that they are holistic
concepts: health and disease are constituted not only on conceptual etiologies or an a priori
understanding of evolutionary advantage, but are constituted on the subjective interpretation of the
individual. In a broad example, take two patients with contrasting socioeconomic backgrounds who
both suffer from asthma. If the wealthy patient acquired the disease through an otherwise healthy
genetic lineage, but the destitute patient acquired the disease through prenatal smoking, is it
concretely justifiable to classify them as the same disease? The phenomenological perspective
accounts for the subjectivity of the illness between the two patients, but I argue further that the
ontology of the “same” disease actually differs: based on the conditions of the worldview of the
patient, the referent of the disease is not identical. Rather, the disease is defined by the subjective
experience of the patient. In sum, I have argued that the normative, phenomenological approach best
accounts for the subjectivity in illness and in accounting for historical influence on scientific and
medicinal theory, and ultimately redefined the ontology of health and disease.