The Problem:
From the publication of De Veritate by Edward Herbert to the publication of On Liberty by John Stuart Mill, more than 200 years later, there is a veritable straight line. Whether or not Herbert understood the impact of his rejection of systematic theology and Scripture as the basis for understanding what it means to be human, doesn’t matter here. His rejection of any apriori definition of human being is, because, inevitably, the absence of an apriori definition of what it means to be human led directly to Mill’s Principle of Harm. Mill’s Principle of Harm has had a disproportionate impact on life in the 21st Century.
In short, if you aren’t familiar with the Principle of Harm, it comes down to this: Unless you can prove that my personal choices will harm you in some quantifiable, verifiable, way, stay out of my life. You can’t tell me what to do. Whether someone on the far right refuses to wear a mask or be vaccinated, or someone on the left who asserts, “My body, my choice,” all moral decisions come down to whatever the individual wants to do or determines is in his or her best interest. Nothing else enters into the equation. Neither does any sense of a “common good,” or “moral absolute.”
Theoretically, the Principle of Harm is implicitly counter balanced by the principle of redress. When I harm you, or you harm me, it falls to the society as a whole, to the government, to fix the harm that has been caused. Not quite an eye for an eye and a tooth for a tooth, but, nonetheless, an important guarantee, and an important check on everyone’s right to everything. I can act as I choose, I can choose whatever I want, however, I need to bear in mind that my actions might have harmful consequences, and I will be held responsible for them.
Well, just as there is a veritable straight line from Herbert to Mill, there is another from Mill to Situational Ethics, authored by Joseph Fletcher. Situational Ethics removes intentions and consequences from the equation of moral deliberation. Only the moment matters, and, in that moment, there is but one question: What is the loving course of action in this moment? Now, as much as Fletcher argued that if we chose agape, dispassionate spiritual love, over eros, which is to be understood as any form of love not purely dispassionately spiritual, we will always make the correct choice in a given moment, yet in fact, in a consumer culture, in a society that recognizes no common good or moral absolute, eros always wins.
So, Fletcher didn’t know, or understand, that, in less than a decade, Situational Ethics would give rise to the anthem of the 1960s — If it feel good, do it. And, about 20 years later, to the anthem of contemporary American culture: Just do it. I want to be very clear: Whether you stand to the right or to the left, the net effect is the same: Just do it. Just doing it has become the definition of freedom in America. It has become the justification for being “pro choice,” for abdicating the idea that one is responsible for one’s actions, as much as it is the justification for not regulating guns, not wearing a mask, getting a vaccine, or even paying taxes. If you offend me in an way, I just ghost you.
The principle of redress is now viewed as a needless imposition on our personal freedom. On the right or left, we resist any attempt to hold us accountable for our actions.
So, what has this got to do with healthcare? Ah, it has everything to do with it.
Our understanding of the Principle of Harm, which could prove to be very different from Mill’s understanding, leads us to conclude that:
Unless you or the society as a whole can demonstrate a clear, measurable, quantifiable, tangible, harm, one does not exist. Therefore, I am free to do whatever I choose.
If it involves my body, I have complete autonomy without regard to the social consequences. I can smoke if I want to smoke. I can be obese if I want to be obese. I can refuse to be vaccinated or wear a mask, and, if I so desire, I can take deworming medicine designed to be used on horses to “cure” COVID. I can eat whatever I want, even if I know doing so will impact my health. I can decide to have an abortion without allowing the person with whom I had intercourse to have any say in the matter. I can change my gender, change my sex, own as many guns as I want, promote conspiracy theories… All without limit and without your interference.
Except, I expect you to save me, to invest any and all resources on my behalf, when I have a stroke, contract COVID, have a heart attack, get lung cancer, diabetes, an STD, break a hip when I fall because I am too heavy to carry my own weight…. Add whatever you want to the list. I expect you to take care of it even though I never once thought about the impact of my choices on you, the society as a whole, or the healthcare system.
And no, I don’t want to pay for healthcare. It is just too expensive. Needlessly. Since I don’t want to be responsible for the consequences of my decisions, I shouldn’t have to be responsible for paying for my care.
It is amazing, given this view of the world, that people even stop at a traffic light, wear a seat belt, or adhere to any sense of law and order. Or, perhaps, we will simply reach a point where, if I don’t want to stop at a traffic light, if I don’t want to park where I am supposed to, I won’t — I won’t and I won’t accept the consequences. After all, the First Amendment….
Well, all actions, even masturbation, it can be argued, have social consequences. We can pretend they don’t exist, or that we aren’t responsible, but they exist and we are. Or, put less politically correctly, your refusal to be responsible and to acknowledge that a common good does exist does hurt me. I pay higher healthcare costs. When you can’t pay when you go to the ER, I pay that. Not directly, but I pay. When you refuse to lose weight, you are costing me money too because you skew the statistics which now suggest that at my age I am more likely to have a stroke, diabetes, or other related disease because, most likely, I too am assumed to be overweight. When you smoke and get cancer, I pay for that too, and when you refuse to acknowledge there is a common good and thus do not agree to be vaccinated, I pay for that too.
We all pay. Some of us pay more directly — if my father had a stroke and there were no ICU beds available because they are being used by people who have been irresponsible and selfish — people who chose not to be vaccinated — my father would pay with his life. You wouldn’t know, and you likely wouldn’t care because, as far as you are concerned, you are the only important person. Only you matter.
The Solution:
The only way forward is to reinstate the principle of redress. This is our only hope.
So, this is what I propose:
We, as a society, acknowledge and accept your autonomy.
We, as a society, will hold you responsible for your decisions. This is the principle of redress.
In very clear terms, this means:
You have a right not to agree to be vaccinated. However, if you contract COVID, you are on your own. We will make you comfortable. Nothing more.
You will be expected to pay for any and all costs associated not only with your choices, but to compensate those who are harmed by your choices. So, if you give me COVID, you get to pay for my medical bills as well as any lost wages.
You have a right to smoke. However, if you contract cancer, you are on your own. We will make you comfortable. Nothing more.
You have a right to be obese. However, if you contract diabetes, have a stroke, or other directly related disease, you are on your own. We will make you comfortable. Nothing more.
For any and all diseases related to the life style which you have chosen, we will do nothing to intervene. We will take no action save to make you comfortable as you die.
If as a result of your refusing to wear a mask, be vaccinated, or, if you have a transmissible disease, COVID or HIV, for example, and you infect someone and they become ill because of your contact with them, you will be charged with reckless endangerment, and, as noted above, you will be billed accordingly. If you transmit the disease and the person to whom you transmit the disease dies, you will be arrested and tried for manslaughter.
Since your actions hurt us, then, we will institute a “health tax” on all the unhealthy choices you make. You want that Baconator Combo for $9.40, well, we will add a progressive tax, which, over three years will take the cost of that combo to $19.00. Want a refill on that 32 ounce carbonated drink? Sure, ante-up another $1.00. From potato chips to heavily salted fries, whatever it is, if it is unhealthy, it will be taxed. We will use this money to offset the cost of your bad decisions on our lives.
Will this be pleasant? No. Painful? Oh, yes. And that is the point. You did it. You own it. That is the end of it.
