As a philosophy student, I came to understand that definitions are important. . All arguments depend on foundational propositions, and often those propositions are based on definitions and axioms. No wonder Socrates said, “The beginning of wisdom is the definition of terms.”
Philosophers and ethicists have historically grounded their arguments and treaties in solid definitions. Probably the best known of these were the Scholastic thinkers, who took the need for clear and precise definitions to a whole new level. While it is impractical to argue in that fashion, we need to take a lesson from the ancients and look at the foundational definitions that make up our moral and political discourse. No place needs this more than our current health-care reform debate.
It is strange that with so much discussion about health-care reform, we have heard so little about the definition of “health.” If the state is under a moral obligation to ensure that its citizens have a minimum level of health-care access, it assumes that the state or electorate is functioning with a basic definition of “health.” One of our problems in the current debate is that we are using multiple definitions.
The simplest definition of “health” is the absence of disease. While this makes for a quick definition, it creates problems for modern policymakers, who must then take up the challenge of ensuring the elimination of all disease. Attempting to control different ailments from arthritis to congestive hearth failure would be problematic for any government. In addition, this classical definition does not take the individual’s mental state into consideration and does not account for the conditions or factors that contribute to health in the first place.
The most popular definition used today was proposed by the World Health Organization (WHO) in the preamble to its constitution in 1948. It states, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” While this definition gives one a broader picture of an individual’s health, it suffers from impracticality. It expands the requirement for states to account for and protect the physical as well as social well-being of its citizens. If elimination of disease was too broad, the WHO’s definition is impossible to implement in the real world; it suffers from being inflexible and utopian. No state can ensure the physical let alone mental and social well-being of its citizens.
Still others have defined health in terms of human flourishing. In short, a healthy person is more than one who is free from disease, but one who can continue to be productive and flourish as a human being. These types of definitions appear to be much more manageable to discuss, but now “human flourishing” needs defining. Human flourishing depends on far more than medical treatment and often is defined differently by each society and individual. These definitions are problematic because the state cannot have a policy that is customized for each citizen.
The last type of definition can be seen in community-based societies, perhaps the best example of which is how Aboriginal tribes view health as a community concept. Health is far more than the condition of one member; it is about the social, spiritual and emotional condition of the tribe. A definition of this type pushes the health-care debate back to the local level and focuses on how the community perceives itself. At a national level, different communities may need different or conflicting social goods. This definition does not assist the state in negotiating tribal or societal conflicts with regard to resource allocation.
While all of these definitions have merit in and of themselves and many are mutually overlapping, they force us to focus on what we mean by “health” and “health care.” The WHO’s definition works well as a comprehensive definition of health, but it is difficult to transform it into pragmatic policies. The community and human-flourishing definitions work well for Christian theology and moral thinking, but they tend to focus on individuals and the local community. This does not help the global or national debate. Moreover, all four definitions are too idealistic to be implemented in reality.
This should force lawmakers and ethicists to have an open discussion about what we mean by “heath” and “health care.” We have spent too much time discussing a need for reform and not enough time discussing the meaning of our basic right. If human beings have a basic right to health care, then what do we mean by “health” and how is society obligated to protect this right?
The mistake that is often made in the debate about health-care reform is either failing to define our terms or using them interchangeably, thus making them meaningless.
Monty M. Self is the instructor of spirituality at Baptist Health Schools Little Rock and the Oncology Chaplain for the Baptist Health Medical Center – Little Rock.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.