The devilish details

Any principles that are not part of the world of nature (law of tooth and fang; survival of the fittest; simple self/family/species interest) arise from myths we create about the dignity of God and man. That many of these transcend different cultures indicates a need of humanity for something beyond the primitive existence of the plant or animal. We try to learn about the world to mitigate the sometimes seemingly cruel natural law.

Moral and ethical people make decisions based upon principles. Principled decisions can often impact our individual freedoms and finances. Laws are just codified principles, with structure to interpret and enforce them. So far, not all moral principles are encompassed in laws. Some see this as a shortcoming of society, others see it as a way individuals can still exercise judgement to choose good, enabling individuals to be virtuous in their own eyes.

When it comes to health care, we come to several problematic details.

• Do we decide by individual or group? Since few things can be predicted with 100% certainty, we can never know if our preventive interactions or treatments will be beneficial to any individual, but certainly can make statements about group effects. Is it reasonable to apply group data to individuals, or can we allow individuals to freely opt out, even if their choice statistically is likely to impact us with great financial burden?
• If a disease leads to more suffering than preventing it, is it more noble to prevent it? What if preventing it means interfering with an individual's freedom or finances?
• If adherence to therapy leads to less suffering, is it right to insist on adherence? What if adherence leads to less financial burden on the society as a whole?
• Does suffering indicate a need for society to help? What about one person causing the suffering of others? Impact on others is a slippery slope. Certainly, a person walking the streets with a virulent, highly contagious infection is a health problem for others as well as a potential financial crisis for society as a whole. What about a woman, perhaps depositing upon society the burden for care of a child that is highly deformed or unwanted? What about a man who is homeless and who's behavior, appearance and odor are an affront to others? What about the woman, who sees her life as terrible because of her appearance, and acts miserably to others, who would be a much happier person and a better citizen if she only had plastic surgery?
• If there are two ways to prevent a disease and one is less expensive than the other, should society allow the individual to choose or should society make that choice?

In a world where we feel it is our moral obligation to pay for the care of others, is there a moral obligation of individuals to take care of themselves to help defray the costs to others? In a world where we feel there is a financial obligation to pay for the care of others, should there be a financial penalty for individuals who fail to take care of themselves? Since all laws are backed by force, should equal force be applied to both situations?

We often hear of psychological diseases that make a person unable to adhere to the typical standards of good health. I have no doubt that there are similar health issues that make some people unable to adhere to laws of financial obligation. If we can excuse one, why can't we excuse the other?