Theor Med Bioeth. 2019 Feb;40(1):1-19. doi: 10.1007/s11017-019-09483-y.
Theoretical medicine and bioethics
David G Limbaugh
PMID: 30826976 DOI: 10.1007/s11017-019-09483-y
Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful in his harmful dysfunction analysis (HDA). Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield's HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. For instance, one can conceive of cases where simultaneous disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder. I argue that the sense of harm that Wakefield should employ in the HDA is dispositional, similar to the sense of harm used when describing a vile of poison: "Be careful! That's poison. It's harmful." I call this harm in the damage sense. Using this sense of harm enables the HDA to avoid Feit's arguments, and thus it should be preferred to other senses when analyzing harmful dysfunction.
Keywords: Disease; Disorder; Dispositions; Harm; Philosophy of biology; Philosophy of medicine; Philosophy of psychiatry; Philosophy of science; Systematic harm
