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is shared by all members. It is like a family where one can see that the individual
members are part of the same family however; they do not share a single feature.
The prototype resemblance theory of disease gives this Wittgensteinian frame-
work a further twist. As well as some family members are more typical than others,
so are some diseases more typical than others. Such as an orange is a more typical
fruit than a coconut and a sparrow a more typical bird than a penguin, so is heart at-
tack a more typical disease than hair loss. But how does the set of prototype diseases
come into existence? Ultimately, the understanding of disease rests on democratic
ground: “there are some anthropological constants which all rational human beings
would be prepared to label a 'disease' by pointing to them and declaring, 'look: this
is a disease!”' [12, p. 621]. The prototype theory of disease is thus grounded in the
lifeworld in such a way that rational human beings cannot but recognize these states
as diseases. Prototype diseases are thus baptized as such. Other human conditions
can be called disease to the extent to which they resemble the prototype disease.
More specifically: The more the symptoms of certain human conditions are similar
to the ones of prototype disease, the more they can be classified as diseases. The
boundary between non-disease and disease cannot be drawn clearly - this follows
from the observation about of disease being a non-classical concept.
The reading of the text at this point is ambiguous: The prototype resemblance
theory of disease might be understood in a Universalist, rationalistic vein in terms
of all diseases classified as such by all rational human beings. But it also might be
defined more cultural relativist as it is the case with concepts such as fruits or birds.
In the same way as a coconut might be considered a more typical fruit than orange in
some parts of the world, so the prototype diseases might be dependent on the cultural
framework. In the
Handbook of Analytic Philosophy of Medicine
(
Handbook
,for
short), Sadegh-Zadeh writes that disease “is a social construct in that it is a society-
relative category whose prototypes are established by that society” [13, p. 565].
Depending on a universalist/rationalist or relativist/constructivist interpretation of
the prototype resemblance theory the consequences are different. In the first case,
there exists a set of diseases, which each rational being has to agree that this is a
disease. In the second case, the qualification of disease is stronger dependent on the
respective culture. Both interpretations are not without problem: The Universalist
interpretation has to face the tough challenge that disease turns out to be a category
beyond the social and cultural influences as the set of prototype disease must be
the same at every moment in history. The constructivist interpretation leaves room
diseases that might leave the door open for discriminatory uses of disease; like the
branding of homosexuality as one.
The normative turn, lastly, is a reflection of the inherent normativity of the con-
cept of disease. Having a disease - more specifically: being ill - serves as a call for
others to provide assistance. Diseases “are action provoking.” [14, p. 135] Defining
diseases is not merely a descriptive endeavor but rather strongly value-laden one.
If we call something a disease, we are called upon to assist in case of the medical
profession or at least to relieve the sick person from his duties. That disease is a de-
ontic concept makes medicine a deontic discipline like morality. As a consequence,
the difference between morality and ethics (as a reflection of morality) is akin to the
