Broadening and Balancing the Goals of Medicine: Battling Disease and Treating the Healthy

Abstract

Boorse provides an elegant statement of medicine’s traditional goals of preventing, treating, and ameliorating the effects of disease. He also presents strong arguments that healthcare providers may ethically treat individuals when there is no disease present or threatened. To encompass such actions, he offers an additional goal of medicine: “(IV) Using biomedical knowledge or technology in the best interests of the patient.” Boorse points out that (IV) threatens to subsume the other goals, since preventing or treating disease is only ethical when aimed at serving the patient’s best interests. In this paper, I argue that (IV) does not subsume the other goals since sometimes healthcare workers battle disease or its effects without “using biomedical knowledge or technology.” For instance, a physician may soothe a patient with compassionate attention or folk therapies. Conceiving (IV) as supplementing the traditional goals of medicine, rather than subsuming them, generates a picture of medicine where confronting disease proactively or reactively remains central, even if additional uses of biomedical knowledge or technology are ethical as well. I describe how Norman Daniels’s account of healthcare justice fleshes out this picture. Finally, I argue that the ability of Boorse’s Biostatistical Theory (BST) to provide useful definitions for stating the goals of medicine and for grounding Daniels’s theory supports the BST’s account of disease and health.