SNOMED CT Editorial Advisory Group

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A question from a member country on when to use "X (person)" vs. "X of subject (person)" has exposed issues with determination of equivalence in information models that either split the relationship from the condition or uses a precoordinated Situation concept to represent the SUBJECT RELATIONSHIP CONTEXT.

A report on the use of person concepts as values for the SUBJECT RELATIONSHIP CONTEXT attribute is located at: https://docs.google.com/spreadsheets/d/1LTPSInpRC_HMPniQANM8NL86WCieSAttoPYDS_yxjno/edit#gid=1

"X of subject" concepts were introduced and primarily used as values for SUBJECT RELATIONSHIP CONTEXT, but are currently modeled as subtypes X (person). Is Person the correct hierarchy for these to be placed?  
"X of person" was introduced to support the SUBJECT_RELATIONSHIP_CONTEXT of Situations.

A reference paper written in 2006 provides some historical background: https://confluence.ihtsdotools.org/download/attachments/17039782/Subject%20relationship%20context%20values_EDC_20060127.doc?api=v2

The main distinction made in the reference paper is that between an "Entity" and the "Role" played by an Entity.  However, this distinction is not made within the person hierarchy, with << 444148008 |Person in family of subject (person)| primarily representing roles that Person entities play being in the same Person hierarchy. Since the 444148008 |Person in family of subject (person)| is primarily used as values for the SUBJECT RELATIONSHIP CONTEXT attribute, we can question why it is in the Person entity hierarchy.


We are not separating roles from entities in the current hierarchies.  Because these are classes and not instances, we are constrained in how we can represent them.  This is more challenging in the current context of changing family constructions.  Father/mother and other familial relationships need to be explicit in that what is being referred to is the hereditary/genetic relationship between the patient and the subject relationship context. Need to consider the social context in this as well.  Do we need to separate out biological from social familial structures?  

In general, there is a feeling that we need to represent both the genetic and social constructs of familial relationships.  The X of subject (person) concepts were developed to support a specific attribute and should they be separated out.  

Fetus of subject is another issue. Do we need to be more specific in the definition of the SUBJECT RELATIONSHIP CONTEXT so we define explicitly what type of relationship we are trying to represent.  Is this an entity to entity relationship or an entity to role relationship?  

A related question to fetus.  

This is an issue in mental health as well that crosses over the biological and social aspects of relationships.

Questions

  • A question raised by the reference provided is whether a well-established role (e.g. father) can also exist as an entity?  
    • Can a father exist as a standalone entity without the establishment of a relationship to another entity?
  • Are familial relationships Roles or Persons?
  • Should X of subject (person) concepts be moved out from the Person hierarchy into their own "value set" to support the SUBJECT RELATIONSHIP CONTEXT attribute? 
  • How do we distinguish between the mother and the fetus in some procedures and disorders?
    • How do we handle "Fetus of subject" given the sensitivity of some members of having a (person) semantic tag?