Boorse’s discussion of the alleged normativity of the “choice of goals” directly relates to the argument I talked about yesterday, the argument about the “perspective of the gene” (DeVito). This is how the objection is formulated by Miller Brown:
“How are we to determine those highest -level goals of organisms which lower-level processes function to acheive? … It may be true that what interests the physiologist is what promotes individual surivial and reproduction. But Boorse’s account was designed to show that the concept of disease is non-normative. At best, what he has shown is that given such a choice of highest-level goals, “function statements will be value-free …” But such “empirical matters” are significant only in terms of the goals chosen. What assurance do we have that these are the goals of tthe system whose “species design” we have determined?” (25)
Boorse answers that
“… his point is clear: The BST makes a normative choice, from a whole class of biological goals, of individual survival and reproduction. My answer, again, is that there is no choice here – that is simplyl what disease is, as the concept is best reconstructed from medical classifications. The real normative choice is medicine’s commitment to combat disease, rather than to promote it, to enrich doctors at any cost, to advance world socialism, preserve planetary ecology or biodiversity, or serve infinitely many other possible goals. Unquestionable medical practice rests on a normative choice to combat disease. But that does not show that the meaning of disease rests on a normative choice unless one assumes that the meaning of “disease” is fixed by medical practices” (25)
What to say about this wonderfully written and striking reply?
Boorse is reminding us that he is concerned primarily with conceptual analysis, not normative theory. More precisely, his goal is to provide the best conceptual analysis of pathology (not doctors!) considered usage. All that’s claimed is that pathology’s considered usage best fits with the analysis “disease = abnormal deviation in the efficiency of a causal contributor (function) to the two goals of reproduction and survival”. The normative choice is made by doctors, when they choose to combat what in their pathology texts figures as “pathology” (that is abnormal deviations in the efficiency of a causal contributor to the goals of reproduction and survival). Notice that Boorse is not claiming that the choice of the dual goals of reproduction and survival is read off the facts of nature (in the usual sense). Rather, he is claiming that it is “read off” facts about considered usage of language by a specific category of people. The choice of the two goals results from conceptual analysis, not from natural necessity.
As far as Boorse goes, this rebutall of the problem of the normativity of the choice of functions might be Ok. But we are actually interested in how Daniels employs Boorse, for the sake of clarifying the content of a normative claim. We are interested in Daniels’s normative position, and we turn to Boorse because Daniels accepts Boorse’s analysis of health.
To see if the choice of the two goals of physiology matters we must turn to Daniels’ argument concerning the political importance of health – or better, about the political importance of health-as-seen-by-pathology-as-seen-by-Boorse. We must turn our attention to the claim that society ought to restore “standard causal contribution to the two goals of reproduction and survival”, which is the real content of Daniels’ claim, obtained by substituting the term “pathology” with its Boorsian analysis.
To evaluate this, we must read Daniels’s justification of the moral and political importance of health care just as a thesis about the moral and political importance of restoring species typical contributions to the two goals of reproduction and survival. If we do this, I bet, Daniels’ arguments become less persuasive.
Daniels’s master argument concerns the relation between health and equality of opportunity. If stated as a thesis about the relation between standard causal contributions to the dual goals of reproduction and survival and equality of opportunity, it loses some of its original intuitive appeal. If our target is fair opportunities, what’s so special about the deviations from this biological standard? Isn’t the standard too biological? The correlation between this standard and opportunities is at best indirect. From the point of view of strenght of correlation, Daniels should have not focused on “pathologist’s disease” (deviation from species -typical ability with respect to reproduction and survival) but on “economists’ disease” : “extreme deviation from the species-typical norm with respect to all-purpose abilities to achieve primary goods”.
The moral of the story is, I think, that the choice of the pathologist’s standard is based on another sort of considerations: epistemic considerations (a point stressed in the discussion by Roberto). The only reason which justifies the choice of the “overall goals” characteristic of physiology (reproduction and survival, if Boorse is right) is that physiology is in better shape than economics (or cultural anthropology) as a science, and therefore less controversial.
So the real argument in favor of disease as an indicator of missing opportunities, as opposed to subnormal capacity to achieve primary goods, is the (alleged) more controversial status of human claims about who is abnormal with respect to the anthropological/economic capacity to achieve primary goods. [Marx?]
How good is this argument? I think it is quite bad for two reasons: 1) mental functions: it is not easier to establish how mental function contribute to the species-typical goals of reproduction and survival than how mental functions contribute to the ability to acquire primary goods; 2) the fact of agreement: if there is a consensus on the moral importance of disease, it does not regard what Boorse calls the “theoretical” concept of pathology, but the more practical notion of illness or clinical pathology that, as Boorse concedes, is heavily value-laden.