Emmanuel Smith

In their article ’Is Pregnancy a Disease? A Normative Approach’, Anna Smajdor and Joona Räsänen contend that, on several of the most prominent accounts of disease, pregnancy should be considered a disease. More specifically, of the five accounts they discuss, each renders pregnancy a disease or suffers serious conceptual problems otherwise. They take issue specifically with the dysfunction account of disease and argue that it suffers several theoretical difficulties. In this response, we focus on defending the dysfunction account against their main objections and show why a version of the dysfunction account is viable on account of the indispensability of normativity in biology and medicine. After disarming their main objections to the dysfunction account, we briefly respond to their treatment of the normality of pregnancy and then draw a distinction between adverse symptoms and underlying causes to show why even though pregnancy may have ’disease-like’ features, it is not a disease.

I argue that a general feature of human psychology provides strong reason to modify or reject anti-reductionism about the epistemology of testimony. Because of the work of what I call “the background” (which is a collection of all of an individual's synthetizations, summarizations, memories of experiences, beliefs, etc.) we cannot help but form testimonial beliefs on the basis of a testifier's say so along with additional evidence, concepts, beliefs, and so on. Given that we arrive at testimonial beliefs through the work of the background, to be justified in holding a testimonial belief, we must not only have a rational speaker's say so, but we must also form such beliefs in a right way. If this is right, then, contrary to typical anti-reductionism, justified testimonial beliefs require more than just a trustworthy testifier's say so – another requirement is that they are formed in a right way.

I argue that, if doxastic involuntarism is true, then we should reconceive what are traditionally called reasons for belief. The truth of doxastic involuntarism would rule out a certain understanding of reasons for belief according to which they are reasons to form, alter, or relinquish beliefs. Thus, reconceiving reasons for belief would require reconceiving doxastic obligations. I argue that, in fact, a reconception of reasons for belief warrants abandoning the notion of doxastic obligations, understood as obligations to perform acts of belief formation, alteration, or relinquishment. Instead, the only sorts of obligations we would have that concern our doxastic states would be aretaic or practical.

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one’s concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield’s hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield’s account and suggest how they might be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual’s authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield’s original account faces.