Definitions of medicine, disease and health are some of the most complex and philosophically intriguing discussions one can have in a medical context. There seems to be no universal truth that can be applied to these terms, as each of them can be viewed subjectively through the viewpoint of value-based arguments or through objective, factual definitions.
The definition of disease through theories such as the biostatistical theory of health, health as well-being, etc. show that the definition of medicine is not entirely scientific, nor is it entirely value based. However, it is a complex and ever-changing mixture of the two, depending on the individual circumstances of how this argument is applied.
Firstly, the definition of medicine as the “curing people of diseases” can be scrutinised, which is often mentioned as the key defining point of medicine. It can be argued that this is not entirely correct, as there are fields of medicine where the aim of the practitioners is not necessarily to cure the patent of disease but mitigate and reduce the symptoms of that disease. For example, according to the WHO, palliative medicine “improves the quality of life of patients and that of their families.”. Furthermore, any form of symptomatic treatment for diseases, some which may be terminal and so deemed ‘incurable’, is proof that the sole aim of medicine cannot simply be to cure disease. In fact, we can redefine medicine as aiming to improve the quality of life of people with disease, and thus the practice of medicine takes on a more holistic approach. Therefore, we have already deconstructed the first assumption which is commonly stated with regards to the definition of medicine.
However, we have yet to define exactly what is meant by disease. For that we must take a closer look at two different theories of the definition of disease.
Firstly, we take the biostatistical theory of health, as put forward by Christopher Boorse who stated that “a disease is a dysfunction of a subsystem of the body.” Put simply, this theory states that disease is a failure (or dysfunction) of the parts of the body, to carry out functions to statistically ‘normal’ levels, dependent on the age, species, gender, and so on. On the face of it, this theory does make sense; for example, the parameters we use to diagnose high potassium/bilirubin/white blood cell levels in the blood, etc. are based on calculated ranges that are known to be accurately reflective of the statistical normal. However, a key weakness in this theory is that for certain recognised illnesses, a patient may have statistically normal biological indicators of health, for example: mental illnesses or phantom back pain. Therefore, this theory cannot be applied as a universal truth and we cannot define what a biological dysfunction is through scientific or statistical methods alone; hence, this seemingly supports the value-based argument.
The second theory is that of “health as well-being”, which has been aptly defined as “[bringing] values back into the assessment of health, without leaving facts behind.”. Here, well-being is dependent on an individual being able to achieve their ‘vital goals’, which are personalised for every person and are the conditions that must be achieved for a person’s minimal happiness. Therefore this theory seems to suggest that disease must be based on the values of a person, because the vital goals of a person are dependent on his/her values. And so we can argue that the definition of medicine must be more value-based. However, a key point is that although this theory relies heavily on the patient’s subjective view of their own health, that view can be heavily influenced by science, and how scientific methods are applied in the context of that disease. For example, a doctor must use scientific methods to diagnose and understand the cause of disease and decide on the treatment/s needed for that patient. This in turn will affect the patient’s vital goals, and how they predict the outcome of their illness; whether they presume they have a good prognosis is based on the advice of the doctor, which is in turn based on science. So even though the vital goals of a patient are entirely subjective, the way in which those vital goals are seen and adjusted are heavily influenced by science. Therefore, science is still a fundamental part of medicine, and we cannot say that medicine is not entirely scientific and based on values.
In conclusion, we can see how medicine cannot be defined as either completely scientific or completely value based and if we take either of these theories as absolute and try to apply them to all contexts of medicine, then, we will uncover a rabbit-hole of contradictions to these arguments. The key here is to view both theories as complementary, and not mutually exclusive. This allows us to understand that the value-laden definition of disease does not diminish the scientific aspect but instead serves as a way to support and make practical use of its scientific methods.
Medicine is thus based on the beautiful harmony between science that enables doctors to diagnose and treat physical illnesses, and the experiences and values of the patients that receive treatment for their illness, which may not have any outwardly physical manifestations, but cause distress and discomfort to the patient either way. Therefore, through whichever way you define disease, it is a complementary blend of scientific and ‘non-scientific’ that ultimately best fits the definition of medicine.
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