The doctor walks in.
Head burrowed to his chest, meticulously scanning the diagnosis before him.
Perturbed, he seemingly stares at the file as if it were staring back.
Equally bewildered, the awaiting patient nervously inquires, “C’mon, already!”
The doctor making immediate and sharp eye contact promptly replies, “I’m sorry, but this cannot be correct. It can’t be heart disease because you’re an asshole!”
Could you imagine?
What’s a diagnosis without a moral judgment?
If you live an immoral life, chances are you suffer not from disease but a choice.
Thus, heart disease is not a disease but a choice…
This is unbelievably illogical and if you believe it chances are you’re an asshole 🙂
The Role of Morality in Diagnosis?
Something should appear off to you in the above anecdote.
The real question is: Should morality in any form enter into a diagnosis?
Does not diagnosis belong to the scientist?
Should not science, per Karl Popper, must be falsifiable?
“In so far as a scientific statement speaks about reality, it must be falsifiable; and in so far as it is not falsifiable, it does not speak about reality.”
Therefore, either morality is falsifiable and qualified to enter the realm of diagnosis or it’s an unnecessary component.
This article is not an attempt to undermine the importance of ethics in scientific research. That would be the height of folly. I am, however, arguing against morality being a qualifier in medical diagnosis.
LiveScience.com proposes the following definition:
The word “science” is derived from the Latin word scientia, which is knowledge based on demonstrable and reproducible data…True to this definition, science aims for measurable results through testing and analysis. Science is based on fact, not opinion or preferences.
- Is Morality Objective or Subjective?
- Is Morality Fact or a Preference?
- Is Morality Relative?
These questions plague contemporary thought, most philosophers denying morality being anything other than a language game localized within the confines of a specific community. However, no one really operates as if morality is simply preerence. Ergo, the dilemma.
To the point, morality being falsifiable even indirectly is met with deep skepticism.
It cannot be objectively grounded in facts reached inductively (e.g. scientific method), It is seemingly beyond the scope of the scientist and is universes detached from objective diagnosis.
If your heart is riddled with heart disease and this has been proven through testing and analysis then your moral choices have absolutely nothing to do with the fact of that diagnosis nor the concept of disease, at least not in the moral sense.
This, however, does not mean morality doesn’t play a role in treatment – it’s a crucial social component. Nonetheless, the opinion (moral judgment – designating an individual as immoral), must be separate from the scientific fact (diagnosis according to the proper scientific concept of disease).
Further, if one is diagnosed with heart disease this does not somehow negate personal responsibility for their prior mode of living. If the individual with heart disease was a thief this is not somehow perfectly acceptable now that they have a disease.
Social conventions and/or religious standards determine moral responsibility. This sphere of understanding is outside the scope of the scientific method; it’s more philosophical or theological in nature.
Again, what I am attempting to emphasize is that whether an individual is immoral or not does not enter into the facts of the diagnosis.
Heart disease is present because measurable results through scientific data and analysis deem it to be. In like manner, addiction as a disease can be quantified.
Why Is The Disease of Addiction Often Denied on Moral Grounds?
This article is primarily about the scientific CONCEPT of disease. Moreover, it is about how addiction is a disease per the above concept; regardless of how you may FEEL about the subject.
Nonetheless, this is why the disease concept is often denied on moral grounds – because it ‘feels’ like a cop-out, it ‘feels’ like an injustice.
Unfortunately, the scientific method cares little for personal feelings. So, chances are if you are arguing against addiction as a disease then you have an entirely different concept of disease then what science proposes.
Therefore, as you can see, the argument is over concepts; so what is your concept based upon?
The addict may or may not be an asshole – but this is completely distinct from the disease diagnosis.
Regarding the issue, Peg O’ Connor writes,
“A little logic is helpful here, since the “choice or disease” question rests on a false dilemma. This fallacy posits that only two options exist. Since there are only two options, they must be mutually exclusive. If we think, however, of addiction as involving both choice and disease, our outlook is likely to become more nuanced. For instance, the progression of many medical diseases is affected by the choices that individuals make. A patient who knows he has chronic obstructive pulmonary disease and refuses to wear a respirator or at least a mask while using noxious chemicals is making a choice that exacerbates his condition. A person who knows he meets the D.S.M.-IV criteria for chemical abuse, and that abuse is often the precursor to dependency, and still continues to use drugs, is making a choice, and thus bears responsibility for it.”
Addiction is a Disease and Addiction is Not a Disease.
–The Hijacked Brain Theory—
The brain is not dishonest even if the addict may be; the grey matter discloses all. The current model displays distinct features of a hijacked brain; a diseased brain. The scientific concept cares little about the moral decisions leading to the hijacking…the case is as closed as the concept.
P.S. The scientific method will yield far different results than a method that operates outside the parameters of the philosophy of science. So once more I’ll ask, “What concept do you argue for?”
For further exploration, into the subject, particularly if you prefer videos please watch the documentary Pleasure Unwoven by Dr. Kevin McCauley.
Dr. McCauley proposes that the ramifications of addiction on one’s neurobiology is such that the primitive midbrain starts to hijack and inform the prefrontal cortex rather than vice versa. If choice is centered and executed in the prefrontal cortex than the addict’s decisions are governed by instinctual impulse and survival. Something has gone awry which circumvents reason and rationality.
Brilliantly, Pleasure Unwoven argues that addiction is ultimately an impairment of the pleasure sense. For example, the deaf person has an impairment in their sense of hearing; the blind person in their sense of sight; and the addict an impairment in their sense of pleasure.
We struggle with the latter due to moral implications as mentioned earlier in the article. However, Dr. McCauley demonstrates just how the impaired pleasure construct reroutes the basic functionality of the brain, triggers the primitive midbrain to confuse the addiction with something necessary for survival, such as food or drink. Whether you agree with my limited initial assessment or not is immaterial, watch the documentary, then come share your conclusion.
If you enjoyed this post leave a comment below. If you have any questions, comments, or disagreements please leave a comment below. The purpose of this blog is to engage in topics/books/etc. together, to challenge each other to be more and to grow. If you prefer just shoot me an email.
- Karl Popper. The Logic Of Scientific Discovery (1934)
- Kevin T. McCauley. Pleasure Unwoven: A Personal Journey About Addiction (2012)
- Dr. Michael Miller President of the American Society of Addiction Medicine.
- M. Scott Roberts. The Truth Of Addiction: Understanding The Science of Addiction (2013)