Handbook of Bioethics: / Philosophy and Medicine Bd.78 (PDF)

THE LOGIC OF HEALTH CONCEPTS (p.205)

I. INTRODUCTION

It is often maintained that health is one of the major goals of medicine or even the goal of medicine. This idea has been eloquently formulated by the American philosophers of medicine Edmund Pellegrino and David Thomasma in their book A Philosophical Basis of Medical Practice (1981, p. 26):

Medicine is an activity whose essence lies in the clinical event, which demands that scientific and other knowledge be particularised in the lived reality of a particular human for the purpose of attaining health or curing illness through the direct manipulation of the body and in a value-laden decision matrix.

Although some other goals of medicine exist, such as saving lives and advancing quality of life, health is still taken to be the central goal of medicine and health care in general. However, the formidable task of interpreting the nature of health remains. What more specifically is health? To what more precise goal shall we direct our efforts in medicine and health care?

These questions are not simply academic. They are of great practical and thereby ethical concern. The consequences for health care diverge considerably, not least in economic but also in social and educational terms, if health is understood as people’s happiness with life, or their fitness and ability to work, or just the absence of obvious pathology in their bodies and minds. There are adherents of all these ideas in the modern theoretical discussion on health.

One of the major problems in this discussion is to establish the relation between the notion of disease and that of health. Are the two notions directly linked, so that health is the total absence of disease, or is there a much looser connection? Is health something over and above the absence of disease? Is health even compatible with the existence of disease? We seem to have varying intuitions in this regard. We seem also inclined to