On respecting individual autonomy, creating structures that allow all people to live as we choose to

Building a heathier world means letting people be who they are.

These essays are concerned with thoughts that contribute to the health of populations, that can inform science and scholarship and, indirectly perhaps, action. Ultimately, The Healthiest Goldfish aims to be a constructive project. I am interested in building structures that we can all contribute to, that we can create, that generate health. But in talking about building an intellectual architecture that generates health, I fear that sometimes we forget the “why” of our work—the reason we are trying to generate health. This fear has been a reoccurring theme of these essays. As I have written before, we are generating health not for its own sake, but so that people can live, and live fully. Health is a means not an end, and it is important that we leave room for the joy that accompanies living healthy. 

With that point made, though, I think that there remains a different point to emphasize towards a practical philosophy of health. How exactly do these structures support living? Notions of what it means to live optimally have been developed in recent years in a growing literature about human flourishing. All of that is to the good. But the particular part of this goal that I want to address today is people living as they choose to, and the balance we have to strike with how we think about this and how we act to respect it.

This notion of choice raises a tension: what do we do when people choose to live in ways that are bad for health? This can be an uncomfortable question to face. When we do as much work as we do to generate conditions for people to be healthy, to create freedom from disease, we do so with an implicit expectation that people will then use that opportunity to live ennobled lives, to conduct themselves in a way that somehow elevates the human condition, as befits the hard work we have done to create space for such living. We are comfortable with the idea that we create structures so that all can be healthy when we do so with the expectation that all will then live in a pro-social way and pay it forward, doing more good. But what if this is not always the case? What if we are creating space for people to engage in behavior that does not align with our values? Such behavior might involve acting counter to our designs for a healthier world for populations, or counter to our designs for the health of individuals. What if the people we are trying to support emphatically do not pay it forward? 

To concretize this a bit, how much patience should we have for people who choose to work for companies that create harmful products, for example by working as part of the legal team for cigarette and firearms companies? To concretize further, how should we regard those who, living within structures that create opportunities for health, choose to be couch potatoes and watch endless reruns, to the detriment of all physical and mental health?

I suggest a twofold answer to these questions.

First, our tolerance for all people should be abundant. To be a bit more dispositive about it, it is arguably wrong to be thinking in terms of tolerance at all. Doing so has a ring of condescension to it, of smug certainty about the correctness of our perspective. In the world of ideas, it is important to consider, always, the possibility that we might be wrong, that others might be right, and that, even when the person we are engaging with is indeed wrong they still can have much to teach us. We also have a responsibility to be thoughtful in our engagement with different values and perspectives for the sake of respecting the individual autonomy and dignity of all. If we are aiming to generate space for people to be healthy so they can choose to live, to embody the enlightenment value of personal autonomy, of respect for a person’s choices, it is on us to respect those choices, not stigmatize or chastise. The latter move would be quite misaligned with the moral and aesthetic goals for health and inconsistent with a centering of autonomy that should be core to any philosophy of health.

Second, these very choices should, somewhat circularly, encourage us to engage in doubling down on our work to discourage such behavior, without judgement or prejudice, but as relentlessly as we can, while preserving our respect for the autonomy of individuals. Respecting the perspectives of others does not mean forgoing our own, nor does it mean we should not advocate for them less vigorously. For example, we can accept that some people will want to work for firearms manufacturers even as we make a robust, data-informed case for a world without guns. Making this case is a far better use of our time and energy than castigating individuals who do not share our views. Because if we make a sufficient moral argument against the existence of firearms, our hope is that no one will want to traffic in them any further, solving that particular problem. Similarly, if we incentivize activities more exalted than couch potato-ing, we can create a structure of incentives where healthier activities are more attractive and accessible. When we find ourselves becoming frustrated with the behaviors of some who act counter to how we would have them live their lives, we should use this feeling as motivation to engage more effectively—always with compassion and respect—in the work of winning arguments towards supporting the policies that can create a healthier world for all.

There will always, of course, be outliers, people who do not agree with the aspirations of a healthier living. And that is OK. In fact, it is more than OK. It is a necessary feature of the better world we are hoping to build. There is a scene at the end of the film Collision, a documentary about a debate between theologian Douglas Wilson and antitheist Christopher Hitchens, when Hitchens makes a surprising admission. He says that, were he to succeed in convincing nearly everyone on earth to become atheists and find himself facing the last holdout, the only religious believer left, he would not try to convince that person to become an atheist. He would not want to fully eradicate the view he so passionately opposes. He confesses that he does not quite know why he would not do so, only that he would not. We might imagine it is because the continued persistence of perspectives we do not agree with help prevent our vision from becoming overbearing, authoritarian. A healthy world is one that respects individual autonomy, where everyone can live as they wish to live, and we should not wish it otherwise.

Core to building this world is our ability to live with contradictions. This can be difficult for a science-based discipline like ours. We aim to identify problems in order to develop and implement clear solutions to them. It can be counterintuitive to say we should accept contradictions, ambiguities, and unresolved tensions in our pursuit of a healthier world. But a healthier world is one where contradictions remain present, reflecting as they do a world where people are truly free to live as they choose. Human beings are contradictory—life is contradictory. We may not always like what this implies, but this is the reality of our existence, and the pursuit of health must always be rooted in what is human, what supports the living of rich, full lives in all their perplexities and contradictions.   

I am pragmatic enough to realize that we are not likely to ever fully succeed in these efforts. We will always want, to some degree, to iron out complexity; we will always be, to some degree, uncomfortable with those who seem to dismiss our efforts or who actively work against them. This is part of my reason for writing about this today. Just as the communities with whom we engage are human, we are human too, and while some may never accept us or be receptive to what we say, we may never be fully at ease with these holdouts to health. But we can still accept, in a spirit of compassion and humility, that creating a healthier world means creating one where people can live as they wish to.