COVID-19 as the underlying cause of death: disentangling facts and values

In the ongoing pandemic, death statistics influence people's feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization's rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts (causal chains) and values (the importance of prevention).

The concept of disease in the time of COVID-19

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease (disease judgements) and for who may be accorded the social privileges and personal responsibilities associated with being sick (sickness judgements). In this article, we consider an ideal diagnostic test for coronavirus disease 2019 (COVID-19) infection with respect to four groups of people-positive and asymptomatic; positive and symptomatic; negative; and untested-and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social (risk of) harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency.

Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components of harm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decision not to regard the harm requirement as a necessary criterion for mental disorder is tenable for a number of practical and theoretical reasons, some pertaining to conceptual issues surrounding the two components of harm and others pertaining to the problem of false negatives and the status of psychiatry vis-à-vis somatic medicine. However, we believe that the harm requirement can be (provisionally) maintained among the specific diagnostic criteria of certain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specific diagnostic criteria of certain individual mental disorders, it should be unpacked and clarified.