Lindstrøm Jon A
IFIKK University of Oslo, Blindern, Oslo, Norway.
Med Health Care Philos. 2012 May;15(2):165-73. doi: 10.1007/s11019-011-9341-0.
According to the 'fact-plus-value' model of pathology propounded by K. W. M. Fulford, 'disease' is a value term that ought to reflect a 'balance of values' stemming from patients and doctors and other 'stakeholders' in medical nosology. In the present article I take issue with his linguistic-analytical arguments for why pathological status must be relative to such a kind of medico-ethical normativity. Fulford is right to point out that Boorse and other naturalists are compelled to utilize evaluative terminology when they characterize the nature of diseases and biological dysfunctions. But the relevant 'biofunctional judgements' are no less factual and empirical for that. While it is indeed evaluative to say that biological dysfunctions involve failures to execute naturally selected functions, such judgments are not bound to entail anything about what is good or bad for us, and what should be treated or not. In the last part of the paper I ruminate briefly on the relationship between 'biological evaluationism', on my construal, and descriptions of 'causal biology'. As I note in my conclusion, a strict bioevaluative concept of disease can be valid for every species on earth, and thus be of particular usefulness in general biological contexts.
根据K. W. M. 富尔福德提出的病理学“事实加价值”模型，“疾病”是一个价值术语，应该反映出源自患者、医生以及医学分类学中其他“利益相关者”的“价值平衡”。在本文中，我对他关于病理状态为何必须相对于这种医学伦理规范性的语言分析论证提出质疑。富尔福德正确地指出，博尔瑟和其他自然主义者在描述疾病和生物功能障碍的本质时不得不使用评价性术语。但相关的“生物功能判断”并不会因此而减少其事实性和经验性。虽然说生物功能障碍涉及未能执行自然选择的功能确实是评价性的，但这种判断不一定会涉及对我们有益或有害的事情，以及应该治疗或不应该治疗的事情。在论文的最后一部分，我简要思考了我所理解的“生物评价主义”与“因果生物学”描述之间的关系。正如我在结论中所指出的，严格的疾病生物评价概念对地球上的每个物种都可能是有效的，因此在一般生物学背景下可能特别有用。
