Naturalism in the Philosophy of Health is a comprehensive last word on the current debate between naturalistic and normative conceptions of health and disease. It explores from many points of entry the utility of and reasons behind philosophical efforts to seek a definition of health concepts. The debates arise from the seminal 1975 work of Christopher Boorse, whose "Biostatistical Theory" (BST) shaped the debate between naturalist and normativist views of health and disease and provided the main naturalist definition of health still accepted today. Boorse adds a paper to this edited volume to further clarify and extend his theory. The goal of the volume is to reassess the relevance and status of naturalism in the analysis of health concepts and map out its implications both for healthcare and for the debate on health enhancement. The volume seeks to clarify and potentially improve the BST, explore alternative forms of naturalism, and investigate the reasons and utility for philosophical clarifications of definitions of health concepts.
The vital implications of an analytical study in health definitions will be readily evident even to the lay reader: labelling a condition as a "disease" has broad, various, and often critical social and practical consequences from treatment decisions to psychological impacts to sociological and legal implications and health insurance and public health policies. The demarcation between normal and pathological, as well as the question of whether some conditions, such as fibromyalgia, osteoporosis, and hypertension, can be classified as diseases, is of critical import, not only to the people who suffer from these conditions, but for health insurance decision-making, public healthcare system policies, and social attitudes. Boorse's original works carving out the definitions of health and disease defended the existence of a theoretical and value-free concept of health as distinct from alternative practical and value-laden concepts of health, such as the diagnostic, therapeutic, clinical, social, positive, and so on. Boore's naturalistic definition of health helped to establish the pivotal naturalist distinction between the normal and the pathological, based on three (now debated) concepts: the reference class; statistical normality; and biological function. The theoretical concept of disease was established as a kind of internal state that compromises "normal functioning," where normal functioning of a part of a process is seen as its statistically typical contribution to the survival and reproduction of a biological individual of a given species (the "reference class"). Both Boorse's conclusions (and the debate spawned from them) and his method of conceptual analysis (that is, a definition that consists of necessary and sufficient conditions) set the ground of the conceptual arena for the debates in the field known as the Philosophy of Health.
The volume is presented in three sections: the first part focused mainly on the BST. Authors, while generally sympathetic to the naturalist spirit of the theory, raise some new criticisms and suggest some improvements to the original definitions. Lemoine and Giroux, for example, argue that the particular "naturalism" of the BST seems more methodological than ontological. This leads the authors to question two pivotal claims implicit in Boorse's methodological naturalism: that theoretical, value-free scientific concepts of health and disease should be given priority; and that conceptual analysis is the right method for defining theoretical health and disease. Since conceptual analysis is not useful for defining 'weak theoretical' terms, such as disease, the authors question not only the general priority given to conceptual analysis for definitions, but another important assumption that has been largely neglected in the literature on the BST: that physiology provides the grounding theory underlying medicine. In this fascinating paper, the authors shake the ground of philosophical theory on health by suggesting that other key biomedical sciences should be taken into account in the definition of health and disease.
Other highlights of the volume include Daniel Hausman's "Is a comparativist approach to health more relevant than a non-comparativist one?" In this paper, Hsausman defends and develops a comparativist approach by demonstrating how the BST can be interpreted in a comparativistic way, since its definitions rest largely on comparisons of the functional efficiency of parts and processes.
Another fascinating paper is "What a naturalist theory of illness should be" by Thomas Schramme. Schramme develops, in this paper, his argument that a naturalist concept of illness is explicitly evaluative. He argues, against Boorse's claim, that the concept of illness is always evaluative because implicit in the diagnosis of illness is the idea that the condition is harmful to the person affected. In contrast to many normativists, then, Schramme insists that the scope of the concept of illness is restricted by the concept of disease. Precisely because naturalism allows that certain pathological conditions fall under the rubric of illnesses, independently of what the affected persons feel or believe, the naturalist concept of illness is granted objectivity, despite its evaluative aspect.
This book is not light reading and is not directed at the tastes of all educated readers. However, it will serve well as an senior level undergraduate introduction to the Philosophy of Health or as a text in a special graduate studies course in this field. A very few but glaring English errors may put the reader off in the early pages, but I attribute this failing to poor editorial work on the part of Springer. It is well worth the read!
© 2016 Wendy C. Hamblet
Wendy C. Hamblet, Ph.D. (Philosophy), North Carolina A&T State University.