The harm of medical disorder as harm in the damage sense
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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.
KeywordsDisorder Disease Harm Systematic harm Dispositions Philosophy of psychiatry Philosophy of medicine Philosophy of biology Philosophy of science
For helpful feedback on earlier versions of this paper, I am very grateful to James Delany, Neil Feit, David Hershenov, Robert Kelly, Steven Kershnar, Danielle Z. Limbaugh, Kathryn E. Limbaugh, Sean Marzolf, Travis Timmerman, Neil E. Williams, and the fellows at the Romanell Center for Clinical Ethics and the Philosophy of Medicine. A special thanks to the anonymous referees at this journal for their helpful and thorough comments.
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