Lauren Ross
Two main philosophical positions contrast the role of value in the definition of disease. The descriptivist position, championed most influentially by Christopher Boorse’s biostatistical theory (BST), claims that the definition of disease should be value-free, an “objective matter” that can be read, more or less, from the scientific facts of nature. The opposing normativist position asserts instead that this definition should involve value, although many different philosophers have widely different conceptions of how exactly it should.
I argue that the Boorsian theory fails to provide a definition of disease that accounts for dysmenorrhea, a disease of severe pelvic pain with menstruation. According to Boorse’s BST an organism is diseased if and only if it experiences subnormal function, with regard to its species, age-group and sex, which impinges upon the organism’s survival or reproductive fitness. The example dysmenorrhea not only fails to fit the BST’s analysis in that it lacks dysfunction and does not reduce survival or reproductive fitness but it also undermines the rationale for that analysis in that its treatment (hysterectomy) diminishes the patient’s survival and reproductive fitness, and does so far more than the disease itself.
Second, I argue for the normativist position in maintaining that the definition of disease must include at least some value because, as demonstrated by the example of dysmenorrhea, it encompasses the notion of suffering—a subjective experience of the patient. Suffering is value-laden because it depends on the patient’s judgment of her condition (its effects on daily life, severity, etc.) and personal preferences (longevity, quality of life, etc.).
My assessment of “value”, in the definition of disease, refers to a subjective assessment of worth made by an individual or collective, and as such, depends on their judgments or preferences. Values are often juxtaposed to objective or empirical scientific facts which, through detached scientific experimentation, provide descriptions of ourselves and our world. Of course whether there is a sharp fact-value distinction is controversial; my argument requires that only a rough distinction of this sort exists and I will not broach the controversies related to the topic.