On the moral obligation to be healthy

I started this post in May 2010, shortly after the event I termed Backpocalypse 2010 (in an ill-disguised attempt to use humor to distance myself from the pain and terror I felt), in which I injured my back to the point of needing to take a hiatus from my course of study at massage school. But while the personal resonance mentioned below has lessened some, the questions and issues involved are still here, and still concern me — and ought, I would argue, concern you.

Should we strive to be healthy? Most people would say yes.

Do we have an obligation — to ourselves, our families, our community (or country, or world for that matter) — to maximize our health; by which we are supposed to understand to mean our ability to function (to be “productive”, preferably in an explicitly capitalist way), and the longevity thereof? Maybe you wouldn’t say yes to this, but it’s the same question as above, just explicated a little.

I say no. Why?

As it stands, the moral obligation to be “healthy” according to the above definition is what:

  • gives fatphobes the “right” to comment on my appearance, my diet, my activity level, my life (because, of course, everyone knows that fat is unhealthy).
  • creates pressure on a pregnant person to use every test available to determine whether her pregnancy is “healthy enough” to continue, whether or not she herself wishes to.
  • supports telling some people that they are not good enough to have children in the first place — because how dare they risk passing their disability, their atypicality, their ill health, their moral failing on to another generation?
  • allows us to shame women for not breastfeeding, rather than focusing on the ways we can help her meet her own breastfeeding goals.
  • defends forced-medication rulings for those whose thoughts and emotions don’t fit society’s expectations.
  • allows us to tsk-tsk “those people” for not eating “right”, for making “bad food choices”, ignoring the multitude of reasons why people (especially those without class privilege) might eat “suboptimal” food.

None of that is OK.

The idea of moral obligation to heath has a particular resonance right now, when I feel the sting of inability, when I question my worth as I possibly fail, again, at a goal I have set myself.

Long ago I gave up on trying to fit into office work. Then I gave up (or set aside) the idea of being an academic student in a traditional college (which hurt far more than giving up temping, as you can imagine). Now I’m facing the potential loss of practicing massage therapy1, while simultaneously finding myself unable to eke out enough time to write, either. And I wonder: what is the point of me? Am I ever going to be able to make a living? If not, what good am I?

And the assumption behind those fears is, of course, highly problematic. It is the idea that we are only valuable for what we earn or produce — a capitalistic definition of “value”.

Which is not to say I “shouldn’t” want health or productivity for itself — nor that I should. Let’s just toss out all “shoulds”. The simple fact is that I DO want to do these things for themselves (I chose massage because I love it), and I DO want to be “productive” because I, like almost everyone else on the planet, want to be part of something (my community, my movement, my tribe, my family). The problem isn’t the idea of health2 or productivity; the problem is when we make those things moral obligations, rather than recognizing that they have inherent value, and that, lacking outside pressure, people will still want them for themselves.

When we make health an obligation, we create a hierarchy of people, based often on things outside of their own control. We say that some people are better than others, because of chance or choice or circumstance. We say that if you’re not “healthy” (by whatever criteria the judger has decided to focus on, often related barely or not at all to my or your or science’s definition of “health”), you aren’t working hard enough, you don’t know enough, you aren’t buying the right things. We allow people the grace of bad luck old chap if they can prove that it’s not their fault (and please, dear reader, take a moment to contemplate the impossibility of proving a negative, and the burden of having to do it over, and over, and over again), but still, under that, is the sometimes unspoken yet always detectable question are you really doing everything you possibly could to get better?

The burden this places on people — is placing on me — makes a difficult situation so very much worse (or, for some, turns what is simply and joyfully their life into a trial — not the state of their health but the social conversation around it is what drags them down). It’s not enough that we may not have the health we want, that our bodies may not do what we wish of them, that we may be limited in our choices: the moral obligation to health means we are failing those around us. It’s not enough that we may struggle, that I struggle: the moral obligation to health means we struggle with our society’s disapproval as well.

So no, I do not believe there is a moral obligation to health in some imaginary “objective” sense, nor that we as a society should impose one. Rather, I would say, society has the moral obligation to assist each person to be as healthy as ze wants to be (including, as my culture so spectacularly fails at right now, removing barriers to health and health care), and to respect the intrinsic motivation and decision making of its members.

Health — in the fullest sense of an individual’s optimal wellness, whatever that means to them — is not something we need to bribe or shame or obligate each other into pursuing. And to try is not only futile but counterproductive and often, as I feel so acutely now, cruel.

In the nearly-year since I started writing this, I have spent hundreds of hours in many practitioners’ offices working to regain my ability to move and to perform massage safely and without pain; have graduated massage school; and just this week passed the written portion of my licensing exam. The imposition of a “should”, an obligation, toward health added a layer of anxiety to my initial period of injury that this post reflects — but it was out of my own desire, not out of obligation, that I worked so hard toward recovery and that I continue to work on my physical wellness. It was only after coming to some sort of peace with the idea that I might not be able to perform massage — might not be productive in the way I’d so long planned, might once again fail, or defy, the expectations and pressures society places on me — that I was able to be centered enough to move forward, and do it in a way that was healthy for all of me, body and mind.

  1. Not a certain thing, but my back is not yet healed enough to perform regular, full-length massage, and in my darker moments I despair that it ever will.
  2. Though perhaps part of the problem is how we define health.
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19 Responses to On the moral obligation to be healthy

  1. Thank you for this. I agree that productivity and health as moral obligations have been constructed as such by modern capitalism and have no basis other than the assumptions that also support capitalistic logic. The result is often a maddening gauntlet of double-binds that those who do not live up to the ideal of health have to run just to be able to live lives that have value for ourselves, much less for those who would judge us.

  2. Liver Transplant

    Amen. One does not strive to be healthy as an obligation. Being healthy is a privilege. Working to be healthy is a good thing, but failing to be healthy is not a sign one is worthless. Ill health does interfere with things one wants to do, so one tries. But ones health is not under ones own control. One can influence it for the better, and certain actions can ruin ones health.

    Having survived a hospice death watch and a liver transplant, I know good health for what it is. A blessing. One that inevitably goes away for all of us.

    I hope yours comes back enough to actually do massages for income. Not because you must, but because you want to.

    Keep on keeping on. I really enjoy your writing.

    P.S. my own health is good at the moment, but who knows about tomorrow?

  3. This has echoes of child-rearing philosophies in it. There are parents who believe that they must meticulously train their children into “productive” behaviour, and those who believe that children will naturally want to be productive.

    And as I see the parallels, I find the fact that society treats us with such paternalism – like a parent “training” a child – to be a little bit alarming.

  4. Excellently thought-provoking piece. I’m not sure I’ve ever heard it framed quite this way, and it’s a perspective that needed to be shared.

    I also like Amber’s point about the parallel to parenting – what do we assume children will do left to their own devices without extrinsic rewards/fear of consequences for their actions? Actually, same goes for one’s political persuasion as well. What are your assumptions about human nature?

    Thinky thoughts.

  5. Poor health or lack of health…however you want to say, shouldn’t be the scarlet letter. BUT…

    Do I have a moral obligation to attempt to create the conditions for good health to occur in my children… to the best of my ability with external considerations provided? I can’t say no to that. Conversely, do I find it morally reprehensible that a parent who has the means and education to provide healthy food or environment consistently chooses not to? I can’t say no to that either. Do I as a mother have the obligation to strive for health (not necessarily to BE healthy/disease free/able bodied) but make efforts/attempts within my means? I can’t say no to that…

    • aps — My questions would be 1) obligation to whom? and 2) what ARE the “conditions for good health to occur in [one's] children”?

      Do you have an obligation to your child? Well, that’s more or less between your and your kid (or you and your conscience), and not for public discussion. If to society, then:

      Is there some objective, absolute value for these conditions by which society is to judge you, beyond shelter and food and some level of social interaction? Because I know parents who absolutely love and adore and are striving to do the best for their children who let them eat whatever they want and watch television all day, and others who eliminate all screen media and artificial substances, and each considers their way right and the other close to if not actually abusive (and the same dichotomy goes for those who, say, CIO v cosleep, or spank v GD, or school v unschool, or vaccinate v unvaccinate, or any other topic you care to name…). And I know still more parents who don’t have that kind of idealistic philosophy who consider it a win if their kids get fed and haven’t bled that day, and think their way is right, too, even though they aren’t “striv[ing] for health” as much as shrugging and saying “good enough”. And I’m not in a place where I want to call any of these parents “wrong” or “bad” or say they’re failing their obligation (I do have Strong Opinions on some of the topics and think some choices are wrong, but I still won’t declare the parents bad).

      Are there parents who really do, objectively, awfully fail in their duties, not even out of circumstance but out of lack of will? Some tiny number, yes. Just like there really are people who are out to hurt themselves and scam the social net. But they’re outliers only, not particularly relevant to this conversation. I decline to give them much attention, and I refuse to allow their existence to justify the judgment of the majority who are doing “good enough” and would continue to do so (probably better!) if the imposed obligation to do so were removed.

      As for an obligation for my own health to my kid(s) (if you really just meant you, then by all means, go for it, but I’m responding here to the generalization, as we’re talking about society and obligations), again I find that “obligation” does nothing to increase the likelihood of health and can instead put up barriers to it. If an individual feels differently, then great, whatever works for them, but I’m going to strongly resist anything that says I “owe” my child (or my partner, or my parents, or____) my health — or even “just” my striving toward it. If I want to move more freely so as to be able to do more with the Boychick, then it is a want, for my own quality of life and for the happiness it brings me to see him happy, and that is more than enough motivation. To turn that loving feedback loop into an obligation, something that I’m supposed to do, or I’m bad (or…?)? That seems obscene to me, as well as wholly unnecessary.

      (And if this comment comes across as antagonistic, I apologize; it is intended to be opinionated only.)

  6. **Applauds**

    Thank you for articulating what I have not been able to yet.

  7. I think a lot of this ties in to ideas of success and failure in our culture, as well (I say our because I know that even though you live on the other side of the country (and what are you doing THERE, Arwyn! sheesh!) you are in the same country as me and share that culture).

    In general, to be successful, you have to have a lot of money, and a nice house, and a car, and work a good job (usually a 9-5 and then work extra to be super-productive!) and married in a hetero marriage and have a dog and a cat and 2.5 kids and go on vacation every year and blah blah blah.

    Which, if that’s what someone truly wants, sure, that’s successful.

    Where I have the problem is that’s the only way to be successful – much like being able to do that is the only way to be considered healthy.

    I’ve been working a lot this year on redefining successful for myself (because I have deep-seated notions that the whole 9-5 thing, and how miserable so many seem to be doing it, means that we’re sincerely DOIN IT WRONG), and now having read this, I think I need to redefine healthy, as well. I am not a moral failure if I don’t have a 9-5 office job, and I am not a moral failure if my back goes out again and I can’t walk.

    So, thanks :)

  8. Pingback: An Open Letter to Those Who Judge the Morality of Health | Live Once, Juicy

  9. LivingTheQuestions

    Have you seen the new book, Against Health: How Health Became the New Morality ? I quite liked it, and given this post, if you haven’t already read it, I think you might, too.

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  11. Last night I attended a discussion that defined moral studies as determining what would create well-being in people, including health. One person made the argument “if I want to spend my days smoking heroin, I should be able to do that, as long as I don’t end up in the hospital and you have to pay for it, then it’s not immoral”.

    The discussion centered around the fact that most people don’t have to be forced not to drug ourselves to death, because we have plenty of natural motivation not to do so, but that got me thinking. Who says I shouldn’t have to pay for said hospital visit? If someone is willing to do that to his own body, would he really stop and say “oh no wait, I can’t do this, they won’t treat me at the hospital afterward”? And if that were my own son in the hospital, wouldn’t I want him to be treated?

    What angers me is that we treat those among us who are fat in the same way, as though we even should put their right to be fat and still receive health care on the table for debate. We even dare to call them immoral for inflicting “their” fat upon “our” health care system (notice how it’s never their system too). I try to avoid slippery slope arguments, but I can’t help but think “what will be the next unforgivable sin?” Being pregnant (this arguably already is)? Being over the age of 65 (ditto)? Living more than 5 minutes away from the nearest emergency room? Going outside during the day for even a minute without full sun-block, shades, and a wide-brim hat? Clearly all these people are a burden upon the rest of us!

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  13. What you are describing sounds very much like a description of the sick role-the idea that in return for the priviledge of not working (or not being productive in whatever way) people have to constantly prove thier inability to be productive and will be punished by thier social group if they do not. There is a moral and social obligation.
    Let me just insist that this isnt my idea and although I find the sick role pretty disgusting for many reasons (invisible disabilities for one) it is something that you see a lot of in life. People are punished for not being obviously sick enough.
    I think its part of fat bias -fat is a sickness/disability-sick people are less/not productive- fat people are therefore less productive. To “deserve” the sick role (which fat people are supposedly claiming by being fat) fat people must constantly be trying to lose weight to avoid the punishment attatched to not doing so.
    It doesnt seem to me a truly moral thing though but a purely social one- “if we are having to work so hard to be productive, why arent you unless you can prove to us you are sick”

    just a few thoughts- what do you think?

    • Ruth — I think your analysis is pretty well right on, alas. I’ve watched friends here in the US try to get on Social Security Disability, and they basically have to prove themselves completely incompetent (it’s not enough that they have more challenges and that the world doesn’t want to employ “people like them”, they have to prove near-complete incapacitation) — and then, if they do get it, have to go through “job training/placement” workshops, because otherwise they’re “lazy” and a “drain on the system” (and “probably cheating” to boot). It’s absolutely awful.

      I think the fat stigma is a related but distinct idea: like I mention above, it’s sort of ok to be sick if you’re REALLY sick, but heavens forbid you don’t do absolutely everything to try to be “better”, because then you’re just being (again) “lazy” and a “drain on the system”. Combined with the cultural hallucination we have that fatness is a product of low willpower and is completely changeable if we just try, then to prove that we aren’t simply lazy slobs we have to both try to lose weight AND (more importantly) be seen to be trying, to avoid that stigma.

      And re moral v social: morality is, I would argue, entirely socially constructed. What makes the difference is the weight we attempt to place on each value/obligation/whatever: we can (ok, most of us, most of the time) accept that, say, bowing versus hand shaking is pretty much a social difference, but, say, bikinis versus burqas? Cue HOLY MORAL OUTRAGE, BATMAN!!!11!! Even though which one is acceptable and which isn’t in any given location is just as socially constructed as bowing or shaking hands. And one of the reasons the imposed obligation to be “healthy” (as opposed to healthy per my definition) is so problematic is that, at least in this culture (I cannot speak to any other), we’ve given it so much weight (heh) that it is seen as a moral issue, not merely a social one, giving the judgers the “right” to declare that anyone not (being seen to be) striving for maximal “health” is not just outside social norms, but objectively a bad person. Which seems to me, if you’ll pardon me this, pretty damn morally reprehensible itself.

      …yeah, tangent. Not even sure where I started there, but there ya go. You got some thoughts back. :)

  14. Been thinking on this one for a while…because while the moral obligation part clearly falls on me (fat, asthmatic, thyroid issues that are clearly genetic given the family history)….the part of it I worry about is my kid.

    There’s been a lot in the news lately about cutting medicaid, because clearly all those poor people and people on disability who get it ought to get off their asses and be not sick, because they’re a drain on the rest of us.

    A friend reports that one of her state legistators (in Utah) has said that taking tax money from people to pay for things like medicaid is *stealing* from them. Said legistator wants to get rid of medicaid entirely, and figures people can have BBQs as fundraisers if they can’t afford their treatments.

    Here’s the thing though. We have insurance (I’d venture to argue we have a top of the line “Cadillac” type plan, given the things that have been covered without question or denials that needed to be appealed). We did *everything* we were supposed to do (and you know what I mean when it comes to all the crazy rules about what pregnant women can and can’t do). And yet my son was still born early, and in need of significant medical intervention. His NICU bill alone was over $2 million – and no matter how good your insurance is, your copays on that will bankrupt just about anyone.

    He gets medicaid as a backup through a waiver – a very hard to get piece of paper that says that even though we make too much and own too much to get their help…he was so sick that if we lost our insurance, he’d end up in a medical facility, and then he’d get medicaid anyway. It’s *cheaper* this way – cheaper to keep him at home than to put him in a hospital or nursing home.

    Now, not every kid is like mine – mine is growing and healing, and will likely lose his waiver spot this summer because of how much he’s improved. By the time he starts kindergarten, everyone will assume he’s a “normal” kid who will grow up to be a “productive” member of society….but not every family is so lucky, and it’s often impossible to judge at a very early age which kids will be ok in the long run. Not that he won’t still have issues….just that the things that are left are more normal, and thus less likely to draw the kind of attention that his current slew of tubes and machines cause – asthma, for example, and being an amazingly picky eater, and maybe not running as quickly as other kids.

    So….that moral obligation thing? Yeah. It’s gonna hit my kid like a ton of bricks one of these days, and of all the things kids ask their parents, things like this scare me the most.

    What’s it worth to society to trade the moral obligation to *be* healthy for the moral obligation to help those who need help?

  15. My sister had MS and it eventually stole her ability to move anything but her head (and then later to breathe). She said one of her biggest struggles was with being a “bad” patient – doctors didn’t like her because her body refused to get better. (She finally found a good doc whose ego wasn’t tied up in her recovery). You see, good patients make progress, good patients get better because they “fight” and have some kind of strength of moral character that allows them to recover, while bad patients just keep getting worse.

    I’m almost 50 and it is only recently that I have switched my mindset from “I should get healthier” to “What do I want my body to do?” I want to be healthier to be more capable, not to please anyone else. That is making all the difference.

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