Concepts of Disease: Dysfunction, Responsibility and Sin

This conference aims to explore the understanding of disease as an evolving concept of multi-disciplinary concern in medicine, the humanities—e.g. research in philosophy, the Hebrew Scriptures, the New Testament, Christian moral theology and Buddhist thought—the social sciences, and law. In particular, the conference seeks to investigate the moral responsibilities or failures that are implied by present and emerging notions of disease, but also the conceptual components of these notions. To this end, we especially intend for the conference to stimulate ongoing conversations about concepts of disease between humanities researchers and healthcare workers (e.g. doctors, nurses, therapists, researchers, etc.).

Our central questions for the day will be as follows. Is disease a biological and/or molecular dysfunction, a failure of will and personal responsibility, and/or sin? Conversely, how are these terms defined with regards to disease? How do they relate to each other? And how does the medical and/or moral understanding of disease around these issues impact on philosophical and theological, technological and legal negotiations? What are the endpoints of emerging developments in medicine implied by what we mean by disease? If identifiable, are these developments irreversible? Most importantly, how will any of these developments relate to the broader civic place of healthcare and the regard citizens have for each other? By focusing on the notion of disease between dysfunction, responsibility and sin, the conference seeks to investigate the moral and ethical implications of emerging trends in healthcare.

Confirmed speakers

Havi Carel (Professor of Philosophy, University of Bristol), Jonathan Herring (Professor of Law, University of Oxford), Joshua Hordern (Associate Professor of Christian Ethics, University of Oxford), Neil Messer (Professor of Theology, University of Winchester), Andrew Moscrop (GP and Researcher, Department of Primary Care, University of Oxford), Thomas Schramme (Professor of Philosophy, University of Liverpool), Katherine Southwood (Associate Professor, University of Oxford), Jan Westerhoff (Associate Professor in Religious Ethics, University of Oxford), Therese Feiler (Wellcome Trust Postdoctoral Researcher, University of Oxford)

Call for posters on the conference theme: Please send your abstract no later than 28 November 2016 to therese.feiler@theology.ox.ac.uk

Context

The notion of disease is formed at the borderline of the sciences and the humanities. It is crucial for what it means to be a patient, for the interpretation of pain and suffering, for how the sick and dying are cared for, and for how the healthcare system is organised. The way we understand disease—or indeed illness as the patient perception of disease—defines the practical scope for medical research and intervention, as well as the horizon of hope.

Philosophical, technological and social-political shifts in recent decades have not remained without effects on the understanding of disease both as a biomedical and a moral concept. The turn away from old-school, “priestly” medical paternalism towards autonomous, in parts libertarian notions of the individual has resulted in new freedoms, especially those which safeguard a place for patients’ own interpretations. At the same time, they seem to imply a new set of responsible authorities that define, administer and control disease. Technology, in particular new molecular, stratified and personalised medicines, have generated conceptual questions about how disease is both a matter of genetic risk, or even determinism, but also something one may be held responsible for. In terms of socio-political developments, the neoliberal modernisation of healthcare systems has impacted on the communal, social and political understandings of disease. It has begun to be understood as part of the tragic conditio humana, a self-inflicted state implying guilt, but also a “good” that large industries trade in.

How disease is related to the nexus of responsibility, sin, fault and guilt has significant civic and political implications with respect to how patients, especially those thought to be irresponsible in some way, are regarded by others, and how they regard themselves. The movement towards ‘responsibilisation’ in healthcare may stand in some tension with the more common view in welfarist polities that ill-health should be understood, from a procedural prospective, as a matter of bad luck; and especially so since causal, environmental connections between disease and responsibility are so uncertain. This raises the broader question of what implications for the nature and role of compassion follow from how disease and sin are interrelated.

Further questions that may be addressed include:

- How does the emphasis on increased patient autonomy, including versions of consumer-autonomy, influence both the concept of disease and moral responsibility?

- What implications for the societal meaning of healthcare can be gleaned both from synchronic and diachronic insights from theology, the philosophy of medicine, literature, possibly even music? What can these fields tell us about the connection between disease, sin and moral responsibility? Conversely, what are the heuristic, moral and legal limitations of these terms?

- What are the implications of developments in genomic and personalised medicine for the connection between disease, responsibility and sin?

- What are the implications of a ‘responsibilisation’ of healthcare for what should be meant by ‘compassion’ in healthcare?

- What can we learn about emerging moral conceptions of disease from particular diseases such as cancer, AIDS, epidemics, or psychiatric conditions?

- How do philosophies such as transhumanism or neuro-philosophy value or devalue disease?

- Is there any merit in the use of military and combative metaphors to describe the responses to disease? (e.g. 'fighting', 'battle')

Programme:

9.30 Welcome and Introductions (Therese Feiler, Joshua Hordern, Andrew Papanikitas)

Session I

Joshua Hordern (University of Oxford): Responsibility, Disease and Sin: Compassion in Theological and Religious Traditions

Jan Westerhoff (University of Oxford): Illness and Existential Suffering (duḥkha), Cyclic Existence (saṃsāra), Karma, and Compassion (karuṇā) in Buddhism (Title TBC)

11.00 – 11.20 Coffee break, elevenses and networking

Session II

Katherine Southwood (University of Oxford): Metaphor, Illness and Identity in Psalms 88 and 102

Therese Feiler (University of Oxford): Coram Deo – coram mundi: Fruitful Ambiguities of Sin and Disease in Reformation Theology

12.45 – 1.30 Lunch

Session III

Neil Messer (University of Winchester): Theological Theses concerning Health, Disease and Flourishing (Title TBC)

Havi Carel (University of Bristol): The Phenomenology of Illness (Title TBC)

2.45 – 3.15 Tea & Coffee

Session III

Andrew Moscrop (GP; University of Oxford): Social Determinants of Health and Disease (Title TBC)

Jonathan Herring (University of Oxford): Rationing by Fault

Thomas Schramme (University of Liverpool): Disease and Dispositions as Objects of Individual Responsibility

5pm Wrap-up and farewell (Andrew Papanikitas, Therese Feiler, Joshua Hordern)

Medical Humanities
Compassion in Healthcare
Audience: Open to all