Abstract
Christopher Boorse’s biostatistical theory of health and disease (BST) puts forward a naturalistic definition of these two concepts. Indeed, ‘naturalism’ in the philosophy of medicine was initially defined in terms of the BST, and has often been since. This chapter is an attempt to clarify in what sense Boorse does in fact defend a naturalistic definition of health and disease. We identify different theses that make naturalistic claims regarding health and disease and which help analyze the core claims of Boorse’s naturalism. Some of them have mainly to do with the central role physiology plays in medicine. But, as no physiologist has hitherto proposed a satisfactory scientific definition of ‘disease’ and ‘health’, Boorse’s naturalism must at the same time: (i) propose just such a definition; and (ii) prove that it is central to medicine. Our claim is that even if Boorse’s definition possibly succeeds in (i), it merely assumes (ii). We conclude by examining the necessity that a naturalistic definition of health and disease takes into account not only physiology but also other medical sciences.
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Notes
- 1.
The opposition is so important to the definition of naturalism that Boorse felt the need to coin the term ‘normativism’, without referring to its opposite (Boorse 1997): indeed, he accepts ‘non-normativism’ as a more accurate description of the BST (personal communication). This should not, however, undermine the claim that the BST is a genuinely naturalistic theory of health and disease.
- 2.
See Boorse 1975, 57: “The root idea of this account is that the normal is the natural. The state of an organism is theoretically healthy, i.e. free of disease, insofar as its mode of functioning conforms to the natural design of that kind of organism. Philosophers have, of course, grown repugnant to the idea of natural design since its co-optation by natural-purpose ethics and the so-called argument from design. It is undeniable that the term “natural” is often given an evaluative force. Shakespeare as well as Roman Catholicism is full of such usages, and they survive as well in the strictures of state legislatures against “unnatural acts”. But it is no part of biological theory to assume that what is natural is desirable, still less the product of divine artifice. Contemporary biology employs a version of the idea of natural design that seems ideal for the analysis of health”.
- 3.
“Diseases are conditions foreign to the nature of the species” (Boorse 1977, 554).
- 4.
The Harmful Dysfunction Analysis is the claim that for something to be pathological, harm done (according to social standards) and biological dysfunction (according to science) are conjointly required.
- 5.
For another kind of criticism of Boorse’s notion of “reference class”, see (Kingma 2007).
- 6.
According to Wachbroit, it is not statistical, but it is not without link with the statistical: “statistics, for example, may provide important evidence for determining biological normality and biological functions” (Wachbroit 1994).
- 7.
See for example Canguilhem (1991, 123): “The question is whether it is physiology which converts – and how? – descriptive and purely theoretical concepts into biological ideals or whether medicine, in admitting the notion of facts and constant functional coefficients from physiology would not also admit – probably unbeknownst to the physiologists – the notion of norm in the normative sense of the word. And it is a question of whether medicine, in doing this, wouldn’t take back from physiology what it itself had given”.
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Lemoine, M., Giroux, É. (2016). Is Boorse’s Biostatistical Theory of Health Naturalistic?. In: Giroux, É. (eds) Naturalism in the Philosophy of Health. History, Philosophy and Theory of the Life Sciences. Springer, Cham. https://doi.org/10.1007/978-3-319-29091-1_2
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