In contrast to the “normativist” view, “naturalist” theorists claim that the concept of health refers to natural or normal states and propose different characterizations of healthy and diseased conditions that are meant to be objectivist and biologically grounded. In this article, we examine the core concept of these naturalist accounts of disease, i.e., the concept of biological malfunction, and develop a new formulation of the notion of malfunction following the recent organizational approach to functions in the philosophy of biology. We focus on the notions of adaptive regulation and functional presupposition to develop a new conceptual framework that justifies the ascription of malfunctional behaviors to biological systems according to the embodied normativity of biological organizations.
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According to Canguilhem, organisms are healthy insofar as they are normative with respect to environmental fluctuations. Therefore, health implies the organismic capacity to tolerate variations within what is typical for a given organism, as well as the living system's ability to adapt and establish new behavioral patterns in order to meet changing demands [2, p. 132]. Canguilhem's approach provides an eco-organismic strategy to contextualize a naturalistic account of health and disease (see ). The formulation of organizational malfunction we develop in this article can be seen as a contribution to this naturalistic project.
Although there are some exceptions (see, for instance, [7, 8]), there is a general assumption that the notion of function is a normative one, since it refers to some effect that is supposed to take place [9, pp. 12–15; 10, p. 144]. As Peter McLaughlin [11, 12] points out, functions show a particular type of relation between certain means and goals in a system, namely, one that goes beyond the standard concept of causality and has a normative flavor: in order for some systemic goals to happen, some effects need to occur, effects to which we refer as “functions.” The attribution of functions consequently implies the postulation of a specific type of effect with respect to the functional traits. This type-token relation is what allows us to evaluate a system’s activity in normative terms. For example, saying that the heart’s function is to pump blood is equivalent to affirming that tokens of the type “heart” should pump blood. In the event it fails to do so, the heart would not be working properly, i.e., it would be functioning “wrongly” according to a norm ascribed to tokens of the type “heart.”
There are also some “hybrid” approaches that combine different aspects of these two perspectives [22–24]. These approaches claim that both biological and value-laden factors play important roles in the conceptualization of health and disease. In this article, we shall explore the scope and limitations of the naturalist-objectivist project, and since these hybrid approaches defend the necessity of including external values, we shall consider them as “non-naturalist” views, and therefore, we will not focus our analysis on them. The philosophical debate between normativist and naturalist approaches is described in [1, 13, 20].
More recently, Hausman , Schroeder , and Garson and Piccinini  have defended new versions of the BST that emphasize the comparative aspect of this approach. These new theories are presented as improvements of Boorse’s account, and although they can solve some of the problems of his theory, they do not provide a satisfactory solution for the “line-drawing problem,” insofar as they are still based on a bio-statistical characterization of “normal function.”
This new approach has been introduced as an improvement and an integration of the well-known “etiological” and “systemic-dispositional” approaches [37, pp. 816–821]. For a critical survey of these two mainstream perspectives and a review of the current state of the debate on functions in the philosophy of biology, see .
Regulation, therefore, requires a fundamental distinction within the system of two different operational levels, such that a subsystem (the regulatory subsystem) functionally modulates the low-level (i.e., basic or constitutive) functions, which, in turn, constrain the underlying processes constituting the system. All these adaptive changes are themselves ultimately functional, in the sense that these changes are biological traits' effects that satisfy the organizational definition of function. In their work, Alvaro Moreno and Matteo Mossio  have argued that the specificity of regulatory functions is that they are second-order functions. In this article, we do not focus on this specificity.
Though it is reasonable to think that prebiotic systems could have maintained stability against perturbations (to a certain degree) through mere feedback mechanisms, when these systems increased their functional complexity, only an operationally differentiated subsystem (i.e., adaptive regulation) could ensure stability against perturbations.
It is worth noting that there are important similarities between our conception of “functional presupposition” and the conception of this idea proposed in  and . According to these authors, functional presupposition is a structural property that allows us to conclude the existence of a concrete system's part or trait and its function by considering the whole set of the rest of parts or traits. Our interpretation of functional presupposition, by considering the functional behavior of the whole system and its parts, allows us to postulate a range of functioning of a trait that is determined by the regulatory system. Thus, by considering the structure and dynamics of a system's component, it is possible to postulate the “necessary” existence of a functional trait, the range in which the function of that trait has to be performed, and accordingly, certain aspects of its structure.
Significantly, it would be interesting to explore, in future developments of the organizational approach, the extent to which this "human value free" normative perspective can be adopted in fields other than medicine. For instance, this account could be useful for a theoretical account of the notions of health and disease in plants and (non-human) animals, and even to deal with key notions in the study of ecological and social systems, such as “sustainability,” “resilience,” or even “norm.”
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The authors would like to thank Alba Amilburu, Elodie Giroux, María Gonzalez-Moreno, Juan Carlos Hernández, Maël Lemoine, Matteo Mossio, David Teira, and an audience at the 5th Philosophy of Medicine Roundtable conference for helpful discussion of this material; and Susana Monsó, Daniel Kim, and two referees for this journal for detailed comments on earlier versions of the article. The work was funded by grants from the Basque Government (IT 590-13), the Spanish Ministry of Economía y Competitividad (FFI2011-25665), the Spanish Ministry of Industria y Innovación (BFU2012-39816-C02-02), and the Universidad Nacional de Educación a Distancia (PROY-2013-029-UNED).
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Saborido, C., Moreno, A. Biological pathology from an organizational perspective. Theor Med Bioeth 36, 83–95 (2015). https://doi.org/10.1007/s11017-015-9318-8
- Biological organization