HAROLD MERSKEY VARIABLE MEANINGS FOR THE DEFINITION OF DISEASE*

ABSTRACT. It is argued that there is no agreed definition of disease. Purely biological definitions are inadequate and combined biological and social defini-tions are not yet satisfactory. One approach has been to say that what doctors treat is disease. We are uncomfortable with that because we feel it releases people from obligations on a basis of convenience. In practice the weight given to the idea of disease varies according to what it will imply about obligations and privileges. It is suggested that what doctors treat can be accepted as disease provided that we recognize that the significance of disease must vary with circumstances. Those circumstances include the agreement, more or less, of all persons affected when someone is considered to be a patient. The individual must also be competent and not constrained except by his own biological or psychological characteristics. Key Words: disease, patient-physician relationship, obligation. I. WHY WE MIGHT WANT TO DEFINE DISEASE The Country Wife by William Wycherley is one of the two or three most famous restoration comedies and still a popular play. Its plot turns on the deception practiced by a man who persuades his doctor to put it about that he has become impotent, so that his acquaintances trust him with rather ready access to their wives and daughters. A cynical friend commented on this play that it showed that one could get away with anything with the help of a doctor's note. Other possibilities of this sort, albeit perhaps less exciting, spring readily to mind. Men are released from military service, disability payments of considerable value are provided, legal excuses are established, family responses are altered, an