This week on Imperfect Cognitions, we showcased a couple of posts by authors with papers published in a special issue from the European Journal of Analytic Philosophy (EuJAP). The special issue on the Philosophy of Medicine was guest-edited by Anke Bueter and Saana Jukola.
In this third and final post, the guest editors of the issue Anke and Saana give a summary of the special issue and the other papers included in it. Anke is an associate professor at Aarhus University. Her main research interests lie within feminist philosophy of science and philosophy of psychiatry. Saana is a post-doctoral researcher at the Ruhr-University Bochum. She is interested in the philosophy of medicine, social epistemology, and values in science.
Philosophy of medicine has become established as a distinct branch of philosophy relatively recently. Of course, philosophical questions concerning, for instance, the nature of disease or the ethical responsibilities of physicians are not new. However, less than 15 years ago it was possible to ask: “Does Philosophy of Medicine Exist?” (Marcum 2008, 3). Since then, the field of research has become increasingly independent from bioethics, philosophy of biology and other neighbouring subfields of philosophy. Philosophy of medicine now has professional associations, specialized journals, and textbooks.
For the special issue on philosophy of medicine for the European Journal of Analytic Philosophy, we were particularly keen on receiving submissions investigating the interconnectedness of epistemic, metaphysical, ethical, and/or political aspects of medical research and practice. A major motivation for editing the special issue was the recognition that many of the critical philosophical questions that arise in the context of medicine and healthcare cannot be answered by drawing on just one philosophical tradition.
For example, the current COVID-19 has clearly demonstrated how ethical and political considerations cannot be ignored when discussing what mitigation measures should be undertaken. In what follows, we briefly summarize the topics of the articles that appeared in this issue.
In their contribution “Diagnostic Justice: Testing for Covid-19” Ashley Graham Kennedy and Bryan Cwik discuss diagnostic testing. They argue that testing for COVID-19 has different goals depending on whether it is done for clinical care for individuals, as entry criterion to trials in clinical research, and in surveillance on population level. Each of these goals is connected to different epistemic challenges and moral obligations towards test subjects.
Daria Jadreškić also looks at questions raised by the COVID-19 pandemic in her article “Adapt to Translate – Adaptive Clinical Trials and Biomedical Innovation”. Her focus is on clinical trials that have to be conducted under intense time pressure. Jadreškić argues that the validity of so-called adaptive trials has to be assessed on a case by case basis and with a focus on implementation.
In addition, she shows that adaptive trial design is not a novelty introduced by COVID-19 research, but can be placed within the larger context of the productivity crisis in pharmaceutical research and new developments in translational medicine.
In her article “Wrongful Medicalization and Epistemic Injustice in Psychiatry: The Case of Premenstrual Dysphoric Disorder”, Anne-Marie Gagne'-Julien shows how the framework of epistemic injustice can be applied to identifying problematic medicalization.
She expands Kaczmarek's pragmatic account of medicalization by combining it with insights from theorizing on epistemic injustice and applies it to the case of "Premenstrual Dysphoric Disorder. According to her, this is a case of wrongful medicalization because the process of establishing the diagnosis was not adequately inclusive. You can read a blog post about her paper here.
Jacob Stegenga’s contribution also deals with medicalization. The focus of his “Medicalization of Sexual Desire” is on low female sexual desire and the respective DSM diagnosis of “Female Sexual Interest/Arousal Disorder”. Stegenga analyses two conflicting perspectives on low female sexual desire:
The so-called mainstream focuses on its biological underpinnings and considers it a genuine disease. The critical view, in turn, focuses on the social context and cultural factors that impact sexuality and respective ideas of normality. By examining arguments for both views, Stegenga suggests focusing on pragmatic considerations of the harms and benefits of medicalizing the condition.
Kathleen Murphy-Hollies’ paper “When a Hybrid Account of Disorder is not Enough: The Case of Gender Dysphoria” applies Jerome Wakefield’s concept of mental disorder as harmful dysfunction (HD). Murphy-Hollies argues that HD leaves the relation between its components (“harm” and “dysfunction”) undertheorized and, consequently, may lead to pathologization of normal states.
Particularly in the case of gender dysphoria, assessing why purported dysfunctions are perceived as harmful and disvalued. This has two implications. Firstly, there is a distinction between sex dysphoria and gender dysphoria. Secondly, the legitimacy of the diagnosis of gender dysphoria depends on how we conceptualize gender in a sociological sense. You can read a blog post about her paper here.
In the final article of the special issue, “The Quantitative Problem for Theories of Dysfunction and Disease” Thomas Schramme addresses the issues of medicalization from a more general and conceptual angle. His focus is on the problem of how to draw a line between “functional” and “dysfunctional” traits. Schramme argues that this quantitative problem can be based on biological facts about goal-effectivity and does not require making value-laden judgments.
Thus conceived, biological dysfunction is a necessary condition for a state or process to be a disease. Yet, it is not sufficient, as Schramme shows by introducing a distinction between biological and clinical dysfunction. While the identification of clinical dysfunction calls for evaluative and pragmatic considerations, the fact that it is based on empirical questions about biological functions helps to avoid over-medicalization, Schramme argues.