Current dilemmas in defining the boundaries of disease

Jenny Doust, Mary Jean Walker, Wendy A. Rogers

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)350-366
Number of pages17
JournalJournal of Medicine and Philosophy (United Kingdom)
Volume42
Issue number4
DOIs
Publication statusPublished - 1 Aug 2017

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Medicalization
Polycystic Ovary Syndrome
Chronic Renal Insufficiency
Decision Making
Myocardial Infarction
Medicine
State Theory
Kidney
Guidance
Syndrome
Biological Function

Cite this

Doust, Jenny ; Walker, Mary Jean ; Rogers, Wendy A. / Current dilemmas in defining the boundaries of disease. In: Journal of Medicine and Philosophy (United Kingdom). 2017 ; Vol. 42, No. 4. pp. 350-366.
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Current dilemmas in defining the boundaries of disease. / Doust, Jenny; Walker, Mary Jean; Rogers, Wendy A.

In: Journal of Medicine and Philosophy (United Kingdom), Vol. 42, No. 4, 01.08.2017, p. 350-366.

Research output: Contribution to journalArticleResearchpeer-review

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