Boundary object and pragmatism in the philosophy of medicine

The case of ALS-disease or ALS-syndrome debate

Abstract

In the philosophy of medicine, the tendency towards definitionism in the concept of disease is increasingly being challenged. Taylor and Vickers speak of “conceptual fragmentation”, which affects several concepts such as species, intelligence, race, memory and disease. These concepts, long thought to have a single underlying meaning, are now thought to have multiple distinct meanings. There are several possible approaches to this “conceptual fragmentation” in the philosophy of medicine, such as pluralism, eliminativism or pragmatism. I argue that the notion of the boundary object, derived from the ethnology of science and already used in the medical context by sociologists and ethnologists, is useful in the philosophy of medicine to clarify the pragmatism to be applied when talking about the concept of disease. To illustrate this, I’ll focus on a specific case, that of the nosological debate around amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder, that can be resolved by approaching disease as a boundary object.