Medicalization, values and patient participation

Abstract

The question whether and how to define something as a disease has been contentious in practice. In the thesis, I argue that when deciding whether and how to define something as a disease, values must be relied upon. Against the value-free ideal of science, I use the argument from inductive risk to show that medicalization is inevitably value-laden. Instead of worrying about any value influence in medicalization, I propose that values interfere with medicine’s epistemic and ethical goals only when they are held dogmatically and/or contradict medicine’s ethical goals. To mitigate such pernicious influence of values, values should be managed through a negotiation between diverse actors. This includes sometimes patients who as outsiders are particularly well positioned to challenge values within medicine. In this way we improve the chances that disease definitions are epistemically and ethically acceptable. These are disease definitions that support medicine’s epistemic and ethical goals.