“Pregnancy is a Disease”: the Consequences of Denying Teleology

Just this year, a distinguished bioethics journal, The Journal of Medical Ethics published an article with the title: “Is Pregnancy a Disease? A Normative Approach” [1]. The two authors of the article, Anna Smadjor and Joona Rasanen answered this question in the affirmative. Having followed the academic abortion debate for years, I don’t often get shocked by things I read in bioethics journals, but this occasion was an exception.

The claim that pregnancy is a disease is no longer just a claim thoughtlessly made by placard holders or keyboard warriors who haven’t thought through the implications of such a statement. The idea that pregnancy is a disease is now being seriously argued by academics with considerable understanding of biology.

To be absolutely clear: these authors are not merely arguing that complications during pregnancy are pathological. On this, all reasonable people can agree. The instance of ectopic pregnancy: a life-threatening complication in which the embryo attaches to the fallopian tube rather than the uterine lining, is one example of a condition that is undoubtedly pathological, and certainly akin to a disease. No – what these authors argue is that ordinary pregnancy itself – the means by which human life is handed on from one generation to the next – can be reasonably viewed as a disease, a pathology.

The thesis that pregnancy is a disease is a symptom (pardon the pun) of the materialist assumptions that pervade academia. Materialism – the philosophical position that the only thing that really exists is the matter, or the smallest component parts of matter that make up the physical universe – is academic orthodoxy, but, as Christian apologists have long been arguing, this worldview is far less plausible than indoctrinated undergraduates are allowed to think. That leading academics are now arguing that pregnancy is a disease is a window not only into the consequences of a materialist outlook on the world, but also into the inadequacy of materialism for explaining the most ordinary things of life, including what counts as a disease and what does not.

This becomes clear as Smadjor and Rasanen’s paper unfolds. In order to make a conclusive case that pregnancy is a disease, one has to give a plausible definition of what a disease is – an account of the necessary and sufficient features shared by all diseases – and show that pregnancy possesses these features. Smadjor and Rasanen, at the outset of their article, confess that they do not achieve this conclusive goal. Defining “disease” adequately is something these authors have a most difficult time doing. In their paper, they downplay the significance of this by arguing that no-one yet has managed to successfully define “disease”: “What counts as a disease is a recurring question in philosophy of medicine. Experts disagree about the criteria by which we can distinguish diseases from other phenomena. Some believe that diseases can be defined with reference to some objective truth, others that the term is purely or partly socially constructed. Whichever view one takes, it is difficult to find a theory that accommodates all those conditions we take, intuitively, to be diseases, while excluding all those that, intuitively, we do not.” [2]

In other words, even if we cannot conclude decisively that pregnancy is a disease, the idea is still a reasonable one to entertain. This is because the best available contenders for a definition of “disease” available to us entail that pregnancy is a disease. It makes for entertaining reading surveying the definitions of “disease” these authors consider to be the best available to us…

One possible defining feature that all diseases have in common, the authors argue, is that they are experiences that are bad for those who have them. What does “bad for” mean? One way of understanding what it means for an experience to be “bad for” someone is to say that it causes physical discomfort, displeasure, or pain. Pregnancies can be difficult and painful – so,
according to this possible definition of disease, pregnancy counts as a disease. This is an obviously unsatisfactory definition of disease: according to such a definition, physical exercise could also be viewed as a disease.

Another possible way of understanding an experience as “bad for” someone is its being, for whatever reason, not valued by, or unwanted by, the person to whom it happens. Under this reasoning, unwanted pregnancies are diseases, and wanted pregnancies are not – whether pregnancy is a disease, under this definition, varies case to case according to subjective valuation.

This too, of course, is an unsatisfactory definition. According to such a definition, an appendectomy performed on a young child who resents the fact that they need the operation could be considered a disease. Similarly, as the authors themselves note, many people find value in the fortitude and gratitude for life that comes from having experienced conditions that we would, without question, describe as diseases, such as cancer. Subjective valuation, then, does not appear to be a very promising means to defining “disease”.

Another candidate definition of “disease” is that it is a condition that can be treated medically. Pregnancy, indeed, can be “treated” medically – either through medical assistance during birth, through abortion, or through treatment of symptoms during pregnancy. Under this definition, pregnancy can be classed as a disease, but this definition, too, is unsatisfactory. A woman who is unhappy with the size of her breasts has a “condition” that can be treated medically: a plastic surgeon can provide her with implants. But having smaller breasts than one would like is not a disease.

The way the authors talk about pregnancy in their opening paragraph is suggestive of another way to define “disease” – as an experience that is accompanied by physical or physiological symptoms that are unusual or out of the ordinary:

“Imagine a patient who visits the doctor having an abdominal mass that is increasing in size, causing pain, vomiting and displacement of other internal organs. Tests are booked, and investigations are planned. But when the patient mentions that she has missed her period, these alarming symptoms suddenly become trivial. She is pregnant! No disease, nothing to worry about. But is this the right way to think about things?” [3]

Diseases bring with themselves unusual or out-of-the ordinary physical symptoms. So does pregnancy. Ergo, pregnancy is a disease. This definition, too, is unsatisfactory. The few times in my life I got up on stage to sing a solo in a musical, strange things happened to my body before I stepped out under the spotlights. I started sweating. My heart race increased. My hands shook. My knees wobbled. My stomach turned. Unusual symptoms for sure! Thankfully, I did not have a disease. My body was simply preparing me for something I do not usually do. Smadjor and Rasanen essentially hope to show that it is reasonable to view pregnancy as a disease by arguing that pregnancy meets the conditions of many, and not just one, obviously wrong definition of “disease”. Needless to say, this is not a very satisfying argument.

Several bad definitions of “disease” – even several bad definitions all taken together – do not add up to a good definition of “disease”. Unless we have a far more compelling possible definition available as to what counts as a disease and what does not, one cannot make any claims about whether pregnancy does, or does not, count.

As it happens, there is a plausible definition of “disease” available to us which avoids the obvious problems inherent in the other definitions, and it is a definition of “disease” that the human race has implicitly understood for millennia. This is the idea that a disease (or more broadly, any pathology) involves some dysfunction on the part of the body, or a bodily system. This definition accords with what has, traditionally, been seen to be the purpose of the art of medicine: to restore the natural functions of the body to working order.

This definition of disease as bodily dysfunction does look very much like a good candidate definition that ‘accommodates all those conditions we take, intuitively, to be diseases, while excluding those we do not.’ Defining disease as dysfunction enables one to say that exercise does not count as a disease even though it is painful – for exercise generally enhances, rather than undermines, the function of the body’s organs. It enables one to say that the appendicitis, not the appendectomy, is the disease inflicting the reluctant child, even if the child subjectively thinks otherwise. It allows one to say that, even though some unwanted conditions (like measles) are diseases, others (like having smaller-than-average breasts) are not. It allows one to say that cancer is a disease, even if cancer sufferers find long-term value in the experience of cancer.

It enables one to say that the unusual heart activity that precedes a solo on stage is not symptomatic of a disease, but that the unusual heart activity that precedes a heart attack is. It enables one to say that ectopic pregnancies are pathological, but that pregnancy itself is absolutely not. There is no dysfunction involved when a uterus performs its natural function of gestating new life.

Why, given the explanatory power and intuitive appeal of the definition of disease as dysfunction, do Smadjor and Rasanen dismiss it, treating it only briefly? The reason, in short, is that embracing the dysfunction account of disease requires one to give up on materialism. The notion that body parts have functions is ultimately an Aristotelian idea, according to which nature, and entities within the natural world, exhibit teleology or purposeful behaviour. Not necessarily conscious purposeful behaviour, but purposeful behaviour nonetheless. The notion that there are objective purposes or functions to bodily organs implies the existence of objective normative facts in the world – facts about the ways in which organs should behave.

Such normative facts about the ways that organs should behave give us grounds for making basic evaluations of bodily organs such as “healthy” or “unhealthy”, “good” or “bad”. A human heart, for instance is a “good” heart if it fulfills its function of pumping blood, “bad” insofar as it fails. But if the human heart is as the materialist sees it – just a clump of cells, arbitrarily grouped together under one word by human language, without an objective purpose written into its very nature – then there can be no sense in evaluating a heart as good or bad. All we can do is settle for a subjectivist account and say that the clumps of cells we call “hearts” are good insofar as a person value what their heart does, bad insofar as a person does not value this. And this way of seeing things, of course, entails the implausible definition of “disease” as a subjective condition.

Aristotelian teleology, and normative facts in the world, thus, are indispensable to basic biological concepts such as health and disease. But they do not fit into a materialist picture of the world.

The notion that organs have purposes is also suggestive of the existence of a designer behind the universe. This was not an argument Aristotle made himself, but the idea was later picked up by popularisers of Aristotle in the Middle Ages, and particularly by Thomas Aquinas. The eagerness to avoid the dysfunction account of disease – at the expense of rejecting the most plausible definition of “disease” there is – is a testament to just how far academics will go to close the door to the existence of God.

The entry, into bioethics debate, of the proposition that pregnancy is a disease is another lesson in the truth that ideas have consequences. The rejection of Aristotelianism that began centuries ago (for which the Protestant Reformation, we must humbly acknowledge, was partially responsible) has led to some truly bizarre consequences in the world of ideas.

The consequences are not only bizarre, but nihilistic. If the way in which humans reproduce is a disease, then what does this say about humans?

Emma Wood is a Sydney-based pro-life philosopher.

She has published academic work in the ethics of abortion, has lectured in political philosophy at Campion College, Sydney, is a Research Fellow with Women’s Forum Australia, and regularly speaks to schools, churches, and the Lachlan Macquarie Institute about abortion and the issues surrounding it.

Footnotes

1. Anna Smadjor & Joona Rasanen, J Is Pregnancy a Disease? A Normative Approach. Journal of Medical Ethics. 2024. 0:1-8. doi:10.1136/jme-2023-109651, accessible at: https://jme.bmj.com/content/early/2024/01/28/jme-2023-109651?rss=1

2. Ibid. 1

3. Ibid. 1