United States Coast Guard Academy, New London, Connecticut, USA.
The College of New Jersey, Ewing, New Jersey, USA.
J Med Philos. 2020 May 21;45(3):332-349. doi: 10.1093/jmp/jhaa007.
Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield's harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns (dysfunctions) in evolved mechanisms that cause significant harm to the organism. We argue that Wakefield's account is not a promising way to distinguish between disease and health because being harmful is neither necessary nor sufficient for a dysfunction to be a disorder. Counterexamples to the harmful dysfunction account are considered, such as mild infections, perceptual deficits, and beneficial illnesses. Then we consider two ways of amending the harmful dysfunction account to address these cases and argue that the proposed amendments raise even more serious problems for this account. These problems apply generally to any normativist theory and raise doubts about the entire normative approach to the philosophy of health and disease.
规范主义认为疾病和不良价值之间存在密切的概念联系。我们通过提出反对杰罗姆·韦克菲尔德（Jerome Wakefield）有害功能失常理论的论证来挑战规范主义。韦克菲尔德认为，医学障碍是进化机制的故障（功能失常），会对生物体造成重大伤害。我们认为，韦克菲尔德的理论并不能很好地区分疾病和健康，因为有害既不是功能失常成为障碍的必要条件，也不是充分条件。考虑了对有害功能失常理论的反例，如轻度感染、感知缺陷和有益疾病。然后，我们考虑了两种修正有害功能失常理论的方法来解决这些情况，并认为所提出的修正会给该理论带来更多严重的问题。这些问题普遍适用于任何规范主义理论，并对健康和疾病哲学的整个规范性方法提出了质疑。
