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01-03-2012 | Original Article

Health and Morality: Two Conceptually Distinct Categories?

Author: Per-Anders Tengland

Published in: Health Care Analysis | Issue 1/2012

Abstract

When seeing immoral actions, criminal or not, we sometimes deem the people who perform them unhealthy. This is especially so if the actions are of a serious nature, e.g. involving murder, assault, or rape. We turn our moral evaluation into an evaluation about health and illness. This tendency is partly supported by some diagnoses found in the DMS-IV, such as Antisocial personality disorder, and the ICD-10, such as Dissocial personality disorder. The aim of the paper is to answer the question: How analytically sound is the inclusion of morality into a theory of health? The holistic theory of Lennart Nordenfelt is used as a starting point, and it is used as an example of a theory where morality and health are conceptually distinct categories. Several versions of a pluralistic holistic theory are then discussed in order to see if, and if so, how, morality can be conceptually related to health. It is concluded that moral abilities (and dispositions) can be seen as being part of the individual’s health. It is harder to incorporate moral virtues and moral actions into such a theory. However, if immoral actions “cluster” in an individual, and are of a severe kind, causing serious harm to other people, it is more likely that the person, for those reasons only, be deemed unhealthy.

There might also be some theoretical reasons, e.g. within psychiatry and psychology, for being able to categorize people and their mental states.

Note, however, that medicine and health care sometimes take care of states that do not normally belong to the category of ill health, e.g. pregnancy. Thus, defining terms like “health” or “disease” does not give us absolute answers as to what kinds of issues medicine and health care should deal with.

It might be claimed that Bill Fulford’s theory is such an attempt—a theory where ill health is defined as “action failure” related to “ordinary doings” [8]. It is, however, unlikely that these failures refer to manifest actions. Rather, they refer to the possibility to act, i.e. failures were the person to try (see [15]).

Note also that theories that see health as the absence of disease, and diseases as dysfunctions, in general, do not consider immoral acts as instances of ill health, i.e. disease [2]. They might, however, see immoral acts (or intentions) as caused by dysfunctions.

Tengland [25] presents a theory of mental health built upon Nordenfelt’s general theory of health, and where no explicitly moral criteria are found either.

To have the second order ability is to have the ability to acquire first-order abilities, e.g. to be able to learn a trade (if the person tries to and there is an opportunity to do so).

Most cases of ill health are caused by disorders. Nothing will, however, be said about the relation between health and disorder in this paper, since for the present discussion there is no such need.

Health, as we have seen, has to do with the (2nd order) ability to reach vital goals. Thus, to be healthy is compatible with not acting to reach these vital goals. The individual might choose not to try (or she might be stopped from doing so). This might be seen as indicating that immoral vital goals and other vital goals do not have to come into conflict, since the person might choose to act on one vital goal but not the other. However, one cannot claim that a person has the ability to reach all her vital goals (a requirement for having full health) unless they could all be reached if she tried. Thus, abilities (to reach vital goals) can be incompatible after all.

Even though the former one is better at solving the problem. See Sen [23] for an objectivist theory of quality of life.

Note that this makes health (the ability) slightly less valuable (for the individual, but perhaps not for society!), since all typical societal goals might not be vital or important to a particular individual.

Some of these “automatic” (or inborn) abilities can also be seen as dispositions, e.g. the disposition to perceive (see, hear, feel) when conscious and exposed to the appropriate stimuli.

These abilities might, in the end, have to be related to quality of life (see [26]), in such a way that in order for them to be “health related” they would have to contribute to the quality of life of the individual (see [14]).

The suggestion comes from Bengt Brülde (personal communication).

Carol Gilligan, for example, has criticized Kohlberg's theory for being gender biased [9].

The “body functions” and the “body structures”, which are also part of functionings [29], are probably best interpreted as states and processes that support the health of the individual, i.e. her activities and participation.

Note that, as distinct from (intentional) abilities, vices (as well as virtues) must be displayed, since this is how they are defined, i.e. as dispositions or tendencies.Theoretically, at least, a person can have an ability without ever displaying it, e.g. the ability to throw an object.

Fictive persons or figures, such as Ebernezer Scrooge in Dickens' A Christmas Carol, or the Grinch, are in general not considered unhealthy, but only evil, greedy and egoistic, due to the fact that they are unhappy.

Excluding, perhaps, some of these kinds of clusters of immoral acts when they are conducted in war, or related to certain deeply rooted social practices, such as blood feuds, or mafia traditions.

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Title: Health and Morality: Two Conceptually Distinct Categories?
Author: Per-Anders Tengland
Publication date: 01-03-2012
Publisher: Springer US
Published in: Health Care Analysis / Issue 1/2012
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI: https://doi.org/10.1007/s10728-011-0172-1

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