Tengland Per-Anders
Health and Society, Malmö University, 206 05, Malmö, Sweden.
Theor Med Bioeth. 2007;28(4):257-84. doi: 10.1007/s11017-007-9043-z. Epub 2007 Oct 2.
The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse's. The main problems with Nordenfelt's theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one's culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt's theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of "ability," by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health.
乔治·库什夫称，当代关于健康理论的辩论起点应是伦纳特·诺登费尔特的整体理论，而非已被驳斥的克里斯托弗·布尔斯的理论。本文试图挑战诺登费尔特，并提出一种与他的理论以及包括布尔斯理论在内的其他理论不同的替代理论。诺登费尔特理论的主要问题在于，它是相对主义的，在何种目标可被视为健康这一问题上会导致反直觉的结果，它关注的是错误类型的能力，它使健康测量格外困难，并且它对健康的阐释并不充分，至多只是给出了一个必要条件。所提出的替代理论是二维的。首先，健康是指具备了一个人所属文化中的成员通常所发展出来的能力和性情，并能够在可接受的情形下运用它们；其次，健康是指体验到具有内在原因的积极情绪和感觉。该理论通过不具有个体相对性、在定义中消除目标、对“能力”给出不同解释、使健康更易于测量以及增加幸福维度，解决了与诺登费尔特理论相关的问题。幸福维度与作为能力的健康一起，不仅为我们提供了健康的必要条件，也提供了充分条件。
