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Subject Area: Political Theory

Health and Objective Values - Leonard P. Liggio, Literature of Liberty, April/June 1978, vol. 1, No. 2 [1978]

Edition used:

Literature of Liberty: A Review of Contemporary Liberal Thought was published first by the Cato Institute (1978-1979) and later by the Institute for Humane Studies (1980-1982) under the editorial direction of Leonard P. Liggio.

Part of: Literature of Liberty: A Review of Contemporary Liberal Thought, 20 vols. 19781-982

About Liberty Fund:

Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.


Health and Objective Values

Christopher Boorse

  • University of Delaware

“Health as a Theoretical Concept.” Philosophy of Science 44 (1977): 542–573.

Is health a value-free concept? The medical view of health as the absence of disease is such a value-free theoretical notion because it is based on nonsubjective and empirical elements of biological function and statistical normality. Health involves freedom from disease and thus means statistical normality of biological function: the ability to perform all typical physiological functions with at least the typical efficiency of the species.

The concept of health thus depends on an adequate understanding of disease. A value-free approach to health starts out with a functional account of its negation, disease. Disease is a matter of fact and not of evaluative decision. Health, as the absence of disease also becomes a matter of fact.

The opposite view, that health is a value-laden concept, arises from faulty assumptions. Our health judgments, in this view, must be “practical” judgments about the treatment of patients; it also recommends commitment to “positive” health beyond the simple absence of disease (theoretical health). The first assumption of “practical health” believes that “choosing to call a set of phenomena a disease involves a commitment to medical intervention”; the second assumption of “positive health” leads to unnecessary ethical dilemmas that no medical procedures can unravel.

In clinical and philosophical literature, the scope of the term disease includes injury, as distinguished from illness (a particular occurrence of the universal “disease”), and should not be confused with what tends to produce disease.

This functional account of health follows the classical tradition of regarding the normal as the natural, and by stressing the biological notions of goal-directedness and function. It differs from that tradition by identifying ideal functioning with the empirically typical (i.e., the ideal is non-normative). Diseases may be viewed as internal states that reduce an organism's functional ability below typical levels for its species. Health, then, is normal functioning ability. Here, normal and typical are defined statistically in terms of the species.

This understanding of theoretical health differs from the currently popular notion of positive health: something more than the absence of disease. It is important to distinguish between health and various kinds of excellence.

This discussion of physical health and disease may also be extended to resolve controversies within the field of mental health. Mental health experts often debate how much values influence health judgments and who gets committed. With a valid distinction between theoretical (mental) health and practical health, we could consistently assert the objective status of mental disease in individuals but still object to subjecting them to involuntary “practical” treatment to render them more “excellent.” We need not believe, with Thomas Szasz, that mental illness is a myth to protest compulsory treatment of the “sick.”