Abstract

What is health? What is disease? Thirty years of philosophical debate has failed to answer these questions. Instead the literature has revolved around one single question: are the concepts of health and disease value-free? Naturalists ardently argue in favour, whilst normativists equally vehemently oppose. Neither of these approaches has succeeded, however; naturalists fail to make good on their promise of providing a fully naturalistic account of disease – and even if they were able to provide this, the disease concept they discuss is a pure theoretical one, and not applicable to either practice, ethics or policy. Normativists, on the other hand, fail to unpack the claim that health and disease are value-laden, and offer analyses that beg the question with respect to applications in policy, ethics and practice. It is time for a different approach. Rather than debating value-free or value-laden definitions we should consider how the concepts of health and disease came to be what they are. In this process both values and biological descriptions play an interactive role. The creative synthesis of naturalism and normativism I thus offer moves beyond the traditional stalemate, and has profound implications for bioethicist.