Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. The Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaisance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. The rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led (...) to a reaction against the agressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrest control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates. Keywords: "responsibility for health: social, personal, or professional?", "causes of illness", "self-reliant health care", historical influences, responsibility for health, "victim-blaming" CiteULike Connotea Del.icio.us What's this? (shrink)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is (...) a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction. (shrink)

Why has little progress been made in resolving the debate about the concept of sexual perversion? I suggest that the stalemate is due to misunderstandings and poor methodology. I develop a new methodology for resolving disputes about the correct analysis of the contents of concepts where the disputes have social and political ramifications. When deciding between competing analyses of a concept, we should not just consider facts about our inferential and judgemental dispositions with respect to that concept; we should also (...) incorporate facts about its desired social function. This provides additional resources for making decisions about which analysis to choose, when information about our dispositions alone cannot determine an answer. (shrink)

The purpose of this article is to set out an Aristotelian account of individual autonomy. Individual autonomy is the capacity of the individual to make and act upon judgments for which he is held morally accountable. This sense of autonomy may be contrasted to a number of other senses. Of these, the most important are political or legal autonomy and Kantian principled autonomy. Political or legal autonomy concerns the environment in which an individual operates. It exists where individuals are able (...) to operate reasonably freely.1 For the most part we will not consider this sense except insofar as it is necessary to explain the importance placed on respecting individual autonomy. Kantian principled autonomy has been described recently by Onora O‟Neill in a series of writings.2 On this account, autonomy is seen as a characteristic of the principle behind action rather than of action per se and is not a characteristic of agents at all. (shrink)

I believe that the data is both fascinating and instructive, but in this paper I will resist the conclusion that we must give up Invariantism, or, as I prefer to call it, Unificationism. In the process of examining the challenging data and responding to it, I will try to draw some larger lessons about how to use the kind of data being collected. First, I will provide a brief description of some influential theories of responsibility, and then explain the threat (...) to them from the experimental results. Finally, I will set out my general approach to the data, as well as some specific suggestions about how to think about each set of experiments. I will conclude that philosophers searching for a unified theory need not give up, but that at the same time they can learn a great deal from the new data. (shrink)

The medical profession and medical ethics currently place a greater emphasis on physician responsibility than patient responsibility. This imbalance is not due to accident or a mistake but, rather is motivated by strong moral reasons. As we debate the nature and extent of patient responsibility it is important to keep in mind the reasons for giving a relatively minimal role to patient responsibility in medical ethics. It is argued that the medical profession ought to be characterized by two moral asymmetries: (...) (1) Even if some degree of responsible behavior from patients is called for, placing the dominant emphasis on professional responsibility over patient responsibility is largely correct. The value of protecting the right to refuse treatment and arguments against paternalism block a more expansive account of patient responsibility and support a strong notion of professional responsibility. (2) Insofar as we do want to encourage an increase in patient responsibility, we have good reasons to emphasize prospective rather than retrospective notions of responsibility in clinical practice. Concerns about patient vulnerability along with the determined factors in disease leave little room for blame at the bedside. These two asymmetries generate normative limits on any positive account of patient responsibility. (shrink)

Many believe that it is morally wrong to give lower priority for a liver transplant to alcoholics with end-stage liver disease than to patients whose disease is not alcohol-related. Presumably, alcoholism is a disease that results from factors beyond one's control and therefore one cannot be causally or morally responsible for alcoholism or the liver failure that results from it. Moreover, giving lower priority to alcoholics unfairly singles them out for the moral vice of heavy drinking. I argue that the (...) etiology of alcoholism may involve enough control for the alcoholic to be responsible for his condition and accordingly have a weaker claim to receive a new liver than someone who acquires the disease through no fault of his own. In addition, I show why it is more plausible to reframe the question of priority in terms of control and responsibility rather than virtue and vice. Given that medical resources like livers are scarce, some people may justifiably be given lower priority than others in receiving these resources. (shrink)

When does behavior trigger a lesser claim to medical resources? When does chronic drinking, for example, mean that one has a lesser claim to a liver transplant? Only when one's behavior becomes a callous indifference to others' needs—when one knows the consequences of heavy drinking and knows that by drinking one may end up depriving someone else of a liver.