期刊
JOURNAL OF MEDICINE AND PHILOSOPHY
卷 42, 期 4, 页码 350-366出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/jmp/jhx009
关键词
biological function; biostatistical theory; disease boundaries; medicalization
资金
- National Health and Medical Research Council [NHMRC-633003]
- Australian Research Council [FT130100346]
- Australian Research Council [FT130100346] Funding Source: Australian Research Council
Boorse's biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs-including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions.
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