Revising the BST in the light of political values/ goals.
1. the concept of function
Boorse has claimed that the function of a structure or process can be analyzed as the causal contribution of that structure or process to some goal-controlled mechanism (Boorse 1976). Which goal-controlled mechanism? According to Boorse, the answer to this question is fixed by the context of inquiry. Boorse claims that in the context of human physiology, the relevant goal-controlled mechanisms is the individual organisms.
According to Boorse’s theory, once the context of phisiology is chosen, other causal contributions, (causal relations between a human structure or process and some other goal-controlled mechanisms in the environment) are legitimately considered irrelevant. By focusing on the individual organism physiologists discover that its overall functional organization is governed by the two overarching goals of reproduction and survival (Boorse 1976, 84).
2. functional analysis as potentially politically controversial
The problem with the concept of function is that, even if some authors claim that it can be analyzed in a value-free manner, it is not to be expected that rational individuals will ever agree on such matters, and this agreement is perhaps not even necessary for defining a political notion of pathology, as we try to show. Worse yet, even granting that biological functions can be analyzed in value-free terms, there is never going to be any agreement on which value-free analysis in particular is most correct. Again, this agreemnt is neither to be expected nor is it necessary for political agreement, as it will be shown.
3. construction of a politically justiable notion of function
3.1. our starting points
Having recognized that the alleged naturalistic analysis of function is controversial, we now attempt to ground the choice of a type of functional analysis in liberal political values. We will appeal to the idea of a citizens as free and equal and normal cooperating citizens for the course of their life, characterized by two moral powers: the power to act out of a conception of justice and the power to pursue his own conception of the good.
We hope that we will be able to justify a distinctive type of functional analysis relying solely upon the political idea of citizens. We also hope that the resulting definition of disease can become the focus of an overlapping consensus among different theories of illness and disease, belonging to the public tradition of liberal democracies. To verify this conjecture, we will have to turn to philosophy of biology, philosophy of medicine, but especially medical ethics.
3.2 finding out what political goals we have
We therefore claim that a human organism can be analyzed functionally on the basis of goals derived from those substantive political notions and values which ground liberal and democratic political agreement (in a Rawlsian interpretation thereof).
Following Boorse, we analyze the normal function of a part or process as its statistically typical contribution to some goals, within an appropriately chosen reference class. In opposition to Boorse, we do not consider these goals as given by nature, but as implicit in the political characterization of the powers of individual human beings qua citizens.
We must identify the goals of all the parts of an organism about which we want to be able to say a) that they have a function and b) that they are behaving pathologically (or equivalently, c) that an organism suffers a dysfunction as a result of them). Thus goals can be identified, at the highest level of abstraction, with the goals whose achievement underlies the realization a citizen’s moral powers . Which goals are we speaking about?
In order to answer this question, we must recognize, first of all, that biology cannot provide the answer we seek if at this level of abstraction. Hence we must still address this question at the level of (the anthropology of) political theory.
In Political Liberalism, John Rawls argues that certain goods are things citizens needs as free and equal persons. On the basis of our knowledge of how human socieites work, we may identify those goods with the following, finite list of institutional goods: certain basic rights and liberlities, given by a list, freedom of movement and occupation against a background of diverse opportunities, powers and prerogatives of offices and positions of responsibility in the political and economic institutions of the basic structure, income and wealth, and finally the social bases of self respect. These are called by Rawls “primary goods”.
Where does this bring us? If we use the label “level-1-goal” for the material and psychological preconditions of the realization of the moral powers, we may define “level-2-goals” as those fine-grained goals whose achievement by parts of the organism underlies the ability to take advantage of the above goods (primary goods).
One problem with this definition is that the ability to take advantage of primary goods comes in degrees. Moreover, the degree to which people take advantage of such goods depends on their freely made choices. Hence the problem of defining an adequate standard of exploitation of such goods.
The problem can be side-stepped, partially, by first of all observing that there are certain level-2-goals which must be achieved necessarily if the individual is to take advantage of primary goods to any meaningful degree, in that society. An individual whose parts do not perform the causal contributions needed to keep him breathing, for instance, is not able to take advantage of primary goods to any meaningful degree, since he will soon fall dead if unaided. We will call those level-2-goals the “vital goals” of a citizen’s organism. Notice that vital goals are, by definition, society relative.
But the vital goals of a citizens’s organism of are not all the goals which must be considered in order to evaluate citizen’s health. Even in a just society people end up occupying different social positions and different social positions are attached to different degrees of access to primary goods. This means that an organism allowing the minimal meaningful exploitation of social primary goods might still result inadequate in relation to the requirements and opportunities characteristic of higher social positions. Hence we must find some way for specifying those (level-2-goals) in relation to which the health of citizens (qua citizens) will be evaluated.
The most reasonable strategy for producing this list is to consider all those goals which are to be achieved (by parts of the organisms) in order for an individual to be able, in that society, to take advantage of any primary good to the highest possible conceivable degree. We will call these the citizen organism’s “competitive goals”.
Consider, for instance, contemporary European society. It is hardly controversial that abilities such as reading, understanding complex texts, and being able to perform accurate mathematical operation are required to be able to take advantage of society’s primary good’s to the highest imaginable degree. Even an athlete, in this society, would profit from the ability to read and from a superior grasp of complex arguments and maths (think for example of the advantage those abilities bring when making saving or investment decisions). Hence, the competitive goals of an European citizen’s organism include all those goals that its parts must perform in order to make someone able to read, understand complex texts, and doing advanced maths.
The conjunction of vital and competitive goals tells us which level-2-goals should be used to produce a functional description of a citizens’s organism. The function of a part or process in a human being will be defined as its statistically typical causal contribution to the vital and competitive goals of the citizen’s organism, within an appropriately chosen reference class (e.g. the human species).
Notice the difference between this approach and Boorse’s approach: while Boorse appeals to biology, directly, the justification for this choice of goals starts with an analysis of their relation to a form of political agreement.
By inserting this definition of function in Boorse’s definition of disease in BST, we produce the political definition of a citizen’s pathology as a deviation from the statistically normal causal contribution of that part or process to a citizen’s vital or competitive goal, within an appropriately chosen reference class (for instance, the human species).
The next post discusses how to choose reference classes.