Medicine as Morality

Religion has given way to relativism in the popular American mind over the past century, and I would like to discuss what I believe is an attendant social consequence. There was a time when Judeo-Christian religious morality provided the foil and the mold for individual consciences, at least to a larger extent than today. Unquestioned beliefs were more or less in accordance with its dictates. Adultery, drinking, and gambling were wrong because they were prohibited by God and his representatives—which is not to say people did not engage in sinful activities, but there was a public sense that they were in fact sinful, because there was a public sense of the universal applicability of Judeo-Christian morality. This public sense of sin manifested itself in two effects: guilt in the sinner, and condemnation in the observers. In the case of premarital sex, for example, one or both partners might have felt (both at the time and afterwards) as though, led on by temptation, they were doing something wrong, and any third party who found out would feel the weight of the masses contained within their condemnation. I realize I am painting in broad strokes here, but I am less interested in creating a portrait of the past than of the present.

Today we believe we have largely eliminated this unthinking belief in religion’s objective morality. The weight of the masses appears to be against the condemners of premarital sex, not its practitioners. There are still actions that are generally held by society to be wrong, but in many of these cases there is, ultimately, a relativistic uncertainty to any condemnation, an awareness of the lack of firm ground upon which to stand. Is gambling inherently wrong? Why? How do we know? Who today can answer these questions without resorting to religion and alienating the secular audience?

A religious conception of absolute morality is dead, but its former place does not sit empty. We no longer believe in an afterlife where sins against absolute morality will be punished, but we seem to see that in our present life certain actions are punished. At times these actions are even associated with one of the identifying marks of sin, temptation. Our new god is named Health, and there is little room to doubt its dominion. When we trespass against its sometimes convoluted dictates, the results are often visible within our lifespans, sometimes within a few days or a week. If we overeat, we may get a stomachache. If we drink too much, we may wake up with a hangover. If we smoke for too long, we start to cough and wheeze and eventually develop cancer. The similarity to religious doctrine, where these punishments were merely deferred until the afterlife, is too much for us to miss. Having committed one of the above-mentioned sins—overeating, drinking, smoking—we may feel remorse the next day, we may even feel disgusted with ourselves and resolve to expiate our sins through healthy living. We sometimes view exercise and eating healthy like monks of the Middle Ages viewed mortification of the flesh and fasting; ordeals to undergo in the present in the hope of a future reward for our faith.

This public sense of unhealthy activities as sin is not only demonstrated in individual feelings of guilt. Indeed, in matters of health the public sense appears to give observers free rein to criticize and condemn. It is one thing to entreat your friend or relative to stop smoking, for their own good and the good of those (like you) who care about them. It is another thing for smokers to receive hostile looks and lectures from strangers or distant acquaintances, as often happens. There is more than mere humanitarian concern behind these looks and lectures; there is a strong element of moral condemnation. This easy prejudice against smokers surely contributed to the smooth passage of recent legislation against indoor smoking (in bars, restaurants, and public places) in Italy, France, America, and other Western countries.

So medicine provides a seemingly objective moral structure for a society cast adrift by the death of God. Is there a problem with that? I would say so, because this vision of health is unrealistic. For one thing, bad diseases happen to good people. This is obvious enough that faultless diseases are not usually held against their sufferer (although see Susan Sontag’s “Illness as Metaphor,” where she discusses the common metaphor of cancer as the result of self-repression.) Prostate cancer, for example, which afflicts the majority of men over a certain age and is not linked to any particular vice, is not seen as a punishment. In other cases, though, the popular imagination triumphs over scientific fact. For example, not all fat people eat more than all thin people; as is widely known but vaguely disbelieved, there is such a thing as a genetic predisposition to obesity, and some people’s metabolisms allow them to eat tremendous amounts without their waistlines expanding. This does not stop discrimination against the obese, who must be among the most common victims of the confusion between medicine and morality.

But this, the lumping together of all fat people as gluttons, is not the main problem. The problem is that these supposed sins—overeating, smoking, drinking—are entirely individual matters except for their impact on public health (taking up hospital beds, using public money for medicines), which are sometimes seized upon as excuses to make them public affairs. Of course these claims should be evaluated on their merits, but I think the impact on public health—the negative externality of smoking, overeating, etc.—is easy to exaggerate. If concerns over public health do not justify poking our noses into others’ supposed sins against health, nothing does. Judging someone for overeating is like judging someone for buying an umbrella we find ugly. It is true that in his place I might make a different decision, but this is about the strongest non-health statement we can make. Our confusion between medicine and morality causes overeaters, smokers, and drinkers to feel pangs of religious guilt, often superseding entirely their concerns for their health. We demand expiation from them as though in supposedly trespassing against themselves they have trespassed against the rest of us as well.

As a sort of postscript, I can think of one other institution with a somewhat similar effect to medicine as a substitute for objective morality: money. I have heard economists distinguish three uses of money: as a medium of exchange, a unit of account, and a store of value. The fourth use of money is as a measure of karma. In those social strata where spending more is a bad thing, money allows consumers to measure their sins down to the penny. Living frugally can be a cause for quiet pride, while consumption viewed as luxurious or unnecessary is a “guilty pleasure.” Again, as with health, the more virtuous mode of living (frugality) is seen as more ascetic and disciplined, while the sinful mode (excessive spending) is seen as indulging in sensuous temptation. Perhaps this is the general pattern: in the modern day objective-seeming moral systems arise from the confluence of seemingly objective measures (like money and health) and the empty shells of religious sin and virtue (temptation and asceticism).

Questions for commenters: Can you think of any other institutions, along the lines of medicine and money, that serve as substitutes for objective morality? Can you think of any that don’t currently play that role but could potentially in another time and/or place?


2 Responses to “Medicine as Morality”

  1. the transition from christian morality to a morality of public health has produced some very strange side effects, most notably beliefs wrt healing held by sects like pentecostalists and christian scientists, both of which are inclined against the use of medicine.
    pentecostalists believe (or at least believed, 100 years ago) that one could be healed by way of faith, and that conversely sustained illness is a sign of bad faith. an example: “Sickness is born in a child just as original sin is born in the child. He was manifested to destroy the works of the devil. Every sickness is of the devil.” how’s that for an unexpected source of support for your thesis?
    ps christian scientists apparently have the same sort of thing going on but place the locus of power in people instead of jesus–so you’re actually healing yourself instead of making yourself available for christ’s healing.

  2. “Medicine as morality” has become our truth for sure. In Margaret Talbot’s 11/3 New Yorker article on premarital sex, sociologist Mark Regenerus is quoted as saying that unprotected sex has become “a moral issue like smoking or driving a car without a seatbelt.” And this without a trace of irony.

    A moral issue like driving a car without a seatbelt? Are all the other examples of “moral issues” really so obsolete?

    (Note: My interpretation of Regenerus holds iff we assume both that Talbot is quoting absolutely fairly and that Regenerus’s English grammar is spot on. And I think we can–it’s the New Yorker, after all.)

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