Health Care Analysis

, Volume 20, Issue 1, pp 66–83 | Cite as

Health and Morality: Two Conceptually Distinct Categories?

  • Per-Anders TenglandEmail author
Original Article


When seeing immoral actions, criminal or not, we sometimes deem the people who perform them unhealthy. This is especially so if the actions are of a serious nature, e.g. involving murder, assault, or rape. We turn our moral evaluation into an evaluation about health and illness. This tendency is partly supported by some diagnoses found in the DMS-IV, such as Antisocial personality disorder, and the ICD-10, such as Dissocial personality disorder. The aim of the paper is to answer the question: How analytically sound is the inclusion of morality into a theory of health? The holistic theory of Lennart Nordenfelt is used as a starting point, and it is used as an example of a theory where morality and health are conceptually distinct categories. Several versions of a pluralistic holistic theory are then discussed in order to see if, and if so, how, morality can be conceptually related to health. It is concluded that moral abilities (and dispositions) can be seen as being part of the individual’s health. It is harder to incorporate moral virtues and moral actions into such a theory. However, if immoral actions “cluster” in an individual, and are of a severe kind, causing serious harm to other people, it is more likely that the person, for those reasons only, be deemed unhealthy.


Holistic theory Immoral actions Moral abilities Theory of health Virtues 



I would like to thank Bengt Brülde, Lennart Nordenfelt, Katarina Graah-Hagelbäck, and the two anonymous reviewers for valuable comments on earlier versions to this paper.


  1. 1.
    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). Washington: American Psychiatric Association.Google Scholar
  2. 2.
    Boorse, C. (1977). Health as a theoretical concept. Philosophy of Science, 44, 542–573.CrossRefGoogle Scholar
  3. 3.
    Brülde, B. (1998). Vad är hälsa? Några reflektioner kring hälsobegreppet. [What is health? Some reflections about the concept of health]. Göteborg: Filosofiska Institutionen.Google Scholar
  4. 4.
    Brülde, B. (2003). The concept of mental disorder. Philosophical Communications, Web Series, No. 29. Dept. of Philosophy, Gothenburg University.Google Scholar
  5. 5.
    Brülde, B. (2007). Happiness theories of the good life. Journal of Happiness Studies, 8(1), 15–49.CrossRefGoogle Scholar
  6. 6.
    Brülde, B. (2010). On defining “mental disorder”: Purposes and conditions of adequacy. Theoretical Medicine and Bioethics, 31, 19–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Brülde, B., & Tengland, P.-A. (2003). Hälsa och sjukdom: En begreppslig utredning [Health and illness: A conceptual investigation]. Lund: Studentlitteratur.Google Scholar
  8. 8.
    Fulford, K. W. M. (1989). Moral theory and medical practice. Cambridge: Cambridge University Press.Google Scholar
  9. 9.
    Gilligan, C. (1982). In a different voice. Cambridge: Harvard UP.Google Scholar
  10. 10.
    Heberlein, A. (2010). En liten bok om ondska [A short book on evil]. Stockholm: Bonniers.Google Scholar
  11. 11.
    Kohlberg, L. (1981). Essays on moral development, vol. I: The philosophy of moral development. San Francisco, CA: Harper and Row.Google Scholar
  12. 12.
    Martin, M. (2006). From morality to mental health: Virtue and vice in a therapeutic culture. Oxford: Oxford University Press.CrossRefGoogle Scholar
  13. 13.
    Nordenfelt, L. (1993). Quality of life, health and happiness. Avebury: Al-dershot.Google Scholar
  14. 14.
    Nordenfelt, L. (1995). On the nature of health: An action-theoretic approach, second revised edition. Dordrecht: Kluwer.Google Scholar
  15. 15.
    Nordenfelt, L. (2001). Health, science, and ordinary language. Amsterdam: Rodopi Press.Google Scholar
  16. 16.
    Nordenfelt, L. (2003). Action theory, disability and ICF. Disability and Rehabilitation, 25(18), 1075–1079.PubMedCrossRefGoogle Scholar
  17. 17.
    Nordenfelt, L. (2007). Rationality and compulsion: Applying action theory to psychiatry. Oxford: Oxford University Press.Google Scholar
  18. 18.
    Parfit, D. (1984). Reasons and persons. Oxford: Clarendon press.Google Scholar
  19. 19.
    Plato. (1922). Staten [The republic]. Stockholm: Hugo Gebers förlag.Google Scholar
  20. 20.
    Pörn, I. (1993). Health and adaptedness. Theoretical Medicine, 14, 295–303.PubMedCrossRefGoogle Scholar
  21. 21.
    Rachels, J. (2007). The elements of moral philosophy (5th ed. by Stewart Rachels). New York: McGraw-Hill.Google Scholar
  22. 22.
    Seedhouse, D. (2001). Health. Chichester: Wiley.Google Scholar
  23. 23.
    Sen, A. (1993). Capability and well-being. In M. Nussbaum & A. Sen (Eds.), The quality of life. Oxford: Oxford University Press.Google Scholar
  24. 24.
    Sumner, L. W. (1996). Welfare, happiness, and ethics. Oxford: Clarendon press.Google Scholar
  25. 25.
    Tengland, P.-A. (2001). Mental health: A philosophical analysis. Dordrecht: Kluwer Academic Publishers.Google Scholar
  26. 26.
    Tengland, P.-A. (2007). A two-dimensional theory of health. Theoretical Medicine and Bioethics, 28, 257–284.PubMedCrossRefGoogle Scholar
  27. 27.
    Whitbeck, C. (1981). A theory of health. In A. L. Caplan, T. H. Engelhardt, & J. J. McCartney Jr. (Eds.), Concepts of health and disease: Interdisciplinary perspectives (pp. 611–626). Reading, MA: Addison-Wesley.Google Scholar
  28. 28.
    WHO. (2007). ICD-10 on line. Accessed 10 Oct 2009 at
  29. 29.
    WHO. (2009). ICF browser. Accessed 23 Sept 2009 at

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Health and SocietyMalmö UniversityMalmöSweden

Personalised recommendations