Theoretical Medicine and Bioethics

, Volume 38, Issue 1, pp 15–40 | Cite as

An integral approach to health science and healthcare

  • Patrick DalyEmail author


Defining disease and delineating its boundaries is a contested area in contemporary philosophy of medicine. The leading naturalistic theory faces a new round of difficulties related to defining a normal environment alongside normal organismic functioning and to delineating a discrete boundary between risk factors and disease. Normative theories face ongoing and seemingly intractable difficulties related to value pluralism and the problematic relation between theory and practice. In this article, I argue for an integral—as opposed to a hybrid—philosophy of health based on Bernard Lonergan’s notion of generalized empirical method that provides a way to settle these difficulties dynamically and comprehensively, both in theory, by orienting functional and statistical investigation toward an explanatory ecological viewpoint, and in practice, by framing critiques in relation to the normativity intrinsic to all human inquiry.


Philosophy of health Inquiry Generalized empirical method Schemes of recurrence Functional investigation Statistical investigation 



The author wishes to thank Wendy Rogers and Mary Walker for their detailed and helpful comments on earlier versions of this article. He is also grateful for improvements suggested by Daniel Kim, as well as an editor and an anonymous reviewer of this journal.

Compliance with ethical standards

Conflict of interest

Patrick Daly declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Kingma, E. 2010. Paracetamol, poison, and polio: Why Boorse’s account of function fails to distinguish health and disease. British Journal for the Philosophy of Science 61: 241–264.CrossRefGoogle Scholar
  2. 2.
    Kingma, E. 2016. Situation-specific disease and dispositional function. British Journal for the Philosophy of Science 67: 391–404.CrossRefGoogle Scholar
  3. 3.
    Giroux, E. 2015. Epidemiology and the bio-statistical theory of disease: A challenging perspective. Theoretical Medicine and Bioethics 36: 175–195.CrossRefGoogle Scholar
  4. 4.
    Borges, J.L. 1962. Ficciones. New York: Grove Press Inc.Google Scholar
  5. 5.
    Sisti, D., and A.L. Caplan. 2017. The concept of disease. In The Routledge companion to philosophy of medicine, ed. M. Solomon, J.R. Simon, and H. Kincaid, 5–15. London: Routledge.Google Scholar
  6. 6.
    Lonergan, B. 1992 [1957]. Insight. Vol. 3 of Collected works of Bernard Lonergan. ed. R.M. Doran and F.E. Crowe. Toronto: University of Toronto Press.Google Scholar
  7. 7.
    Lonergan, B. 2003 [1972]. Method in theology. Toronto: University of Toronto Press.Google Scholar
  8. 8.
    Hume, D. 1939 [1748]. An enquiry concerning human understanding. In The English philosophers from Bacon to Mill, ed. E.A. Burtt, 585–689. New York: The Modern Library.Google Scholar
  9. 9.
    Morelli, M.D. 2015. Self-possession: Being at home in conscious performance. Chestnut Hill, MA: Lonergan Institute, Boston College.Google Scholar
  10. 10.
    Lonergan, B. 1985. A third collection. New York: Paulist Press.Google Scholar
  11. 11.
    Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44: 542–573.CrossRefGoogle Scholar
  12. 12.
    Boorse, C. 1997. A rebuttal on health. In What is disease? ed. J.M. Humber and R.F. Almeder, 1–134. Totowa, NJ: Humana Press.CrossRefGoogle Scholar
  13. 13.
    Boorse, C. 2014. A second rebuttal on health. The Journal of Medicine and Philosophy 39: 683–724.CrossRefGoogle Scholar
  14. 14.
    Daly, P. 2017. Functional and statistical investigation in the theory of health. Manuscript submitted for publication.Google Scholar
  15. 15.
    Venkatapuram, S. 2011. Health justice. Cambridge: Polity Press.Google Scholar
  16. 16.
    Venkatapuram, S. 2016. On health justice: Some thoughts and responses to critics. Bioethics 30: 49–55.CrossRefGoogle Scholar
  17. 17.
    Lonergan, B. 1988. Cognitional structure. In Collection, vol. 4 of Collected works of Bernard Lonergan, ed. F.E. Crowe and R.M. Doran, 205–221. Toronto: University of Toronto Press.Google Scholar
  18. 18.
    Temkin, O. 1973. Health and disease. In Dictionary of the history of ideas, ed. P. Weiner, 396–407. New York: Scribner’s.Google Scholar
  19. 19.
    Daly, P. 2009. A theory of health science and the healing arts based on the philosophy of Bernard Lonergan. Theoretical Medicine and Bioethics 30: 147–160.CrossRefGoogle Scholar
  20. 20.
    Lonergan, B. 2001. Phenomenology and logic: The Boston College lectures on mathematical logic and existentialism. Vol. 18 of Collected works of Bernard Lonergan. Ed. P.J. McShane. Toronto: University of Toronto Press.Google Scholar
  21. 21.
    Fleck, L. 1979. Genesis and development of a scientific fact. Trans. T.J. Trenn and R.K. Merton. Chicago: University of Chicago Press.Google Scholar
  22. 22.
    Hausman, D.M. 2011. Is an overdose of paracetamol bad for one’s health? British Journal for the Philosophy of Science 62: 657–668.CrossRefGoogle Scholar
  23. 23.
    Hausman, D.M. 2012. Health, naturalism, and functional efficiency. Philosophy of Science 79: 519–541.CrossRefGoogle Scholar
  24. 24.
    Giroux, E., and M. Lemoine. 2016. Is Boorse’s biostatistical theory of health naturalistic? In Naturalism in philosophy of health: Issues and implications, ed. E. Giroux. Dordrecht: Springer.CrossRefGoogle Scholar
  25. 25.
    Wachbroit, W. 1994. Normality as a biological concept. Philosophy of Science 61: 579–591.CrossRefGoogle Scholar
  26. 26.
    Grene, M. 1995. A philosophical testament. Chicago: Open Court.Google Scholar
  27. 27.
    Kosman, L.A. 1987. Animals and other beings in Aristotle. In Philosophical issues in Aristotle’s biology, ed. A. Gotthelf and J.G. Lennox, 360–391. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  28. 28.
    Bates, M. 1960. Evolution and ecology. In Evolution after Darwin, vol. 1, ed. S. Tax, 547–568. Chicago: University of Chicago Press.Google Scholar
  29. 29.
    Boorse, C. 2002. A rebuttal on functions. In Functions: New essays in the philosophy of psychology and biology, ed. A. Ariel, R. Cummins, and M. Perlman, 63–112. Oxford: Oxford University Press.Google Scholar
  30. 30.
    Allen, T.F.H., and T.W. Hoekstra. 1992. Toward a unified ecology. New York: Columbia University Press.Google Scholar
  31. 31.
    Odum, E.P. 1959. Fundamentals of ecology. Philadelphia: W.B. Saunders Company.Google Scholar
  32. 32.
    McShane, P. 1970. Randomness, statistics and emergence. Dublin: Gill and Macmillan Ltd.Google Scholar
  33. 33.
    Kingma, E. 2013. Health and disease: Social constructivism as a combination of naturalism and normativism. In Health, illness and disease, ed. H. Carel and R. Cooper, 37–56. Durham: Acumen.Google Scholar
  34. 34.
    Fins, J. 2016. Review of Miriam Solomon: Making medical knowledge. In Notre Dame Philosophical Reviews. Accessed October 12, 2016.
  35. 35.
    Canguilhem, G. 1991 [1966]. The Normal and the pathological. Trans. C.R. Fawcett and R.S. Cohen. New York: Zone Books.Google Scholar
  36. 36.
    Vickers, A.J., E. Basch, and M.W. Kattan. 2008. Against diagnosis. Annals of Internal Medicine 149: 200–203.CrossRefGoogle Scholar
  37. 37.
    Broadbent, A. 2013. Philosophy of epidemiology. London: Palgrave Macmillan.CrossRefGoogle Scholar
  38. 38.
    SPRINT Research Group, J.T. Wright Jr., J.D. Williamson, et al. 2015. A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine 373: 2103–2116.CrossRefGoogle Scholar
  39. 39.
    James, P.A., S. Oparil, B.L. Carter, et al. 2014. 2014 evidence-based guideline for the management high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Commission (JNC 8). Journal of the American Medical Association 311: 507-520. Erratum in Journal of the American Medical Association 311: 1809.Google Scholar
  40. 40.
    Omran, A.R. 2005. The epidemiologic transition: A theory of the epidemiology of population change (1971). The Milbank Quarterly 83: 731–757.CrossRefGoogle Scholar
  41. 41.
    Lonergan, B. 1998. For a new political economy.Vol. 21 of Collected works of Bernard Lonergan, ed. P. J. McShane. Toronto: University of Toronto Press.Google Scholar
  42. 42.
    Lonergan, B. 1999. Macroeconomic dynamics: An essay in circulation analysis. Vol. 15 of Collected works of Bernard Lonergan, ed. F.G. Lawrence, P.H. Byrne, and C.C. Hefling Jr. Toronto: University of Toronto Press.Google Scholar
  43. 43.
    Yeats, W.B. 1989. The circus animals’ desertion. In W.B. Yeats: The poems, vol. 1 of The collected works of W.B. Yeats, ed. R.J. Finneran, 346–348. New York: Macmillan Publishing Company.Google Scholar
  44. 44.
    Sulmasy, D.P. 2007. A biopsychosocial-spiritual model of health care. In The rebirth of the clinic, 121-146. Washington, DC: Georgetown University Press.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Lonergan InstituteBoston CollegeChestnut HillUSA

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