Economics of Convention Meets Canguilhem

Abstract

The neopragmatist institutionalist approach of economics of convention (in short EC) still is in need of a conception of health that enables EC to work out a critical standpoint in the analysis of health care institutions. French historical epistemology is an early critique of Comtian positivism in the philosophy of science. The work of the historical epistemologist Georges Canguilhem is the most important approach for a non-reductionist, pluralist conception of health and for the anti-positivist critique of medical concepts of the "normal." This critique has become an influential basis for the critical analysis of quantification in health care. Canguilhem introduced the notions of biological normativity and social normativity, which govern the relation of organisms and their milieus and can be regarded as original sources for value and normative orders. In this contribution, the anti-positivist critique of Canguilhem is presented. Then the link between scientific concepts, knowledge production in the health care system, and health institutions is discussed, which was later on continued by Michel Foucault as a successor of Canguilhem in the field of historical epistemology. It is pointed to the affinities of Canguilhem's approach to pragmatism but also to the capability approach of Amartya Sen. Consequences of Canguilhem's work for EC and links to EC's concepts are worked out. Finally, the relevance of Canguilhem's work to the ongoing digitalization of health care is sketched.