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Monday, July 19, 2004

Is Obesity a Disease?
Medicare has now removed all language from its policies that ban classifying obesity as a disease.  I am not sure what my feelings are on this--Medicare has just stopped short of calling obesity a disease--it seems as though no one will take a firm position on things these days.  Anyway, benefits of calling obesity a disease are numerous for those who are obese.  These include treatments for obesity (which might include prescription medications, or gastric bypass for those who qualify), and a de-stigmatization of obesity.  In recent articles on obesity by way of a response to Medicare's move, obesity is being compared to alcoholism.  In medicalizing obesity, like alcoholism, the stigma of the condition is removed insofar as obesity (like alcoholism) is not viewed as a personal moral failing anymore, but a disease, something that is out of an individual's control.  Looking recently at the free will literature, most of us buy into the moral responsibility thesis whereby to hold an individual morally reponsible (praiseworthy/blameworthy) an individual must be in control of bringing about a state of events.  Or, alternatively, as Frankfurt puts the thesis (a thesis he eventually rejects), an individual ought to be held morally responsible for her actions if and only if she could have chosen otherwise.  Frankfurt of course presents a series of cases that falsifies this thesis, whereby we hold an individual morally responsible for her actions even though she could not have chosen otherwise.   And these Frankfurt cases seem to work well because they accord with our commonsense intuitions regarding moral responsibility. 
 
Back to the obesity case, though.  I am not so sure that medicalizing obesity and calling it a disease will present us with the following dicotomy:  either obesity is a disease (and individuals should not be held responsible for their condition) or obesity is not a disease (rather, it is a result that is due to lifestyle choices, and therefore completely in the control of the individual--that is, the individual is responsible for bringing about her condition).  Even if obesity is a disease (and there is resistance to accept this claim aside from more interesting issues having to do with moral responsibility) it does not seem to follow that this classification precludes holding obese individuals responsible for the state of their health.  This is not of course at the same time to say that we should hold the individual responsible for the state of her health.  Motivation for what I am saying is coming from a piece I recently read (just yesterday, actually) by Nagel, "Moral Luck."  Nagel points out that given intuitions regarding moral responsibility (like the kind Frankfurt very ably identifies), we tend not to hold individuals morally responsible for what is not in their control.  If a state of events comes about that is not entirely within their control, even though they may have had some causal role to play in bringing that action about, we do not hold them morally responsible for what they have done, not at least to the extent that we would someone who was more in control of a certain course of events (take, for example, killing a person in a car accident vs. killing a person via a murder).  But consider some other cases, where we seem to hold agents morally accountable for their actions, even though their actions are in part due to moral luck.  For example, the brave person who stands up to some tyrannical political regime (think Germany), or the person who rescues a child from a burning building.  The circumstances these individuals found themselves in are due to luck--but despite this fact we praise them for their actions.  If, then, certain circumstances or states of affairs that individuals find themselves in are due to luck, and these circumstances provide them with certain opportunities to be virtuous, for example, why should we praise them for their actions when they were partly due to luck?  This last point is Nagel's.  Now let's return to the obesity case.  Even if obesity is a disease, given cases where we hold people morally responsible where what they do is due in part to some kind of luck or other, couldn't we hold even these people morally responsible for being obese?  This kind of position, holding someone morally accountable for being obese is agnostic with respect to whether we classify obesity as a disease or not.  And the parallel here is that obesity (if we are sympathetic to classifying obesity as a disease) is due in part to luck, to factors outside of an individual's control, like genetic predispositions and the like.  Given what Nagel says, we can either obliterate moral responsibility altogether since much of what we do is due in part to luck, or we can retain moral responsibility, identifying the relevant features necessary to hold an individual morally responsible for her actions. And presumably, thinks Nagel, this will depend on what account we give of agency.   
 

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Wednesday, July 07, 2004

Napolean Dynomite
Last night I saw Napolean Dynamite with some friends. As a bunch of geeky philosophers, the movie was very fitting indeed, and Napolean reminded me of some friends. Napolean Dynamite is this geeky high school kid who is an outcast and gets beat up all the time. The movie is throroughly funny and you never feel sorry for Napolean because while some of us (myself included) can sympathize with Napolean, he has this attitude that just makes him gruff on the one hand (or perhaps, rough around the edges) while endearing on the other. Go see it if you haven't already!
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