Kingma Elselijn
University of Southampton, Highfield, Southampton, UK
J Med Philos. 2014 Dec;39(6):590-608. doi: 10.1093/jmp/jhu037. Epub 2014 Nov 4.
The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of "health" and "disease," (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease.
关于健康与疾病的文献通常呈现为自然主义与规范主义之间的对立。本文认为，这种描述过于简单化：自然主义与规范主义之间并非只有一种对立，而是存在多种对立。我区分了四个不同的领域，在这些领域中自然主义和规范主义的主张可以形成对比：（1）日常用法，（2）“健康”和“疾病”概念上的清晰版本，（3）功能障碍的操作化，以及（4）该操作化的正当理由。在此过程中，我提出了回应施瓦茨（2007年）和豪斯曼（2012年）的新论点，并揭示了施瓦茨（2007年）和金马（2010年）所提出论点之间的联系。区分这四个领域的自然主义主张将使我们能够通过以下方式取得进展：（1）就价值观在健康与疾病中可能发挥的作用提供更细致入微的中间立场；（2）协助解决对健康与疾病价值负载性的相对主义担忧。
