Are we responsible for our lifestyle diseases?

Within the last couple of decades more and more research has shown a number of diseases, such as type 2 diabetes and cardiovascular diseases, to be associated with particular lifestyle characteristics such as smoking, lack of exercise, and over-eating. Confronted with such research, it is timely to raise questions about individual responsibility for getting those diseases (or the increased risk thereof), and to think closer about issues such as blame, stigma, and economic burdens.

For instance, a 2011 Danish study asked Danes whether weight loss surgery should be financed by the obese themselves (or the state). 46.5% responded yes, and 20.3% responded that they did not know. Most interestingly, however, 74.5% of those who responded that weight loss surgery should be financed by the obese themselves also responded that if there is evidence that the patient is not responsible for the obesity, then they would change their mind.

The common sense causal conception of responsibility

Are individuals with particular lifestyles responsible for increased risks of corresponding lifestyle diseases? Well, most of us associate the question of personal responsibility with causality. We cause or control our own behaviour and are therefore responsible for our own behaviour, other things being equal. However, the “other things being equal” clause is important. A great deal of research seems to show that obese parents, circumstances associated with lower socioeconomic classes, famine suffering during childhood, and certain genetic dispositions are factors that predict obesity to such a degree that we also have strong reason to believe they are causes of obesity.

Confronted with evidence of such unchosen causes, most of us seem to lower the strength of our judgment about personal responsibility for obesity. Even though we might be the cause of our actions, something external (or indeed internal) is causing us to do them. Social, biological, and environmental factors that are shown to causally influence individual lifestyle simply seem to count as responsibility-softening or even undermining.

Responsibility in a natural world

It is natural to think that all events have a set of necessary and sufficient causes. If so, then our actions are linked to causal chains that go way back in time, and obviously we cannot be responsible for them. If, on the other hand, some of our actions happen randomly, as some interpret quantum mechanics, then they are obviously outside of our control. Therefore, we cannot be responsible for anything neither in a deterministic nor a probabilistic world. Operating in a naturalistic causal framework, responsibility has only one possibility:

Agent-causality is the hypothesis that individuals (agents) can start new causal chains that are neither predetermined nor random. We ought to consider if we, as a matter of genuine free will, possess the ability to perform actions agent-causally. The problem with this hypothesis, however, is that as a matter of definition, agent-causal performance cannot have any further causal explanation. If someone decides to eat a cake agent-causally, then we can infer no causal explanation as for why she decided so. She decided so, and that is the causal explanation. But such an explanation is incompatible with our scientific worldview. Whether we study humans at a psychological, sociological, or biological level, we look for causes as for why we act as we do, and we explain our actions by reference to these causes. If an act actually results from an agent-causal performance, then a scientific causal explanation of that act is necessarily mistaken. Inferring to the best explanation, agent-causality is therefore mistaken, and holding the common sense causal conception of responsibility, we are logically forced to conclude that we are never responsible for anything. As a matter of personal responsibility for obesity and lifestyle diseases, or indeed anything, any new causal findings are necessarily redundant.

Alternative conceptions of responsibility

This conclusion is in no way new among philosophers. Finding it hard to accept it, however, many have attempted to come up with alternative understandings of responsibility that are immune to the implausibility of agent-causality. One approach, by Harry Frankfurt, determines responsibility as a matter of identity confirmation. According to Frankfurt, responsibility requires a correspondence between an individual’s first-order desire and second-order volition. A smoker who, by addiction, has a first-order desire to smoke might also have a second order volition not to be a smoker. If so, he is not responsible for smoking, on Frankfurt’s view, because smoking does not correspond to who he really wants to be. To be responsible, his second order volition should confirm his first order desire. Another general approach, most comprehensively laid out by Fischer and Ravizza, concerns whether we respond properly to reasons. If, for instance, an alcoholic would refrain from drinking the next bottle if we promised him a million euros, then he is reason-responsive, and other things equal, responsible for drinking.

New evidence of the causes of our behaviour makes no difference

However, these alternative approaches to responsibility, so-called compatibilistic approaches, do not operate in a naturalistic causal framework. They are immune to the implausibility of agent-causality, but therefore also to external causal explanations of our behaviour. The widespread common sense intuition that causal influences on our lifestyle count as responsibility-diminishing cannot be accommodated in these alternative approaches. They simply do not regard causality and the question of whether we are responsible for our lifestyle is therefore insensitive to empirical findings of social, biological, and environmental causes as for why we do as we do.

To conclude, any new evidence of causal influences on our lifestyle and disease-relevant behaviour will have absolutely no rational impact on discussions of whether we are responsible for our lifestyle diseases. On one hand, we can accept that responsibility is to take place in our natural world – in which case we can rule it out by way of mere conceptual thinking. On the other hand, we can deny that responsibility is to take place in our natural world – in which case new evidence of “external” causal influences on our lifestyle will not make any difference. It will not make a difference simply because responsibility, according to alternative approaches, is insensitive to any evidence of causes of our behaviour. Of these conclusions, we find it more rationally convincing to declare that we are, indeed, never genuinely responsible for any of our actions.

Featured image credit: Yoga by gazarow. CC0 Public Domain via Pixabay.