How diseases get defined and why it matters


Definitions of diseases rely much on pathophysiology, but also on social and cultural norms. How physicians use their authority to label patients' conditions affects how symptoms are understood and addressed, whether and to what extent treatments are reimbursed, even patterns of empathy expression toward affected individuals.

Dualities like disease and health; illness and wellness; normal and deviant; and natural and unnatural suggest that medicine's use of the power to name is often imperfect and, therefore, always ethically relevant.  

The December issue of AMA Journal of Ethics® (@JournalofEthics) features numerous perspectives on the ethical implications of physicians’ power to name and gives you an opportunity to earn CME credit.

Articles include:

What Are Ethical Ramifications of a Physician’s Power to Name? Whether conditions are recognized as pathological can influence how symptoms get addressed and how treatments are paid for. Calling something a disease can even change our expressions of empathy toward individual patients.

While the physician’s power to name seems prima facie beyond the scope of everyday practice, it is, in fact, central to much of what a physician does every day—from diagnosing conditions to battling insurance companies for coverage to balancing the risks and benefits of treatment.

How Forcefully Should Clinicians Encourage Treatment When Disagreement Persists About Obesity Risk? Pediatric obesity is a significant public health problem, and weight reduction in children with obesity is associated with improved health outcomes. The case of an adolescent diagnosed with obesity whose mother disagrees with the diagnosis illustrates several clinical challenges.

These include diagnosing a disease in an asymptomatic patient whose future risk for negative health outcomes is uncertain, addressing ethical implications of naming a stigmatizing disease, and resolving conflicting goals and opinions of a patient, caregiver and physician. This discussion focuses on navigating disagreement and implementing courses of action.

Peer-Reviewed Diagnosis Codes for Human Trafficking Can Help Assess Incidence, Risk Factors and Comorbid Illness and Injury. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is the system used by clinicians and medical coders to document diseases, symptoms, social circumstances and external causes of illness and injury. Current abuse codes, however, fail to capture the profoundly exploitative nature of trafficking and adequately distinguish trafficking patients from other types of abuse patients.

New codes discussed in this article—the first specific to trafficking—have been approved for the 2019 ICD-10-CM update. They are expected to help strengthen data collection on the incidence of and risk factors for trafficking, the burden of comorbid illness and injury, and the resources needed to effectively care for trafficked persons.

Infertility, Inequality and How Lack of Insurance Coverage Compromises Reproductive Autonomy. Disparities in access to infertility care and lack of insurance coverage for infertility treatment are two marked injustices in U.S. health care. The World Health Organization defines infertility as a disease, and infertility has multiple billing codes in use, but prohibitively expensive treatment and the lack of universal insurance coverage mandates combine to cause health care inequity, particularly along racial and socioeconomic lines.

In the journal’s December podcast, guests include:

  • Bioethicist and legal expert Katie Watson, associate professor of medical social sciences, medical education and obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University.
  • Ob-gyn Maryl Sackeim, MD, a fellow at University of Chicago.

In the episode, they discuss how the language physicians use to describe abortion can affect patients’ experiences and even cause them harm. Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on health care for undocumented immigrants and artificial intelligence in health care. Sign up to receive email alerts when new issues are published.