A Geography of Values in Disease
As Chapters 5 and 6 illustrate, coming to terms with clinical reality is never a purely theoretical endeavor. It is a form of action, which involves diverse modes of intervention and value judgments. In studying the role values play in disease concepts, we are reminded once again that disease is complex. This chapter investigates the ways in which disease reflects what and how we value. Put another way, it investigates the process of valuing, as opposed to the previous chapter’s emphasis on the nature of values. It sets forth a geography of prominent values that frame our understanding of disease.
KeywordsCervical Cancer Chronic Fatigue Syndrome Attention Deficit Hyperactivity Disorder Cervical Intraepithelial Neoplasia Lyme Disease
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- 1.In the nineteenth century (Meinong, 1894), the conception was born that all these questions belong to the same family since they all are concerned with value or what ought to be.Google Scholar
- 2.There are a variety of suggestions regarding how values in disease are to be distinguished. Aronowitz (1998), in particular, does a laudable job diagnosing the force of values in specific disease types (e.g., chronic fatigue syndrome [CFS], ulcerative colitis, Lyme disease, and coronary artery disease). His first case study, CFS, serves as a template for others that are less obviously value-laden. Aronowitz notes six nonbiological values that shape the story of CFS. These are public and professional attitudes and beliefs, professional status, media coverage, ecological relationships, therapeutic and diagnostic practices, and economic conditions. Aronowitz’s case-oriented approach to understanding how values shape disease highlights the varied and concrete nature of the values that frame specific disease classifications. Although this is an approach that has much merit (Erde, 2000, p. 590ff), it underestimates the shared way that humans value. The analysis in this chapter offers such a generalization, which is not meant to contradict a case-study approach. One might note that instrumental values (which tell us how to get from means to ends) are at play in clinicians’ assessments of media’s influence on the development of clinical nosologies and of economic benefits and costs. Alternatively, clinicians’ assessments of the permissible boundaries of therapeutic and diagnostic practices entail judgments about what ideals of activity are proper to an organism. In other words, functional values are at play in disease.Google Scholar
- 3.One benefit is understanding the role disease has played in the evolution of the species (Childs, 1999; Williams and Neese, 1991; Neese and Williams, 1994, 1998 ). One might be familiar with the evolutionary advantages of sickle cell as a prevention against malaria and clinical depression as a way to deal with stressful times. Traits that help organisms to produce children are passed on to future generations.Google Scholar
- 4.The roots of this view may be found in Socrates, and his discussion of the educability of taste.Google Scholar
- 5.The Paps smear is named after Dr. George Papanicolaou, who developed the test in the 1950s.Google Scholar
- 6.Some scientists believe HIV spread from monkeys to humans between 1926 and 1946 and first appears in Africa in the 1930s. Others claims that, in 1959, a man died in the Congo of what we now call AIDS. Others report that gay men in the U.S. and Sweden—and heterosexuals in Tanzania and Haiti—begin showing signs of what we now call AIDS. In And The Band Played On, journalist Randy Shilts designates Gaetan Dugas (at the 1980 San Francisco gay pride parade) as “Patient Zero,” the man whose erotic penchants and compulsion put him causally at ground zero of the American AIDS epidemic ( 1987, p. 11 ).Google Scholar
- 7.Ethics is the study of morality, i.e., standards or judgments concerning right or wrong, and good and bad, conduct or behavior. The word is commonly used interchangeable with “morality” to mean the subject matter of this study; sometimes it is used more narrowly to mean the moral principles of a particular tradition, group, or individual. The term “ethical” is from the Gr. dhiké (techne7,ethical or art. “Moral” is from the L. moralis,moral, pertaining to manner, from mos,manner.Google Scholar
- 8.Larry McCullough and I developed this analysis in Biological Sciences Curriculum Study (1992).Google Scholar
- 9.This discussion of moral considerations in terms of consequences shares important features with our discussion of non-moral considerations in terms of instrumental values. In particular, both appeal to outcomes or results. Insofar as consequential considerations are tied to voluntary decision-making, they are moral ones. Insofar as they may be distinguished from voluntary choice, they are nonmoral.Google Scholar
- 10.There are exceptions. William Bennett’s The Book of Virtues (1993) received great acclaim at the end of the twentieth century. In addition, numerous school systems have moved to adopt codes of virtue in light of the growing incidence of school violence.Google Scholar
- 11.A parallel here is drug abuse (Biological Sciences Curriculum Study, 2001), which in the nineteenth and early twentieth centuries was understood through a moral character model.Google Scholar