Abstract
Medical knowledge aims to identify different diseases as wrong conditions of biological organization. One main issue within the field of the philosophy of medicine is the question of just how confident we can be that what we know about biological organization will help us to identify diseases and propose cures or treatments for them. The concept of biological organization is a complex abstraction which requires the coexistence of constitutive, interactive and experiential aspects; while the main attempts at naturalist descriptions of the concept (functional, mechanistic and systemic) fail to be fully comprehensive. Different arguments have supported a naturalist normativity in medicine; the strongest such perspective contrasts the normal or typical state of organizational elements with their “broken” versions. However, the complexity of biological organization suggests that there are multiple ways of being healthy or diseased. Thus, the normative goal of medicine of identifying diseases encounters two fundamental questions: (1) Is biology itself normative and can it define the “natural” state? (2) Can medicine rely on knowledge other than biological knowledge to identify what goes wrong? As a normative discipline, medicine comes into conflict with the multiplicity in the very ontology of diseases, which needs to be complemented with epistemic pluralism. Philosophy of medicine therefore needs to explore the sources of that normativity.
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Notes
- 1.
- 2.
- 3.
Not all biological individuals are organisms; organisms are characterized by the properties that provide their capacity to persist.
- 4.
Understood as an account that does not provide all the detail, or leaves things out in some respect in relation to the domain of full material realization of a system, but which still provides a literal perspective, without falsity, that is relevant for some purpose. In contrast to abstraction, idealization deviates from the literal perspective and introduces false assumptions, such as infinite population numbers (Godfrey-Smith 2014, 21).
- 5.
The notion of organism has been brought into question in several ways in the past and considered not to be theoretical; but it has acquired a new relevance in more recent biology and philosophy.
- 6.
The theory of autopoiesis considers organization as a criterion to demarcate life from non-life.
- 7.
“[I]t would be absurd for humans even to make such an attempt or to hope that there may yet arise a Newton who could make comprehensible even the generation of a blade of grass according to natural laws that no intention has ordered; rather, we must absolutely deny this insight to human beings.” (Kant 1790, §75).
- 8.
Recent evolutionary biology has addressed the issue of “organismality,” as an account of different kinds of organization produced by evolution. Meanwhile, evo-devo has pursued generative explanations by including developmental processes in evolutionary accounts.
- 9.
“Medical thought has never stopped alternating between these two representations of disease, between these two kinds of optimism, always finding some good reason for one or the other attitude in a newly explained pathogenesis. Deficiency diseases and all infectious or parasitic diseases favour the ontological theory, while endocrine disturbances and all diseases beginning with dys- support the dynamic or functional theory.” (Canguilhem 1991, 40–41).
- 10.
For instance, Wouters (2003) distinguishes four notions of function in biology. One of them views function as the activity a part or organ performs or is capable of performing, without considering the use of this activity. For many authors, this is the most neutral concept of function; but as it does not support multiple realizability, it is a rather unusual concept. The other three notions view function as use or role, because they attempt to identify the role or roles of a given structure or part, understood as its contribution to survival and reproduction (in the case of function as biological advantage), to a selected effect (in the case of the etiological function) or to a complex activity (in the case of function as causal role).
- 11.
The question of the ontology of diseases will not be pursued here.
- 12.
According to Bechtel and Abrahamsen (2005, 423), a mechanism is “a structure performing a function in virtue of its component parts, component operations, and their organization” so that the orchestrated mechanism is responsible for one or more phenomena. This approach is considered to be as useful to understand pathological phenomena as it is physiological ones, insofar as both can be described as mechanisms. In this respect, Nervi follows Craver (2001, 67) who explicitly maintains that his account of functions “does not appeal to any sense of adaptiveness in an environment; instead it appeals only to roles in contextual systems […which] may be adaptive or destructive.”
- 13.
We are told, for example, that “there are many more states of an organ or organ system compatible with disease than with health. […] The same point can be made about function. There are many more states of an organ or organ system compatible with its failing to perform its function than with its performing its function.” (Garson 2013, 326).
- 14.
See footnote 4 above.
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Acknowledgments
Funding for this research was provided by the grant IT 590–13 from the Basque government, and by the grant FFI2011-25665 from the Spanish government’s Ministerio de Economía y Competitivad. I thank Elodie Giroux for her kind invitation both to participate in the Lyon workshop and to collaborate in this volume; and also Antonio Casado da Rocha for his comments and suggestions.
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Etxeberria, A. (2016). Biological Organization and Pathology: Three Views on the Normativity of Medicine. In: Giroux, É. (eds) Naturalism in the Philosophy of Health. History, Philosophy and Theory of the Life Sciences. Springer, Cham. https://doi.org/10.1007/978-3-319-29091-1_8
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