Schaffner K F
George Washington University, Washington, DC 20052, USA.
J Med Philos. 1999 Aug;24(4):365-75. doi: 10.1076/jmep.24.4.365.5978.
Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, I argue, offers an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations. The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's.
评估健康与疾病概念的规范状态会让人涉及到事实与价值之间关系的问题。一些人认为，克里斯托弗·布尔斯的健康与疾病概念缺乏这样一个价值元素，因为它无法解释那些虽被贬低但没有进化功能失调后果的伤害类型。我采用布尔斯的观点，并纳入一些类似休谟的社会生物学假设，以应对这一挑战。我认为，拥有道德情感具有进化优势（因此属于布尔斯对正常功能能力的定义范畴）。然而，这并不等同于情感主义：相反，这些情感可以成为一个价值体系的基础。这种价值结构引入了同情他人痛苦的概念，作为疾病规范维度的基础。例如，它认为疾病的负面价值在于疾病涉及痛苦和功能限制。因此，这里提出的自然主义休谟式解释跨越了规范与描述的鸿沟。当布尔斯的观点扩展到包括社会情感和行为时，就会出现一种比布尔斯或卡斯的概念更宽泛，但比世界卫生组织的概念更狭窄的健康概念。
