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

The ontological status of health and disease remains a central problem in medical philosophy, commonly framed through tensions between naturalistic and normativist accounts. While useful for acute classification, static conceptions of disease contribute to "diagnostic fixation"-the persistence of clinical labels long after active pathological processes have stabilised. This article proposes a dynamic, five-dimensional framework that reconceptualises health not as categorical restoration, but as longitudinal viability. Drawing on Canguilhem's biological normativity and Ian Hacking's theory of looping effects, it argues that diagnostic revisability is a core ethical requirement in contemporary healthcare. By shifting the clinical focus from categorical restoration to longitudinal viability, the framework offers a pathway to mitigate biographical surveillance. The article concludes with practical guidelines for the ethical retirement of diagnostic labels while addressing clinical concerns related to liability and institutional inertia.