Thomas Schramme
University of Liverpool, Philosophy, Faculty Member
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Research Interests: Psychology and Empathy
The article highlights systematic aspects of defining disease. It focuses on three philosophical facets: the ontology, epistemology, and axiology of disease. These are illustrated by historical examples. Ontology is concerned with... more
The article highlights systematic aspects of defining disease. It focuses on three philosophical facets: the ontology, epistemology, and axiology of disease. These are illustrated by historical examples. Ontology is concerned with existence or being. With regard to disease it focuses on issues such as the location of disease and the ontological status of specific diseases. Epistemology is concerned with theoretical aspects of knowledge. Central epistemological questions regarding disease are concerned with etiology and the role of norms. Axiology is the theory of value. In this part, the debate about whether disease is an evaluative concept is introduced. The article also addresses normative consequences of disease.
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Research Interests: Philosophy and Mill
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Research Interests: Philosophy and Humanities
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In diesem Artikel wird argumentiert, dass die Philosophie nicht uber passende Methoden verfugt, reale politische Probleme angemessen zu analysieren. So sind die tatsachlich vorzufindenden Empfehlungen zur Losung solcher Fragen meist... more
In diesem Artikel wird argumentiert, dass die Philosophie nicht uber passende Methoden verfugt, reale politische Probleme angemessen zu analysieren. So sind die tatsachlich vorzufindenden Empfehlungen zur Losung solcher Fragen meist trivial oder unterkomplex. Es wird geraten, zuerst geeignete Instrumentarien der angewandten bzw. konkreten Ethik zu entwickeln, bevor sich PhilosophInnen zu solch komplexen Fragen wie die der Fluchtlingspolitik ausern.
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The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of... more
The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient a...
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Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention... more
Nudges are means to influence the will formation of people to make specific choices more likely. My focus is on nudges that are supposed to improve the health condition of individuals and populations over and above the direct prevention of disease. I point out epistemic and moral problems with these types of nudges, which lead to my conclusion that health-enhancing nudges fail. They fail because we cannot know which choices enhance individual health—properly understood in a holistic way—and because health-enhancing nudges are often themselves bad for our health. They can be bad for our health because they assume inferior agency in their targets and accordingly regularly lead to appropriate resentment and anger—strong emotions which go along with an increased risk of health impairments. Briefly, health-enhancing nudges fail because they are based on persistent ignorance and on a presumptuous attitude.
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The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical,... more
The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims.
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Szasz’s legacy involves two issues in current psychiatry: First, he criticized the concept of mental illness. The DSM-5 debate shows that psychiatry still suffers from unresolved conceptual problems. The definition of the general concept... more
Szasz’s legacy involves two issues in current psychiatry: First, he criticized the concept of mental illness. The DSM-5 debate shows that psychiatry still suffers from unresolved conceptual problems. The definition of the general concept of mental disorder remains unclear. Specific classificatory entities (e.g., autism spectrum disorder) are notoriously contested. Second, he criticized coercive psychiatric practice. Recent developments suggest an ongoing identity crisis of psychiatry as a medical institution. Psychiatry’s tasks are partly related to societal interests (e.g., dealing with dangerous persons). Two psychiatric forms of intervention are therapeutic coercion and compulsion to prevent harm to others. Whether the latter can be squared with therapeutic purposes is unclear. To justify paternalistic interventions such as therapeutic coercion is difficult. Hence, there is enormous pressure on psychiatry’s medical identity. Szasz asked the right questions, not necessarily provid...
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Research Interests: Philosophy and Article
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Jedesmal wenn ich mit Freunden über den Kosovo-Krieg der NATO diskutiert oder gar gestritten hatte, befiel mich eine lähmende Unentschiedenheit. Warum war es so schwer, eine eindeutige Haltung der Zustimmung bzw. Ablehnung gegenüber... more
Jedesmal wenn ich mit Freunden über den Kosovo-Krieg der NATO diskutiert oder gar gestritten hatte, befiel mich eine lähmende Unentschiedenheit. Warum war es so schwer, eine eindeutige Haltung der Zustimmung bzw. Ablehnung gegenüber diesem Einsatz einzunehmen? Dieser Beitrag ist ein Versuch, das der Unbestimmtheit zugrundeliegende moralphilosophische Problem aufzuzeigen. Selbst aus der zeitlichen Entfernung und der Abstraktion von dem spezifischen Beispiel Kosovo hat sich meine Unsicherheit über eine abschließende moralische Bewertung nicht gelegt. Das liegt daran – so meine These -, daß die Situationen, in denen eine sogenannte Humanitäre Intervention (HI) erwogen wird, also solche großen Leids, das nur noch mit militärischen Mitteln beendet werden kann, uns mit einem moralischen Dilemma konfrontieren. Auf der einen Seite soll Menschen in Not geholfen werden, auf der anderen Seite soll bzw. kann dies nur noch mit militärischen Mitteln geschehen; Mitteln also, die selbst notwendiger...
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Der Fall wirkt insofern eindeutig, als zumindest das Handlungsziel festzustehen scheint. Bonnie muss Gewicht verlieren. Wie erreichen wir dieses Ziel in moralisch berechtigter Weise, also mit angemessenen Mitteln? Das bereitet uns... more
Der Fall wirkt insofern eindeutig, als zumindest das Handlungsziel festzustehen scheint. Bonnie muss Gewicht verlieren. Wie erreichen wir dieses Ziel in moralisch berechtigter Weise, also mit angemessenen Mitteln? Das bereitet uns Kopfzerbrechen. Doch schon das Ziel ist keineswegs klar, im Gegensatz zum ersten Anschein. Warum sollte Bonnie abnehmen? Ein wichtiger Grund, der auch in der Fallbeschreibung genannt wird, lautet: Weil sie sich durch ihr hohes Gewicht und ihr Essverhalten selbst schädigt. Doch ob dies zutrifft, ist ein durchaus komplexes Problem, und der vielleicht schwerwiegendste Fehler, den man bei der ethischen Bewertung eines solchen Falls begehen kann, besteht darin, sich ausschließlich von seiner eigenen persönlichen oder professionellen Perspektive leiten zu lassen. Die Antwort auf die Frage, ob sich Bonnie selbst schadet, lautet „ja“, wenn man die medizinischen Folgen im Blick hat; „ja“, wenn man soziale Normen des Aussehens und Verhaltens zum Maßstab nimmt; „vielleicht“, wenn man Bonnies Leben insgesamt betrachtet. Nur die letztgenannte Perspektive ist aber ausschlaggebend. Insofern ist auch das eingangs genannte Handlungsziel nicht ohne Weiteres gerechtfertigt. Im Film, wie auch im wirklichen Leben, sind viele der Nachteile, die eine ungewöhnlich dicke Person erleidet, durch die äußeren Lebensumstände hervorgerufen. Bonnie wird von Kindern aus der Nachbarschaft begafft; ihr eigener Sohn Gilbert schämt sich für sie – er will nicht, dass sie als Witzfigur verschrien ist; sie kann nicht im eigenen Bett schlafen, weil ihr Schlafzimmer im nicht erreichbaren, oberen Stock des Hauses liegt; sie kann nicht allein Auto fahren. Wahrscheinlich hat sie außerdem
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The article highlights systematic aspects of defining disease. It focuses on three philosophical facets: the ontology, epistemology, and axiology of disease. These are illustrated by historical examples. Ontology is concerned with... more
The article highlights systematic aspects of defining disease. It focuses on three philosophical facets: the ontology, epistemology, and axiology of disease. These are illustrated by historical examples. Ontology is concerned with existence or being. With regard to disease it focuses on issues such as the location of disease and the ontological status of specific diseases. Epistemology is concerned with theoretical aspects of knowledge. Central epistemological questions regarding disease are concerned with etiology and the role of norms. Axiology is the theory of value. In this part, the debate about whether disease is an evaluative concept is introduced. The article also addresses normative consequences of disease.
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The first part addresses the concept of needs and their moral significance. That includes the demarcation of needs from desires; subtypes of needs, such as categorical and basic needs; the role of a decent life in the specification of... more
The first part addresses the concept of needs and their moral significance. That includes the demarcation of needs from desires; subtypes of needs, such as categorical and basic needs; the role of a decent life in the specification of needs; and the claim that the satisfaction of needs takes priority over the satisfaction of desires. In the second part, qualitative principles, both comparative and non-comparative, and quantitative measures of need-based justice are discussed. The last part is concerned with methodological and justificatory questions. We analyse the reconstructive and the constructive method of developing a theory of justice and examine Rawls’ model of reflective equilibrium. Special emphasis is placed on the ways in which theories of justice might draw on empirical findings.
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Enhancement, die Verbesserung - möglicherweise sogar Optimierung - des eigenen Selbst, ist ein menschliches Grundanliegen und letztlich ein wesentliches Element der Betätigung menschlicher Freiheit. So verstanden können wir Enhancement... more
Enhancement, die Verbesserung - möglicherweise sogar Optimierung - des eigenen Selbst, ist ein menschliches Grundanliegen und letztlich ein wesentliches Element der Betätigung menschlicher Freiheit. So verstanden können wir Enhancement nicht sinnvollerweise ablehnen. Gleichwohl argumentiere ich in diesem Beitrag, dass es Grenzen der gelingenden Selbstentwicklung gibt. Diese werden mit Bezug auf John Stuart Mill in grundlegenden, genuin menschlichen Fähigkeiten bestimmt. Wo durch Lebensweisen die Ausübung dieser grundlegenden Fähigkeiten verhindert wird, da kann von keiner gelingenden Weise der Selbstentwicklung gesprochen werden. Zuletzt weise ich auf mögliche Grenzen des Ausmaßes der Selbstoptimierung hin, also auf quantitative Gesichtspunkte, im Unterschied zu den zunächst betrachteten qualitativen Aspekten des Enhancements.
In this paper I defend a constitutive role of empathy for morality. I will rely on a particular reading of the notion of morality, which I call "agential". It focuses on mental and behavioural aspects of moral agents. In... more
In this paper I defend a constitutive role of empathy for morality. I will rely on a particular reading of the notion of morality, which I call "agential". It focuses on mental and behavioural aspects of moral agents. In the first section, I explore the general capacity to empathize. In the second section, I will introduce some results of the philosophical and psychological debate on autism and psychopathy in relation to empathy and morality. It will be seen that the currently best explanations of (severe forms of) autism and psychopathy point at deficits in either cognitive empathy or emotional empathy respectively. I will also argue that, whatever the empirical results, we need to conceptually clarify what it means to be a moral agent. Obviously the question what ‘moral agency’ means is not a purely empirical question. I will therefore attempt to develop some steps towards a theory of moral agency in the third section. In conclusion, I believe we are justified in identifying a constitutive role of the capacity for empathy for the development of moral agency.
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In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position... more
In this paper I show that Rawls’s contract apparatus in A Theory of Justice depends on a particular presumption that is in conflict with the goal of conserving environmental resources. He presumes that parties in the original position want as many resources as possible. I challenge Rawls’s approach by introducing a rational alternative to maximising. The strategy of satisficing merely goes for what is good enough. However, it seems that under conditions of scarcity Rawls’s maximising strategy is the only rational alternative. I therefore scrutinise the common account of scarcity. I distinguish between absolute and relative scarcity in order to show that scarcity is influenced by our decisions. If we would not accept the claim to as much as possible without further legitimisation, like Rawls does, then scarcity might not be as severe a problem. Finally, I reject Rawls’s proposed solution for dealing with problems of sustainability, namely his idea of the just savings principle. I con...
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Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The... more
Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the lack of empathy, as some philosophers have proposed -- but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. As this volume demonstrates, philosophers will be better equipped to determine what they mean by "the moral point of view" when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy. ContributorsGwen Adshead, Piers Benn, John Deigh, Alan Felthous, Kerrin Jacobs, Heidi Maibom, Eric Matthews, Henning Sass, Thomas Schramme, Susie Scott, David Shoemaker, Walter Sinnott-Armstrong, Matthew Talbert
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This essay is concerned with different strategies of justifying a welfare state. I begin with a description of the formal aims of its different versions. I then vindicate the transformation of mutual civic responsibilities into... more
This essay is concerned with different strategies of justifying a welfare state. I begin with a description of the formal aims of its different versions. I then vindicate the transformation of mutual civic responsibilities into state-controlled institutions. In the main part I develop three accounts that are typically brought forward in order to justify particular institutions of a welfare state. These models focus on freedom, equality, and security. In conclusion, I argue in favour of a higher-level model of justification, which integrates the valid ideas of the other models. It considers inclusion of all citizens into society to be the main goal of welfare institutions.
George Graham & G. Lynn Stephens (eds.): Philosophical Psychopathology, 340 S., Cambridge, Mass.: MIT Press I994. John Z. Sadler, Osborne P. Wiggins & Michael A. Schwartz (eds.): Philosophi cal Perspetives on Psychiatric Diagnostic... more
George Graham & G. Lynn Stephens (eds.): Philosophical Psychopathology, 340 S., Cambridge, Mass.: MIT Press I994. John Z. Sadler, Osborne P. Wiggins & Michael A. Schwartz (eds.): Philosophi cal Perspetives on Psychiatric Diagnostic Issues, 399 S. Baltimore, Md.: Johns Hop kins U. P. 1994. A. Phillips Griffiths (ed.): Philosophy, Psychology, and Psychiatry, Royal Institute of Philosophy Supplement 37, 243 S. Cambridge: Cambridge U. P. I994. Julia Epstein: Altered Conditions. Disease, Medicine, and Storytelling, 275 S., New York & London: Routledge 1995. Lennart Nordenfelt: On the Nature of Health. An Action-Theoretic Approach, Se cond Revised and Enlarged Edition 214 S., Dordrecht: Kluwer Academic Publis hers I987 & 1995.
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Das Thema meines Beitrags erscheint moglicherweise ungewohnlich, insofern sich die philosophischen Dimensionen der Diskussion uber Gesundheit und Krankheit nicht unbedingt aufdrangen. In erster Linie geht es dabei um Definitionen der... more
Das Thema meines Beitrags erscheint moglicherweise ungewohnlich, insofern sich die philosophischen Dimensionen der Diskussion uber Gesundheit und Krankheit nicht unbedingt aufdrangen. In erster Linie geht es dabei um Definitionen der grundlegenden medizinischen Begriffe, so wie es meist in der Philosophie um die Analyse von Begriffen geht. ,Gesundheit‘ und ,Krankheit‘ gehoren zu den Begriffen, mit denen sich Philosophen durchaus schon eine Weile auseinandergesetzt haben.
Many biological functions allow for grades. For example, secretion of a specific hormone in an organism can be on a higher or lower level, compared to the same organism at another occasion or compared to other organisms. What levels of... more
Many biological functions allow for grades. For example, secretion of a specific hormone in an organism can be on a higher or lower level, compared to the same organism at another occasion or compared to other organisms. What levels of functioning constitute instances of dysfunction; where should we draw the line? This is the quantitative problem for theories of dysfunction and disease. I aim to defend a version of biological theories of dysfunction to tackle this problem. However, I will also allow evaluative considerations to enter into a theory of disease. My argument is based on a distinction between a biological and a clinical perspective. Disease, according to my reasoning, is restricted to instances that fall within the boundaries of biological dysfunctions. Responding to the quantitative problem does not require arbitrary decisions or social value-judgements. Hence, I argue for a non-arbitrary, fact-based method to address the quantitative problem. Still, not all biological ...
I aim to show that the common idea according to which we can assess how bad death is for the person who dies relies on numerous dubious premises. These premises are intuitive from the point of view of dominant views regarding the badness... more
I aim to show that the common idea according to which we can assess how bad death is for the person who dies relies on numerous dubious premises. These premises are intuitive from the point of view of dominant views regarding the badness of death. However, unless these premises have been thoroughly justified, we cannot measure the badness of death for the person who dies. In this paper, I will make explicit assumptions that pertain to the alleged level of badness of death. The most important assumption I will address is the assignment of a quantitative value of zero to death, which leads to the conclusion that there are lives not worth living for the affected person. Such a view interprets the idea of a live worth living in quantitative terms. It is in conflict with actual evaluations of relevant people of their lives.
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In this paper I defend a constitutive role of empathy for morality. I will rely on a particular reading of the notion of morality, which I call "agential". It focuses on mental and behavioural aspects of moral agents. In the first... more
In this paper I defend a constitutive role of empathy for morality. I will rely on a particular reading of the notion of morality, which I call "agential". It focuses on mental and behavioural aspects of moral agents. In the first section, I explore the general capacity to empathize. In the second section, I will introduce some results of the philosophical and psychological debate on autism and psychopathy in relation to empathy and morality. It will be seen that the currently best explanations of (severe forms of) autism and psychopathy point at deficits in either cognitive empathy or emotional empathy respectively. I will also argue that, whatever the empirical results, we need to conceptually clarify what it means to be a moral agent. Obviously the question what ‘moral agency’ means is not a purely empirical question. I will therefore attempt to develop some steps towards a theory of moral agency in the third section. In conclusion, I believe we are justified in identifying a constitutive role of the capacity for empathy for the development of moral agency.
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Szasz’s legacy involves two issues in current psychiatry: First, he criticized the concept of mental illness. The DSM-5 debate shows that psychiatry still suffers from unresolved conceptual problems. The definition of the general concept... more
Szasz’s legacy involves two issues in current psychiatry: First, he criticized the concept of mental illness. The DSM-5 debate shows that psychiatry still suffers from unresolved conceptual problems. The definition of the general concept of mental disorder remains unclear. Specific classificatory entities (e.g., autism spectrum disorder) are notoriously contested. Second, he criticized coercive psychiatric practice. Recent developments suggest an ongoing identity crisis of psychiatry as a medical institution. Psychiatry’s tasks are partly related to societal interests (e.g., dealing with dangerous persons). Two psychiatric forms of intervention are therapeutic coercion and compulsion to prevent harm to others. Whether the latter can be squared with therapeutic purposes is unclear. To justify paternalistic interventions such as therapeutic coercion is difficult. Hence, there is enormous pressure on psychiatry’s medical identity. Szasz asked the right questions, not necessarily providing the most convincing answers. Psychiatry would benefit from a thorough, less prejudiced assessment of his publications.
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Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem.... more
Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem. The capabilities approach puts forward a particular solution to this problem. In this article I will discuss some issues of such an approach in relation to Sridhar Venkatapuram's well-known theory. Another problem I examine is how to determine a threshold of provision within a theory of justice. What is enough in terms of health justice? I argue that we need such a threshold to avoid healthism, the expansion of the pursuit of health over and above the treatment and prevention of disease. This is an especially pertinent problem in public health, which is also the context of Venkatapuram's theory.
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The paper contrasts Lennart Nordenfelt's normative theory of health with the naturalists' point of view, especially in the version developed by Christopher Boorse. In the first part it defends... more
The paper contrasts Lennart Nordenfelt's normative theory of health with the naturalists' point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse's analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health ('health' is not defined as absence of disease but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt's account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt's conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt's is in danger of supporting medicalization. In conclusion, although Nordenfelt's theory is not altogether rejected and even seen in congruence with Boorse's account, it is claimed that the naturalistic framework should obtain conceptual priority.
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The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and... more
The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.
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... are permissible and even required to achieve this aim, hence the political intervention principle is ... or degrading pursuits(DE MARNEFFE 1998, 102), is at least partly compatible with liberalism. ... 162 Thomas Schramme good life,... more
... are permissible and even required to achieve this aim, hence the political intervention principle is ... or degrading pursuits(DE MARNEFFE 1998, 102), is at least partly compatible with liberalism. ... 162 Thomas Schramme good life, for instance by reference to basic human needs ...
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Research Interests: Bioethics, Human Rights, Health, Independence, Liberty, and 6 moreValue, Self Determination, Capacities, Mill, Social, and Medical
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The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and... more
The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.
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In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a... more
In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.
Research Interests: Applied Ethics, Health Care, Social Justice, Ethical Theory, Medical Theory and Philosophy, and 11 moreGatekeeping, Humans, Europe, Clinical Sciences, Health Care Rationing, Theoretical Models, Social Values, Patient Advocacy, Socioeconomic Factors, attitude to health, and Health Services Accessibility
Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that... more
Ageing is often deemed bad for people and something that ought to be eliminated. An important aspect of this normative aspect of ageing is whether ageing, i.e., senescence, is a disease. In this essay, I defend a theory of disease that concludes that ageing is not a disease, based on an account of natural function. I also criticize other arguments that lead to the same conclusion. It is important to be clear about valid reasons in this debate, since the failure of bad analyses is exploited by proponents of the view that ageing is indeed a disease. Finally, I argue that there could be other reasons for attempting to eradicate senescence, which have to do with an evaluative assessment of ageing in relation to the good life. I touch on some reasons why ageing might be good for people and conclude that we cannot justify generalized statements in this regard.
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The paper contrasts Lennart Nordenfelt's normative theory of health with the naturalists' point of view, especially in the version developed by Christopher Boorse. In the first part it defends... more
The paper contrasts Lennart Nordenfelt's normative theory of health with the naturalists' point of view, especially in the version developed by Christopher Boorse. In the first part it defends Boorse's analysis of disease against the charge that it falls short of its own standards by not being descriptive. The second part of the paper sets out to analyse the positive concept of health and introduces a distinction between a positive definition of health ('health' is not defined as absence of disease but in positive terms) and a positive conception of health (health is seen as an ideal). An objection against Nordenfelt's account is developed by making use of a specific example of an ambitious athlete. It is stated that Nordenfelt's conceptualisation includes too many phenomena under the umbrella of ill health. An ideal conception of health like Nordenfelt's is in danger of supporting medicalization. In conclusion, although Nordenfelt's theory is not altogether rejected and even seen in congruence with Boorse's account, it is claimed that the naturalistic framework should obtain conceptual priority.
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According to Norman Daniels, the moral significance of health needs stem from their impact on the normal opportunity range: pathological conditions involve comparative disadvantage. In this paper I defend an alternative reading of the... more
According to Norman Daniels, the moral significance of health needs stem from their impact on the normal opportunity range: pathological conditions involve comparative disadvantage. In this paper I defend an alternative reading of the moral importance of healthcare, which focuses on non-comparative aspects of disease. In the first section I distinguish two contrasting perspectives on pathological conditions, viz a comparative versus a non-comparative. By using this distinction I introduce a related disparity regarding the moral importance of personal responsibility for disease. I claim that people are usually prepared to disregard individual responsibility for disease, if it involves non-comparative harm, but not if it entails mere disadvantage. Since disadvantage means to have less than equal opportunities, Daniels' conception of opportunity is vital for his theory. It is therefore scrutinised more closely. I try to show that he wavers between two interpretations of the notion of opportunity, which are again linked to the distinction between a comparative and a non-comparative point of view. Finally, I criticise Daniels' supposition that persons have an interest in the normal opportunity range.
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In this paper, I discuss several arguments against non-therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue... more
In this paper, I discuss several arguments against non-therapeutic mutilation. Interventions into bodily integrity, which do not serve a therapeutic purpose and are not regarded as aesthetically acceptable by the majority, e.g. tongue splitting, branding and flesh stapling, are now practised, but, however, are still seen as a kind of 'aberration' that ought not to be allowed. I reject several arguments for a possible ban on these body modifications. I find the common pathologisation of body modifications, Kant's argument of duties to oneself and the objection from irrationality all wanting. In conclusion, I see no convincing support for prohibition of voluntary mutilations.