Philosophy 2803 – Lecture III

What is Health?

WHO Definition

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (p. 24)

Note the links drawn between health and peace.

Compare to discussions today of the root causes of terrorism.

“the health of all peoples is fundamental to the attainment of peace and security” (p. 24)

Criticisms of the WHO Definition

Too grand

Vague (“well-being”)

Seems to medicalize too many things (including happiness)

Overestimates the importance of doctors

Doesn’t leave enough room for individual responsibility (“it’s not my fault, I’m sick”)

See Callahan for more details

A Better Definition?

Callahan: “Health is a state of physical well-being” (p. 34)

Note: Not complete well-being

Not social or mental

Medicine vs. Health

A case can be made that health is a broader concept than medicine

Likewise, a case can be made that having a disease, injury or impairment and being healthy are not incompatible

E.g., sterility is an impairment, but does it mean one is unhealthy?

See Whitbeck for both points

The Normative Element of Health, Medicine, etc.

We won’t worry about a precise definition of health vs. medicine

What is important is the way that judgments about being healthy inevitably involve value judgments

i.e., they’re normative claims

See Whitbeck for a detailed discussion of this

Case #1

Johnny is a short 11-year-old boy with documented Growth Hormone (GH) deficiency resulting from a brain tumor.

His parents are of average height.

His predicted adult height without GH treatment is approximately 160 cm (5 feet 3 inches).

With GH treatment, it is predicted that he will grow several inches taller.

His parents want Johnny treated with GH.

Should we follow his parent’s wishes?

Case #2

Billy is a short 11-year-old boy with normal GH secretion according to current testing methods.

However, his parents are extremely short.

He has a predicted adult height of 160 cm (5 feet 3 inches).

With GH treatment, it is predicted that he will grow several inches taller.

His parents want Billy treated with GH.

Should we follow his parent’s wishes?

Is There a Moral Difference Between the Two Cases?

Most will consider it OK to treat the GH deficient child

What about the child who is likely to turn out to be short for other reasons?

Suggestion: Our answer will ultimately depend, on whether we consider his short stature a bad thing.

I.e., it will involve a value judgment about how bad it is to be a 5’3’’ boy.

So What?

Most of the time, the fact that health is a value-laden term is not problematic since most of the time we can agree about to evaluate a particular condition

E.g., heart attack = bad

Problems do arise, however, in some cases in which it is not clear how we should evaluate a particular condition

What Should We Treat?

Would it be OK to use hormones to fix someone’s height?

Would it be OK to surgically correct deafness?

Would it be OK to lighten someone’s skin?

What’s the difference between these cases?

The Point

Be careful of assuming that health care is an objective, value-free enterprise

It’s full of value judgments. This is simply hidden by the fact that we often agree on the judgments.