This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

Semantic role is the actual role a participant plays in some real or imagined situation, apart from the linguistic encoding of those situations. Semantic roles, also known as thematic roles, are one of the oldest classes of constructs in linguistic theory. Semantic roles are used to indicate the role played by each entity in a sentence and are ranging from very specific to very general. Also, semantic roles are useful in natural language processing. They have proved attractive because they provide (...) a way of representing commonalities across different uses of the same predicate or across uses of distinct but semantically related predicates that may be obscured because arguments with certain semantic roles may have various syntactic realisations. Thus they provide a level of abstraction for the statement of generalisations concerning a variety of linguistic phenomena. In particular, argument realisation generalisations are often stated over a thematic hierarchy, a ranking of semantic roles. However, semantic roles have not lived up to their initial promise. It has proved impossible to find a small set of roles that can be applied across all verbs in a language, let alone across languages. Advances in Research on Semantic Roles provide more sustained discussion of the notion of semantic role. It often traces the development of the notion, as well as its place within current linguistic theory. In addition, it introduces several approaches to semantic role inventories, highlighting the similarities and differences among them, and discusses the limitations both of particular approaches and of semantic role approaches in general. Semantic roles continue to be useful in stating linguistic generalisations, and so descriptive, if not theoretical, uses of semantic role labels persist across subfields, including language acquisition, psycholinguistics, and neurolinguistics. (shrink)

Book reviewed in this article: Homosexuality and American Psychiatry. By Ronald Bayer.

In 2012, the symposium "Christopher Boorse and the Philosophy of Medicine" was held at the University of Hamburg. The initial ideas presented at this event, which celebrated Chris's contribution to the development of what is now a vibrant area of research, especially to the theory of disease, form the core of the papers published in this issue. Similarly to what Robert Nozick once said about John Rawls's work, it can be demanded that philosophers of medicine must now either (...) work within Boorse's theory or explain why not. It is simply the main contender in the so-called naturalist camp of contributions to the theory of disease. All of the papers in this issue address his approach in some respect, and all of them are friendly toward his theory up to a point. In this brief introduction, I try to extract common threads. In doing so, I focus on three issues that have the capacity to determine future debates. The first is the methodology of developing a theory of disease, especially what conceptual analysis amounts to and what it may achieve. The second is the issue of value-ladenness of the concepts of health and disease, a topic that has been at the forefront of the philosophical debate, but which -- to my mind -- has often been misunderstood. The third issue is the problem of the unity of medical terminology. We can ask whether there is only one core medical concept, be it "disease," "pathology," "disorder," "malady," or something else. Alternatively, we might propose different concepts for different purposes. (shrink)

This “open letter” to Christopher Boorse is a response to his influential naturalist analysis of disease from the perspective of linguistic-analytic value theory. The key linguistic-analytic point against Boorse is that, although defining disease value free, he continue to use the term with clear evaluative connotations. A descriptivist analysis of disease would allow value-free definition consistently with value-laden use: but descriptivism fails when applied to mental disorder because it depends on shared values whereas the values relevant to (...) mental disorders are highly diverse. A part-function analysis, similarly, although initially persuasive for physical disorders, fails with the psychotic mental disorders because these, characteristically, involve disturbances of the rationality of the person as a whole. The difficulties encountered in applying naturalism to mental disorders point, linguistic-analytically, to the possibility that there is, after all, an evaluative element of meaning, deeply hidden but still logically operative, in the concept of disease. (shrink)

The contemporary debate on the concept of health is a tug-of-war between naturalists and normativists. Although health can be valued or disvalued, naturalists argue that the concept of health is value-free. In contrast, normativists argue that the concept of health is value-laden. This dissertation examines this controversy focusing on the naturalistic concept of health defended by Christopher Boorse. Boorse claims that health and disease are value-free concepts in the sense that diseased and healthy states can be gleaned (...) from the facts of nature without an appeal to value judgments. ;The dissertation first examines Boorse's critical assessment of both the naturalist and normativist concepts of health that he rejects. Then there is a critical examination of the concept of function, which is crucial to his concept of health. Subsequently, an exegesis of Boorse's concept of health is provided. This is followed by an evaluation of the many replies by his critics and Boorse's rejoinder to them. Finally, a modified version of Boorse's concept of health is proposed taking into account some of the intractable difficulties with his theory. ;There are six main findings regarding Boorse's theory: First, Boorse successfully rejects the main normative concepts of health. Second, he is partially successful against specific naturalistic concepts of health. Third, Boorse's contextualist concept of function is not entirely persuasive. Fourth, Boorse's concept of health is persuasive because he qualifies it to accommodate differences in age, gender, and species type. Fifth, with respect to his critics, Boorse is inconsistent in his reliance on evolution and does not give a proper place to the environment in his account. Sixth, a modified version of Boorse's concept of health, which includes an evolutionary sense of function, homeostasis, and acknowledges environmental factors , is a more appropriate way to understand health. ;This dissertation arrives at three major conclusions: First, Boorse's concept of health is mainly successful in response to the normativists, but he should concede that epistemic norms are part of his concept of health. Second, an evolutionary concept of function is superior to Boorse's part-functionalist account. Third, a prominent place should be given to both homeostasis and environmental factors, along with the factors of age, sex, and species mentioned by Boorse. A modification of Boorse's account reflecting these conclusions will be a more defensible naturalistic concept of health. (shrink)

In the debate over the definition of ‘mental health,’ three different approaches are generally distinguished: the normativist approach, the hybrid approach and the naturalistic approach. This paper qualifies this classification by clarifying the sense in which Christopher Boorse defends a naturalistic approachvis-à-visthe central concepts of psychiatry. This paper also clarifies in what way Boorse is opposed to the normativist approach advocated by some authors of the anti-psychiatric movement, such as Szasz.

Christopher Boorse's Bio Statistical Theory (BST) defines health as the absence of disease, and disease as the adverse departure from normal species functioning. This paper presents a two-pronged problem for this account. First I demonstrate that, in order to accurately account for dynamic physiological functions, Boorse's account of normal function needs to be modified to index functions against situations. I then demonstrate that if functions are indexed against situations, the BST can no longer account for diseases that (...) result from specific environmental factors. The BST is impaled on either horn of this dilemma and therefore must be dismissed. (shrink)

La possibilité d’une définition naturaliste de la santé et d’une distinction entre le normal et le pathologique qui ne repose pas sur des normes culturelles, sociales ou subjectives est au cœur des débats en philosophie de la médecine. Or le concept statistique de la normalité, fondamental pour une définition objective de la santé, soulève d’importantes difficultés. Christopher Boorse défend une « théorie bio-statistique » qui, en articulant ce concept à une notion non normative de fonction biologique, résoudrait ces (...) difficultés. L’identification de la santé et de la normalité au sens statistique demeure toutefois centrale dans sa définition. Après avoir précisé le rôle que joue la normalité statistique dans la BST, nous dégageons, à partir de l’épidémiologie contemporaine, un certain nombre de problèmes et questions que cette définition naturaliste soulève.The liability for a naturalist definition of health and for a value-free distinction between the normal and the pathological is at the core of discussions on health and disease in philosophy of medicine. But the statistical concept of normality, a central one for any objective definition of health, raises numerous problems. Christopher Boorse argues for a « biostatistical theory » which aims at solving these difficulties by articulating a statistical concept of normality and a non-normative concept of biological function. However the BST is still based on identifying normality and health with the most frequent. After analyzing in details the true role of statistical normality in BST, I will show how results and data from modern epidemiology can be mobilized to reveal several limits and difficulties with respect to this naturalist definition of health and disease. (shrink)

This paper argues that we should replace the common classification of theories of welfare into the categories of hedonism, desire theories, and objective list theories. The tripartite classification is objectionable because it is unduly narrow and it is confusing: it excludes theories of welfare that are worthy of discussion, and it obscures important distinctions. In its place, the paper proposes two independent classifications corresponding to a distinction emphasised by Roger Crisp: a four-category classification of enumerative theories (about which items constitute (...) welfare), and a four-category classification of explanatory theories (about why these items constitute welfare). (shrink)

This chapter surveys hybrid theories of well-being. It also discusses some criticisms, and suggests some new directions that philosophical discussion of hybrid theories might take.

Group-based reasons are reasons to play one’s part in some pattern of action that the members of some group could perform, because of the good features of the pattern. This paper discusses three broad conceptions of such reasons. According to the agency-first conception, there are no group-based reasons in cases where the relevant group is not or would not be itself an agent. According to the behaviour-first conception, what matters is that the other members of the group would play their (...) parts in the relevant pattern, not whether they would have the cooperative intentional states constitutive of group agency in doing so. This paper argues against these conceptions and in favour of the powers-first conception, according to which what matters is that the members of the group have practically relevant powers. (shrink)

In this groundbreaking new study, Lowell Nissen explores the use of teleological language in the study of subjects such as behaviorism, negative feedback, and natural selection. He argues that all existing analyses fail to explain how teleological language can be used legitimately, and provides his own analysis in terms of intentionality.

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

Are we witnessing progress or regress in the recent increasing popularity and electoral success of populist politicians and parties in consolidated democratic nations? ... Is the innovative use of popular referendum in Great Britain to settle fundamental constitutional questions a progressive or regressive innovation? ... Similarly, is the increasing use of constituent assemblies to change constitutions across the world evidence of progress in democratic constitutionalism, or, a worryingly regressive change back toward unmediated popular majoritarianism? ... This paper reflects on some (...) of the perils and promise of framing such questions with the conceptual couplet of progress and regress. It considers four compelling critiques of the use of ‘progress’ and its cognates in sociopolitical theory, as well as arguing that such concepts are nevertheless ineliminable for our normative theories. The paper concludes by suggesting that we can avoid the most serious problems by employing only conceptions of political progress and regress that are piecemeal, pragmatic, and processual. (shrink)

This article proposes a way of understanding Kantianism, act-utilitarianism and some other important ethical theories according to which they are all versions of the same kind of theory, sharing a common structure. I argue that this is a profitable way to understand the theories discussed. It is charitable to the theories concerned; it emphasizes the common ground between them; it gives us insights into the differences between them; and it provides a method for generating new ethical theories worth studying. The (...) article briefly discusses the relationship between these ideas and some other recent proposals that emphasize the common ground between Kantianism and versions of consequentialism. (shrink)

We examine the influence of word choices on mathematical practice, i.e. in developing definitions, theorems, and proofs. As a case study, we consider Euclid’s and Euler’s word choices in their influential developments of geometry and, in particular, their use of the term ‘polyhedron’. Then, jumping to the twentieth century, we look at word choices surrounding the use of the term ‘polyhedron’ in the work of Coxeter and of Grünbaum. We also consider a recent and explicit conflict of approach between Grünbaum (...) and Shephard on the one hand and that of Hilton and Pedersen on the other, elucidating that the conflict was engendered by disagreement over the proper conceptualization, and so also the appropriate word choices, in the study of polyhedra. (shrink)

There are compelling medical, ethical, and legal arguments that support mandating use of a central institutional review board for the review of clinical trials performed at multiple institutional sites. Progress against serious diseases depends on this.

Theorists of public reason such as John Rawls often idealize constitutional courts as exemplars of public reason. This paper raises questions about the seduction and limits of analogies between theorists’ account of public reason and actual constitutional jurisprudence. Examining the work product of the United States Supreme Court, the paper argues that while it does engage in reason-giving to support its decisions—as the public reason strategy suggests— those reasons are (largely) legalistic and specifically juristic reasons—not the theorists’ idealized moral-political reasons (...) on matters of fundamental principle. But if constitutional courts do not engage on matters of fundamental principle, then a public reason strategy for assuaging democratic worries about judicial review would no longer be open: prominent liberal and deliberative democratic theorists could no longer point to the alleged superiority of constitutional courts to speak in the name of, and for, the people’s shared political principles. The paper extends beyond the U.S. case study by pointing to three institutional factors explaining the disanalogy between what some constitutional courts do and what public reason theories require them to do. It concludes with considerations about whether the public reason strategy might be more successfully applied to international courts. (shrink)

In this article Cristoph Wulf examines the basic concepts of pedagogy and educational science in the German-speaking world, looking at education and socialization from the perspective of educational anthropology. He makes evident that the complex German concept of Bildung, in particular, can only be fully understood by means of a historical and philosophical analysis.

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task remains of ensuring that the right sorts of information reach the right sorts of people. In what follows we defend the thesis that efforts to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations, and that the communication of healthcare information and knowledge needs to rest (...) on a sound ontology of social interaction. We illustrate this thesis in relation to the HL7 RIM, which is one centrally important tool for communication in the healthcare domain. (shrink)

Authentizitat ist ein in unserem kulturellen Raum allgegenwartiges Phanomen. Doch wem oder was begegnen wir, wenn wir meinen, uns selbst verwirklichen oder alternativ einfach uns selbst treu sein zu mussen? Christoph Wiesinger zeigt, dass wir auf ein Selbst geworfen werden, das zwar als homogener Nukleus der Person projiziert werden kann, sich aber bei genauerem Hinsehen als komplexe sozial verinnerlichte Struktur entpuppt. Das Selbst ist keineswegs objektiv zu fassen, sondern unterliegt sozialen Genesen und wird durch soziale Adressierung unterschiedlich formiert. Das Ereignis (...) von Authentizitat gibt somit Anlass zur Reflexion der Differenz zwischen Erwartung und Erfahrung. Christoph Wiesinger legt die Strukturen des Phanomens der Authentizitat frei, zeigt die theologischen Implikationen auf und diskutiert die praktisch-theologischen Konsequenzen. (shrink)

One recently popular strategy for avoiding the moral error theory is via a ‘companions in guilt’ argument. I focus on those recently popular arguments that take epistemic facts as a companion in guilt for moral facts. I claim that there is an internal tension between the two main premises of these arguments. It is a consequence of this that either the soundness or the dialectical force of the companions in guilt argument is undermined. I defend this claim via (i) analogy (...) with philosophical debates concerning the indispensability of mathematical objects to natural science, and (ii) discussion of the ‘entanglement’ of epistemic concepts and moral concepts in deliberation. I conclude by proposing a positive view of what kind of argument must be used if moral error theories are to be successfully undermined. (shrink)