Essentially, medicine is about health and sickness. These seem simple enough concepts but, what do they really mean? If we ask a professional we might receive an ambiguous answer, which is understandable since consistent definitions of these terms are not even given at Medical Schools. If we resort to the World Health Organization this is the definition we can find: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
According to this definition, we should run to the doctor every time that we feel stressed at work or when the girl to whom we write poems stops talking to us. In my opinion, this is an unsuitable, ambiguous and hedonistic definition but on top of it is not used in clinical practice. As Michel Accad has explained, most clinicians consider the human body as a machine.[i] According to this definition, human bodies have an optimal configuration in which all their parts need to perform the task for which they were created, just as in a car engine. The malfunction of a component produces a disruption in the machine, which is then considered defective, i. e. sick. If we see a healthy human body as a machine in an optimal state, then we can only see its malfunctioning as resulting from an alteration caused by an external or an internal element. This is a cause-effect relationship analogous with the relationships of classical mechanics: if A happens then the result will be B, being A an aggression and B the new defective state of the machine. This leads to a pure materialist perspective of medicine in which the physician acts as an observer and analyst of objective deficiencies in mechanical entities in need of repairs. The physician defines sickness through objective and physical criteria. The existence of a disease is, thus, determined by the doctor, who is considered well trained and qualified to identify objective mechanical malfunctions.
However, a human being is not just an ensemble of flesh, bones, muscles and viscera that occasionally need repairs. It is something else. With this in mind, Michel Accad has introduced the praxeological concept of health. To understand this concept we must first consider its foundations. Firstly, the axiom action explained by Ludwig von Mises. This simple axiom, from which the whole building of economic theory is deduced, says that man acts, which means that man tries to accomplish goals employing concrete means. Secondly, the self-ownership principle, brilliantly expounded by Murray Rothbard. According to this principle, each person is the owner of his body and as such has total decision capacity over it. Thus, we have that every person is an actor and the owner of his own body. From this two insights, Accad redefines the concepts of health and sickness. Where before we saw a body assimilated to a machine, now we see the most intimate property of an actor, of somebody with the ability to choose goals and means.
What if a person were unable to pursue his goals because of the state of his body? Then we could define that person as being sick. Thus, there is a praxeological basis for the definition of sickness. And what about health? According to Accad, health is that state where the physical and mental conditions of a person allow him to pursue his chosen goals.
A person sees himself as sick when he is unable to pursue his goals due to his physical or mental condition. This may range from a cold to a heart attack or the amputation of a leg. What determines the existence of a sickness is not the pathological profile but the effect that it has on the person´s ability to act. In this view, the patient recovers the capacity to consider himself as sick or healthy, thus recovering the last word on matters related to his body. This praxeological definition is the most generally accepted by people, though in an implicit manner. For instance, a heart attack or an asthma attack are usually considered as illnesses since they usually prevent us from pursuing our goals. On the other hand, a cold is seldom considered as an illness since it usually let us pursue our goals. In fact, we can take a step further and think about the case of fibromyalgia, which has no clear organic base, but which is very painful and incapacitating for the person who suffers from it and therefore is usually considered as a serious illness that prevents the carrying out of daily activities.
In the mechanical view, the sick person plays a passive role whereas the doctor establishes a hegemonical relationship with the patient. Actually, the whole health system is oriented in this way, considering patients as malfunctioning machines in need of repairs. As a consequence, there is a uniformity in the services offered, there is no possibility of choosing between competing alternatives and all life is medicalized, which goes from anti-smoking laws to government-led campaigns that promote the use of condoms. Thus, the state assumes the role of a rancher taking care of his cattle.
However, as Accad maintains, the Austrian School may be able of saving medicine. In the new definition of health, the individual decides whether he is ill or not. As the owner of his own body, he is the one that chooses when to go the doctor at his own expense. With the Rothbardian concept of self-ownership, the hegemonic relationship of the mechanical view becomes a contractual relationship, in which the patient pays for a service conducted on his property. Whereas the mechanical conception leads to a paternalistic view of medicine, the praxeological conception considers men as actors and owners which, in practice, would lead to a liberalization of medicine.