Abstract
Jerome Wakefield’s harmful dysfunction analysis (HDA) of medical disorder is an influential hybrid of naturalist and normative theories. In order to conclude that a condition is a disorder, according to the HDA, one must determine both that it results from a failure of a physical or psychological mechanism to perform its natural function and that it is harmful. In a recent issue of this journal, I argued that the HDA entails implausible judgments about which disorders there are and how they are individuated. The same arguments apply to other views that incorporate a harm criterion. More recently, David G. Limbaugh has modified the HDA by providing a novel account of the way in which a disorder must be harmful. Here, I briefly review the relevant issues and then critically assess Limbaugh’s account. I argue in the end that Limbaugh’s revisions do not succeed in making accounts like the HDA more attractive.
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Notes
I think that the comparative account is correct and that problems with preemption and overdetermination can be solved within this framework [7]. With respect to Evan, if his life is worth living, and he would not have existed without his condition, then it is not harmful to him.
Limbaugh suggests that the notion of damage captures an ordinary sense in which the terms harm and harmful are used, and he calls this “harm in the damage sense” [6, p. 2].
With Limbaugh, I follow Christopher Boorse in taking a reference class to be “a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species” [11, p. 684]. My arguments will not turn on this particular understanding, however.
I would like to thank an anonymous referee for pressing me to consider this question, and some other issues related to the cases of being worse off but not badly off.
This aligns with a view of well-being defended by Martha Nussbaum, especially [14, pp. 17–45].
Even if disorders that produce more-or-less instantaneous and painless death are rare, a general theory of disorder must account for them. In fact, such cases might not be so unusual after all. One might think of sudden infant death syndrome (SIDS), for example, or sudden cardiac death.
I am indebted to an anonymous referee for suggesting this possibility.
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Feit, N. Medical disorder, harm, and damage. Theor Med Bioeth 41, 39–52 (2020). https://doi.org/10.1007/s11017-020-09516-x
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DOI: https://doi.org/10.1007/s11017-020-09516-x