Beyond diagnostic fixation: a multidimensional framework for health and longitudinal viability

Area of Science:

• Medical Philosophy
• Bioethics
• Clinical Informatics

Background:

• The ontological status of health and disease is debated, often framed by naturalistic vs. normativist views.
• Static disease concepts lead to "diagnostic fixation," where labels persist post-pathology.
• Existing frameworks struggle with the dynamic nature of health and disease over time.

Purpose of the Study:

• To propose a dynamic, five-dimensional framework for reconceptualizing health and disease.
• To argue for diagnostic revisability as an ethical imperative in healthcare.
• To offer strategies for mitigating biographical surveillance through revised diagnostic practices.

Main Methods:

• Conceptual analysis drawing on Canguilhem's biological normativity.
• Application of Ian Hacking's theory of looping effects.
• Development of a dynamic framework for health and disease classification.

Main Results:

• Health is reconceptualized as longitudinal viability, not merely categorical restoration.
• Diagnostic revisability is identified as a core ethical requirement.
• A framework is proposed to shift clinical focus from static labels to dynamic patient trajectories.

Conclusions:

• Shifting to a longitudinal viability model can mitigate biographical surveillance.
• Ethical retirement of diagnostic labels is feasible, addressing clinical and institutional concerns.
• The proposed framework supports more adaptive and patient-centered healthcare practices.