Journal of Medicine and Philosophy, 33: 101105, 2008

doi:10.1093/jmp/jhn006

Metaphysical Problems in the Philosophy of

Medicine and Bioethics
AARON E. HINKLEY
Rice University, Houston, TX, USA

In this issue of The Journal of Medicine and Philosophy, we have four papers that deal with various issues relating to various metaphysical issues in
the philosophy of medicine and bioethics. In this issue, one of the essays focuses on the concept of disease in medicine, whereas the other three essays
examine metaphysical issues surrounding the development of the human
embryo with regard to issues such as abortion, contraception, and altered
nuclear transfer.
The first essay in this issue is The Prototype Resemblance Theory of Disease by Kazem Sadegh-Zadeh. In this paper, Sadegh-Zadeh draws upon a
paper he had previously published in The Journal of Medicine and Philosophy, Fuzzy Health, Illness, and Disease where previously the author analyzed the concept of disease with the tools of fuzzy logic, and he gave a brief
sketch of a prototype resemblance theory of disease. In his current paper,
Sadegh-Zadeh more fully fills out just such a theory of disease. He argues
that disease is a nonclassical concept. In doing so, Sadegh-Zedeh draws in
part upon Wittgensteins discussion of family resemblances with regard to
language games in Philosophical Investigations, where the concept of game
is shown to have no one essential component. The notion of a family resemblance concept is used by Sadegh-Zadeh in contrast to the classical understanding of a concept, wherein a concept has a set of defining, or essential,
features or characteristics that is a necessary or sufficient condition for all
objects that fall under its scope. He further distinguishes classical from nonclassical understandings of concepts; he argues that classical concepts are
reducible categories, whereas nonclassical concepts are irreducible categories. According to Sadegh-Zadeh, a category is irreducible if there is no defining set of necessary and sufficient features common to all of its instances.
Thus, an irreducible does not satisfy the common-to-all postulate of reducible categories. (p. 12). Sadegh-Zadeh argues that this is no defect of the irreducible categories but instead demonstrates the inability of the classical
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Aaron E. Hinkley

understanding of concepts to capture the genuine complexity of concepts as

they are actually used in human practices. Indeed, according to SadeghZadeh, the category of diseases is relative to human societies because its
prototype elements, as its generators, are instituted by human societies . A
human condition of this type has been christened disease by human beings
in the past to mean that the life of the afflicted person is threatened and she
is suffering and in need of help, treatment, care, advise, and any other useful
assistance that may relieve her pain and prevent death, incapacitation, and
continuing discomfort the afflicted persons state is named disease by the
society to denote something that it finds undesirable and whose amelioration through medical care it finds desirable. (pp. 2930). Therefore, what
constitutes a disease is relative to human societies, but is, also, in relation to
prototypical examples of what society understands to be a disease.
The next essay in this issue of The Journal of Medicine and Philosophy is
Four Queries Concerning the Metaphysics of Early Human Embryogenesis
by A. A. Howsepian. In this paper, Howsepian argues that contrary to what
many on both sides of the abortion debate may claim, the ethical status of
induced (or procured) human abortion is fundamentally tied to metaphysical issues concerning the personhood of unborn humans. (p. 1). It is, therefore, necessary, according to Howsepian, to answer certain fundamental
ontological questions about human embryogenesis in order to be able to
properly address the ethical issues regarding abortion. The questions that
Howsepian asks are as follows:
(1) A human zygote undergoes its first mitotic division. Twinning ensues. Is it coherent to claim that one and only one of the twins is identical with the original zygote? (2) Two human zygotes fuse resulting in a single conceptus. Is it coherent to
claim that the conceptus is identical with one and only one of the original zygotes?
(3) Suppose that human beings pass out of existence as a result of brain death. Does
this not imply that human beings come into existence as a result of coming to possess a properly integrated, functioning brain? (4) At the moment of implantation, do
human pre-embryos become parts of their mothers? (p. 3).

Only by answering these four metaphysical questions, Howsepian argues

that we can begin to have an answer regarding the ethical status of abortion.
He argues that in answer to the first question, although we may not ever be
able to determine which twin is identical with the original zygote, it is coherent to claim that only one of the twins is identical with the zygote. To the
second question, he argues essentially along the same lines as his response
to the first query, even if we cannot determine which of the two original zygotes the postfusion single zygote is identical with, it is coherent to claim
that the one remaining zygote is identical with only one of the original zygotes. To the third question, Howsepian argues that we must either accept
the view that brain death is not by itself a sufficient condition for human
death or that we must understand pre-embryos as being brains, which he

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contends is a clearly absurd view since the brain has not even developed at
this stage. Fourth, he argues that the zygote does not at implantation cease
to be a thing in and of itself and does not simply become fused with its
mother; moreover, he concludes on this ground that live human zygotes,
and human pre-embryos more broadly, are live human persons. Howsepian,
then, argues, there are no good reasonsbased on twinning, recombination, implantation-related mereological, or brain life/brain death symmetry
considerationsfor believing that live human pre-embryos (including live
human zygotes) are not, like us, single, live human persons. Unlike us, however, all such single live human pre-embryos are innocent or, at the very
least, are not guilty of anything whatsoever. (p. 16). Therefore, induced
abortions of live human fetuses, even at the earliest stages of their development and prior to their implantation, are morally impermissible because the
human pre-embryo is a living human person and an innocent one at that
against whom killing could not possibly be morally justified.
The third paper in this issue is On the Duty to Treat Humanity as an Inviolable End: An Analysis of Contraception and Altered Nuclear Transfer by
Lawrence Masek. In his essay, Masek argues that both human contraception
and altered nuclear transfer are morally wrong. However, he suggests he can
demonstrate this view without reference to Roman Catholic moral theology
or views about the natural teleology of human sexuality. However, he does
so on the grounds that both contraception and altered nuclear transfer, which
is the proposed technique for creating human embryonic stem cells without
destroying human embryos, fail to treat humanity as such as an inviolable
end. Both contraception and altered nuclear transfer fail to treat humanity as
an inviolable end by attempting to prevent a given natural, biological process from creating an instance of humanity. Masek attempts to distinguish his
view from Kants by arguing that for Kant, we show respect for humanity by
not treating persons as means to an end, whereas the author argues that his
view assumes nothing about particular persons, who may or may not actually come into existence as a result of a sexual act. According to Masek, his
view regarding treating humanity as an inviolable end entails respect for humanity as such. Treating humanity as such as an inviolable end seems generally to entail preserving human life and taking a nonviolent approach toward
dealing with other members of humanity. However, the author tries to suggest that his view does not necessarily endorse a pacifist approach by making exceptions that allow for violence against human persons under certain
circumstances. Moreover, his view requires at least that one not attempt to
avoid creating new human persons by artificial means but he suggests does
not prohibit the possibility of periodic abstinence for the purpose of preventing conception. The result of Maseks argument with regards to altered nuclear transfer is that it like contraception fails to treat humanity as such as an
inviolable end in itself and should, therefore, not receive government support or funding, not necessarily that the government should legally prohibit

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such practices, just as the immorality of artificial methods of human contraception does not entail that it should be banned or outlawed by the state as
not all actions that are immoral merit being legally prohibited.
The final paper in this issue of The Journal of Medicine and Philosophy is
The Beginning of Individual Human Personhood by Paul S. Penner and
Richard T. Hull. In this paper, Penner and Hull attempt to establish the point
at which a human fetus is sufficiently developed so as to be a fully developed
human being and, therefore, to morally prohibit abortion except in certain unusual circumstances. Indeed, the authors point out, When secularists consider
the fact that there is little ethical difference between a human being on the day
before its birth and the same human being on the day after its birth, they are
confronted with an important question. (p. 2). The authors first begin by examining common approaches to this issue in contemporary bioethical debates. As such they address the issues of consciousness and self-consciousness,
which are often ways in which this issue has been addressed. However, the
authors ultimately reject these considerations because they ultimately involve
the concept of personhood, which is often describe, as the authors point out,
as Being-in-the-World to use a Heideggerian turn of phrase. This creates further problems since as Penner and Hull note, Using this as the marker of the
turn to personhood, that is, the marker of the creation of a human being from
a human organism, could lead a secularist to conclude, as Peter Singer (1993,
18193) has pointed out, that the destruction of a human organism is ethically
permissible for some time after birth since the right to life is grounded in the
ability to plan and anticipate ones future. (p. 3). Ultimately, the authors reject
this move because self-consciousness, they claim, is ultimately a subjective
phenomenon that cannot be objectively, or scientifically, measured by a third
party out in the world. Therefore, as a pragmatic consideration, the authors
turn to the development of the brain and nervous system as well as sensory
organs in the human fetus, which not only can be objectively measured to
some degree but also are contributing factors to the eventual development of
self-consciousness in the human person. Based on these considerations
gleaned from the natural sciences, Penner and Hull ultimately determine that
in order not to destroy a person in the making (as opposed to a mere human
organism), we should refrain from aborting any fetus later than 23 weeks in
the gestation process except under special circumstances. (p. 8). So, the authors conclude that third trimester abortions, with some exceptions for special
circumstances, are morally impermissible because they kill a developing human person as opposed to a mere human organism.

REFERENCES
Howsepian, A. A. 2008. Four queries concerning the metaphysics of early human embryogenesis. Journal of Medicine and Philosophy 33:140157.

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Masek, L. 2008. On the duty to treat humanity as inviolable end: An analysis of contraception
and altered nuclear transfer. Journal of Medicine and Philosophy 33:158173.
Penner, P. S. and R. T. Hull. 2008. The beginning of individual human personhood. Journal
of Medicine and Philosophy 33:174182.
Sadegh-Zadeh, K. 2008. The prototype resemblance theory of disease. Journal of Medicine
and Philosophy 33:106139.

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