London School of Hygiene & Tropical Medicine, London WC1H 9SH.
Bioethics. 2013 Jun;27(5):271-9. doi: 10.1111/j.1467-8519.2011.01953.x. Epub 2012 Mar 16.
I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free-standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society-relative vital goals with a human species-wide conception of basic vital goals, or 'central human capabilities and functionings'. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings-or having the overarching capability, a meta-capability, to achieve a set of central or vital inter-related capabilities and functionings.
我主张将健康视为一个人实现或行使一系列基本人类活动的能力。这些基本活动是通过对现代世界中具有平等人类尊严的人类生活的最小概念进行独立的伦理推理来具体规定的。我通过密切关注 Lennart Nordenfelt 的健康理论并对其进行修改,得出了健康的这个概念。该理论将健康视为实现重要目标的能力。尽管该理论具有优势,但我对其进行了改造,以克服三个重大缺陷。Nordenfelt 使重要目标相对于每个社区或背景,并且显著反映了个人偏好。这样做,Nordenfelt 的健康概念面临着健康的社会相对概念和主观定义的幸福的问题。此外,Nordenfelt 从未明确规定过一组重要目标。这里提出的健康理论用“基本重要目标”或“核心人类能力和功能”取代了 Nordenfelt 的(看似)空的偏好和与社会相关的重要目标。这些核心人类能力来自现在在政治哲学和经济学中熟悉的能力方法(CA),特别是反映了 Martha Nussbaum 的工作。因此,个体的健康应被理解为实现基本的存在和行为的能力,或者拥有实现一系列核心或重要相互关联的能力和功能的总体能力,即元能力。