Medicine, Health Care and Philosophy 4: 311–325, 2001. © 2001 Kluwer Academic Publishers. Printed in the Netherlands. Scientific Contribution The naturalness of the artificial and our concepts of health, disease and medicine Y. Michael Barilan * and Moshe Weintraub Department Medicine C, Sourasky-, Tel Aviv Medical Center ( * Corresponding author: Ichilov Hospital Sourasky-, Tel Aviv Medical Center, 6 Weitzmann Street, Tel Aviv, Israel; Phone: 972-3-6973766; Fax: 972-3-6200439; E-mail: bentovia@shani.net) Abstract. This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference with natural balance. It is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to healthcare. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. Key words: health, disease, medicine, role of, justice in healthcare, nature, concepts of, technology, attitudes to, holistic medicine, enhancement medicine 1. Introduction This article deals with a set of assumptions in contem- porary discussions of health and disease. Numerous works treat some of these assumptions on a separate basis. An explicit treatment of few assumptions is usually associated with implicit reliance on others. We believe that it is crucial to understand the interdepend- ency among these assumptions as a discrete paradigm and as a cognitive cultural consensus (D’Andrade, 1995, pp. 12–16; Kleinman, 1974; Good, 1977; Good and Good, 1992). Only then, it is possible to evaluate them critically, to forward a strong refutation and to come by with an alternative. The task is enormous, and we do not pretend to exhaust the subject, merely to sketch a preliminary framework. The set of assump- tions (A1 . . . A10) is listed below: 1. There is an ontological and natural distinction between things and actions that are natural and things and actions that are artificial. 2. Natural things and actions are good; artificial things and actions are not necessarily good. Rather, they are likely to be bad and are always less valued than natural things and actions when natural substitutes are available. 3. Nature is set in a perfect order which is sustained by God/Mind or self-supporting laws of cyber- netics. The best state of every creature is to abide by its natural place in the Big Ecological Harmony of Nature. 4. The nature of humankind can be delineated, as part of the natural order. 5. Health is the natural condition of humankind. 6. Disease is a deviance from the natural condition of health. 7. The primary role of medicine is restorative. It aims to correct the abnormal deviance from our healthy nature, which the disease has brought about. 8. Nature has healing properties. 9. The mind has power of control over the body and there is always something that one can do about one’s health. 10. Good medicine treats “the whole person” not isolated pathologies.