Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
Centre of Medical Ethics, University of Oslo, Blindern, PO Box 1130, N-0318, Oslo, Norway.
Health Care Anal. 2021 Jun;29(2):127-143. doi: 10.1007/s10728-021-00434-0. Epub 2021 Apr 29.
How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization.
我们如何在健康和疾病之间划清界限？这个至关重要的划界问题具有巨大的实际意义，困扰了学者们多年。这个问题将分三个步骤来解决。首先，我将介绍罗杰斯和沃克的一个重要贡献，他们有力地论证了在健康和疾病之间不可能划出一条界限。然而，对他们论点的更仔细分析表明，为与疾病相关的特征划出一条界限的问题不一定意味着为疾病本身划出一条界限的问题。第二步分析了在健康和疾病之间划界的一些替代方法。虽然这些方法并没有为这个问题提供完整的答案，但它们表明划界问题不应被草率地否定。第三步探讨了划界问题是否可以在痛苦的概念中找到解决方案。特别是，我调查了是否可以通过回归医学的起源，以减轻痛苦为主要和最终目标，为健康和疾病之间的划界提供依据。事实上，我们之所以关注某些现象作为疾病的特征，认为某些过程是相关的，将特定的功能归为功能障碍，是因为它们与痛苦有关。因此，将痛苦作为健康和疾病之间的划界标准可能会阻碍现代医学面临的一系列挑战，例如疾病的无端扩张、过度诊断、过度治疗和医学化。
