The Concept of Disease and Medical Action — A Reciprocal Relationship and Its Relevance to Modern Medicine

Reflections about healing inevitably lead to reflections about the concept of disease. Disease is the constitutive term for the wide field of actions we summarily call medicine. It is disease that defines the goals of these actions, their intentions and ethical legitimation, as well as their justification. Thus disease assumes a normative, action-guiding function. Whenever we perceive and diagnose a disease in a fellow human being, we are obliged to take action. Depending on the nature of the disease, this can involve administering curative or palliative medical treatment, nursing a patient, or giving support and attendance in life's final stages until death. Whenever we detect the threat of a potential illness, we are obliged to take preventive action and seek to protect the person involved from acquiring the disease. The obligation to provide such help can be found across all religions and cultures, despite their otherwise great differences. It can thus be regarded as one of the cornerstones of an ethos that has its foundations in the recognition and acknowledgement of the special dignity of the human being. For a disease not only poses a threat to the union of mind and matter that makes us creatures of nature,. Iit also threatens us as individuals by affecting our power of self-determination and our freedom of action as governed by reason. Disease thus endangers not only our physical existence, but also the personal expression of human dignity that is represented by each and every individual.

This traditional view of medicine and its ethical legitimation is based on the causal relationship between disease and medical action. It is the disease that provides the cause for medical action. Medical actions and their intent are thus goal-oriented consequences of the disease. An ethical legitimation of medical action based on this argumentation, however, requires a consistent concept of disease. Here the difficulties begin. As indicated above, there is, on the one hand, a basic consensus concerning medical actions made necessary because of a disease, such as diagnosis, therapy, palliation and prevention. On the other hand, such a consensus is quickly lost when trying to precisely define the term ‘disease’ and clearly formulate a list of obligatory medical actions and goals. In order to achieve the former, some of the following questions need to be answered: iIs ‘disease’ to be defined as a deviation from a norm or as a different type of normality? How do we define the term ‘norm’ in the context of disease? What are the consequences of the various definitions of ‘norm’ when formulating the aims of medical actions? And when do these actions become obligatory?