Theoretical Medicine and Bioethics

, Volume 36, Issue 1, pp 61–81 | Cite as

Health, homeostasis, and the situation-specificity of normality



Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation-specificity of many normal functions (e.g., digestion) or cannot account for many situation-specific diseases (e.g., mountain sickness). In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation-specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation-specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health.


Health Normal function Homeostasis Self-regulation Christopher Boorse Elselijn Kingma 



The authors would like to thank Matteo Mossio, Ghyslain Bolduc, two anonymous referees, and the attendees at the 2013 Philosophy of Medicine Roundtable, the 2014 Philosophy of Biology Consortium, and the SymposiumControverses et renversements conceptuels dans les sciences du vivant for helpful comments on previous versions of this article. The authors also thank O’Neal Buchanan and Daniel Kim for kindly editing their written English. The research for this article was partly supported by grants from the Fonds de la recherche du Québec—Société et Culture (FRQ-SC), the Centre interuniversitaire de recherche sur la science et la technologie (CIRST), and the Groupe de recherche sur la normativité (GRIN).


  1. 1.
    Boorse, Christopher. 1997. A rebuttal on health. In What is disease? ed. James M. Humber and Robert F. Almeder, 1–134. Totowa, NJ: Humana Press.CrossRefGoogle Scholar
  2. 2.
    Boorse, Christopher. 1977. Health as a theoretical concept. Philosophy of Science 44: 542–573.CrossRefGoogle Scholar
  3. 3.
    Kingma, Elselijn. 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
  4. 4.
    Hausman, Daniel M. 2011. Is an overdose of Paracetamol bad for one’s health? British Journal for the Philosophy of Science 62: 657–668.CrossRefGoogle Scholar
  5. 5.
    Hausman, Daniel M. 2012. Health, naturalism, and functional efficiency. Philosophy of Science 79: 519–541.CrossRefGoogle Scholar
  6. 6.
    Schwartz, Peter H. 2007. Defining dysfunction: Natural selection, design, and drawing a line. Philosophy of Science 74: 364–385.CrossRefGoogle Scholar
  7. 7.
    Ananth, Mahesh. 2008. In defense of an evolutionary concept of health: Nature, norms, and human biology. Hampshire: Ashgate Publishing.Google Scholar
  8. 8.
    Giroux, Élodie. 2010. Après Canguilhem: définir la santé et la maladie. Paris: PUF.CrossRefGoogle Scholar
  9. 9.
    van der Steen, Wim J., and P.J. Thung. 1988. Faces of medicine: a philosophical study. Dordrecht: Kluwer.CrossRefGoogle Scholar
  10. 10.
    Boorse, Christopher. 1987. Concepts of health. In Health care ethics: An introduction, ed. Donald VanDeVeer and Tom Regan, 359–393. Philadelphia: Temple University Press.Google Scholar
  11. 11.
    Garson, J., and G. Piccinini. 2013. Functions must be performed at appropriate rates in appropriate situations. The British Journal for the Philosophy of Science 65: 1–20.CrossRefGoogle Scholar
  12. 12.
    Wachbroit, Robert. 1994. Normality as a biological concept. Philosophy of Science 61: 579–591.CrossRefGoogle Scholar
  13. 13.
    Cartwright, Nancy. 1989. Nature’s capacities and their measurement. Oxford: Clarendon Press.Google Scholar
  14. 14.
    Cartwright, Nancy. 1999. The dappled world: a study of the boundaries of science. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  15. 15.
    Kingma, Elselijn. 2007. What is it to be healthy? Analysis 67: 128–133.CrossRefGoogle Scholar
  16. 16.
    Cooper, Rachel. 2002. Disease. Studies in History and Philosophy of Biological and Biomedical Sciences 33: 263–282.CrossRefGoogle Scholar
  17. 17.
    Ereshefsky, Marc. 2009. Defining “health” and “disease.” Studies in History and Philosophy of Biological and Biomedical Sciences 40: 221–227.CrossRefGoogle Scholar
  18. 18.
    Cannon, Walter B. 1929. Organization for physiological homeostasis. Physiological Reviews 9: 399–431.Google Scholar
  19. 19.
    Cannon, Walter B. 1926. Physiological regulation of normal states: Some tentative postulates concerning biological homeostasis. In A Charles Richet: Ses amis, ses collègues, ses élèves, ed. Auguste Rettit, 91–93. Paris: Imprimerie des éditions médicales.Google Scholar
  20. 20.
    Bernard, Claude. 1927. An introduction to the study of experimental medicine. Trans. Henry C. Green. New York: Macmillan.Google Scholar
  21. 21.
    Bernard, Claude. 1879. Leçons sur les phénomènes de la vie communs aux animaux et aux végétaux. Paris: Baillière.CrossRefGoogle Scholar
  22. 22.
    Cooper, Steven J. 2008. From Claude Bernard to Walter Cannon: Emergence of the concept of homeostasis. Appetite 51: 419–427.CrossRefGoogle Scholar
  23. 23.
    Mossio, Matteo, and Leonardo Bich. 2014. La circularité biologique: Concepts et modèles. In Modéliser & simuler. Épistémologies et pratiques de la modélisation et de la simulation, Tome 2, ed. Franck Varenne, Marc Silberstein, Philippe Huneman, and Sébastien Dutreuil, 137–170. Paris: Éditions Matériologiques.Google Scholar
  24. 24.
    Woods, Stephen C., and Douglas S. Ramsay. 2007. Homeostasis: Beyond Curt Richter. Appetite 49: 388–398.CrossRefGoogle Scholar
  25. 25.
    Bechtel, William. 1985. In defense of a naturalistic concept of health. In Biomedical ethics reviews, ed. James M. Humber, and Robert F. Almeder, 131–170. Clifton: Humana Press.Google Scholar
  26. 26.
    Seidel, Charles L. 2002. Basic concepts in physiology: A student’s survival guide. New York: McGraw Hill.Google Scholar
  27. 27.
    Schaffner, Kenneth F. 1993. Discovery and explanation in biology and medicine. Chicago: University of Chicago Press.Google Scholar
  28. 28.
    Ryle, J.A. 1947. The meaning of normal. Lancet 1: 1–5.CrossRefGoogle Scholar
  29. 29.
    Krohs, Ulrich. 2009. Functions as based on a concept of general design. Synthese 166: 69–89.CrossRefGoogle Scholar
  30. 30.
    Krohs, Ulrich. 2011. Functions and fixed types: Biological and other functions in the post-adaptationist era. Applied Ontology 6: 125–139.Google Scholar
  31. 31.
    McLaughlin, Peter. 2001. What functions explain: Functional explanation and self-reproducing systems. Cambridge: Cambridge University Press.Google Scholar
  32. 32.
    Mossio, Matteo, Cristian Saborido, and Alvaro Moreno. 2009. An organizational account of biological functions. British Journal for the Philosophy of Science 60: 813–841.CrossRefGoogle Scholar
  33. 33.
    Holm, Sune H. 2014. Disease, dysfunction, and synthetic biology. Journal of Medicine and Philosophy 39: 329–345.CrossRefGoogle Scholar
  34. 34.
    Holm, Sune H. 2013. Health as a property of engineered living systems. Bioethics 27: 419–425.CrossRefGoogle Scholar
  35. 35.
    Saborido, C., M. Mossio, and A. Moreno. 2011. Biological organization and cross-generation functions. British Journal for the Philosophy of Science 62: 583–606.CrossRefGoogle Scholar
  36. 36.
    Gould, S. J., and R. C. Lewontin. 1979. The Spandrels of San Marco and the Panglossian paradigm: A critique of the adaptationist programme. Proceedings of the Royal Society of London. Series B. Biological Sciences 205:581–598.Google Scholar
  37. 37.
    Widmaier, Eric P., Hershel Raff, and Kevin T. Strang. 2008. Vander’s human physiology: The mechanisms of body function, 11th ed. Boston: McGraw-Hill.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Antoine C. Dussault
    • 1
  • Anne-Marie Gagné-Julien
    • 2
  1. 1.Département de PhilosophieUniversité de MontréalMontrealCanada
  2. 2.Département de philosophieUniversité du Québec à MontréalMontréalCanada

Personalised recommendations