Abstract

The dissertation addresses the possibilities that health and disease can be defined in some universal and rational manner, thereby enabling medicine and related sciences to be rationally based, based upon such a definition, there are rights to health and to health care, and there is a definite relationship of paternalistic interferences to these rights. ;Representative types of definitions are examined to determine deficiencies and to develop new conceptions. New definitions must reduce vagueness, clarify ambiguity, and remove arbitrary and relative qualities. New qualities must be necessary, universal, and clear, and the definitions must contain descriptive, evaluative, and performative elements. Several historical legacies assist in devising such definitions: the explanation in terms of supernatural and natural origins; the early Greek distinction between health promotion/disease prevention and cure; the distinction between disease as ontological entity and disease as physiological process; the role of descriptive/prescriptive judgments; and the relationship between health and disease. Four positions concerning descriptive/ prescriptive judgments are critically examined including descriptivism, strong prescriptivism, weak prescriptivism, and universal prescriptivism. ;Health is defined in terms of rational autonomy and its necessary, generic features, and disease is defined in terms of health and scientific correlations between mental and physical phenomena and pain. The relationship between rational autonomy and purposive action is presented. The generic features, freedom and intentionality, generate certain universally and logically necessary prescriptions for all agents. Departures from health form a hierarchy determined by their relation to generic features. Two species of health care are distinguished--medical/curative care and health promotion/disease prevention. Rights to health and corresponding rights to a basic minimum level of health care are formulated. The proper function of critiques of medicine is shown, the proper role of medicine is established, and a method to critique a good health care system is proposed. ;Paternalism is defined and applied in relation to autonomy, and three categories of paternalistic interferences are distinguished--justified, unjustified, and justifiable. Finally, a method is proposed to evaluate the physician/patient contract and a right to informed consent is justified