Medicina

Stud. Hist. Phil. Biol. & Biomed. Sci. 33 (2002) 263–282 www.elsevier.com/locate/shpsc

Disease
Rachel Cooper
Department of Interdisciplinary Human Studies, Bradford University, Bradford BD7 1RA, UK Received 5 July 2001; received in revised form 8 November 2001

Abstract This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine thebest existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have been unlucky, and that can potentially be medically treated. All three criteria must befulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it mustbe potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems.  2002 Elsevier Science Ltd. All rights reserved.
Keywords: Disease; Disorder; Health; Christopher Boorse

Whether a condition is considered a disease often has social, economic and ethical implications. Are psychopaths evil or sick? Should theNHS pay for the treatment of nicotine addiction? Is it right for shy people to take character-altering drugs? All these debates may be seen to depend on whether the conditions are diseases, and developing an account of disease may be hoped to help us in addressing such questions. In this paper I attempt to clarify notions of disease. Before the philosophical work begins it is necessary to explainthe terminology that I will be employing. In ordinary language we often distinguish between diseases, wounds, disabilities and injuries.
E-mail address: r.v.cooper@bradford.ac.uk (R. Cooper).
1369-8486/02/$ - see front matter  2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 3 9 - 3 6 8 1 ( 0 2 ) 0 0 0 1 8 - 3

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R. Cooper / Stud. Hist. Phil. Biol. & Biomed. Sci. 33 (2002)263–282

However, in the philosophical literature on the pathological, as well as in much medical discourse, it has become usual to use ‘disease’ to refer to all pathological conditions—whether diseases in the narrow sense, injuries, wounds or disabilities. This is the sense of disease whereby it makes sense to say, for example, that ‘Health is the absence of disease’. Here I shall follow thisphilosophical and medical usage and will use ‘disease’ to refer to all pathological conditions. This paper falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. 1. Boorse’s account of disease—the main contender Christopher Boorse has proposedthe most sophisticated account of disease currently available (Boorse, 1975, 1976a, 1977, 1997). According to Boorse a disease is a dysfunction of a sub-system of the body. ‘Sub-system of the body’ is used in the broadest sense imaginable, referring to organs, systems in the body such as the nervous system, and sub-systems of the mind, for example those devoted to memory or languagecomprehension.1 The overall aims of the organism are to survive and reproduce, and the different sub-systems function so as to contribute to the attainment of these goals. Diseases are then defined as being ‘interferences with [these] natural functions’ (Boorse, 1976a, p. 30). Thus amnesia is a disease because it is a dysfunction of the memory system. H.I.V. is a disease because it causes a dysfunction in...