by Craig Klugman, Ph.D.

One of my family’s Thanksgiving traditions is one common to many, that we go around the table and name something for which we are thankful. This week my list includes several things relevant to bioethics:

• Medicare covering end of life conversations
• The FDA cracking down on medical tests that are less than accurate, highly lucrative, and often destroys lives with unnecessary surgeries.
• The AMA call for a reinstatement of the ban on direct-to-consumer advertising

For most Americans though, they are often thankful for things that make them happy such as their family and their health. A few months ago, I attended a talk by Tod Chambers, PhD. at Northwestern University’s Feinberg School of Medicine on how health has become the goal of life. Chambers spoke about health as the new good, the reason for which we act. According to Aristotle, the good was the aim of all action, sufficient in itself. For Aristotle, that was eudaimonia (often translated semi-correctly as “happiness”), or living the fully satisfying contemplative life. Chambers said that today, it’s health, especially as viewed as longevity.

Healthy then means living longer, unassisted, with no physical or mental problems, and with a positive attitude. You can be an Olympic athlete but if you are not an optimist, then you aren’t healthy.

Most days, newspapers publish/post articles on living longer. In August, the New York Times interviewed a “longevity expert” who gave his tips for living longer. This might be a new mental attitude, more exercise, a different diet, or even that consuming your favorite food (dark chocolate, coffee) is good for you. And by good for you, the articles mean, “help you live longer, healthier.” Government studies even show that being in your prime earning years (50s) during a recession reduces your longevity. Yes, even economics is stated in terms of longevity.

The good is not just living longer, it is living longer in health. I’m not suggesting this is a bad thing. In fact, it’s the goal of public health – to reduce morbidity and mortality to give more people the opportunity to live a full healthy life span. But this can be a bit oppressive for those of us who do not run marathons (though some data suggests that ultramarathoners may have shorter lifespans), or who don’t want to restrict our calories to be just enough to avoid malnutrition (remember that when filling your Thanksgiving dinner plate), or who hold that “thinking happy” allows us to ignore reality.

Health = Living Long without illness = the Good

We spend $30 billion per year at gyms. We spend $21 billion per year on vitamins and herbal supplements. We spend $16.1 billion on activity trackers (i.e. “wearable tech”). And we spend $260 billion in anti-aging products and services. Health is not only good for a body, it’s good for the bottom line.

Logically, if one accepts that healthy longevity is the new good, then, what is right is anything that increases the healthy lifespan and what is wrong is anything that reduces it. If buying a $300 activity tracker or a $100 per month gym membership gives you the means to make you healthier, then by that thinking it’s right to spend that money because it gives you potential access to the good. If you are considering that extra helping of mashed potatoes on Thursday, then by this same thinking, this is a bad choice. Perhaps, it is even a moral failing.

Being healthy is great. It makes you feel good as well as allows you able to be active in life, take care of your kids, and participate in activities. The problem is when you aren’t healthy. Because if the philosophical good is being healthy and living long, then the bad is being sick, ill, not completely self-reliant or simply not exercising and not eating “healthy.” Those who suffer from disease, illness, disability, or age would be viewed as something other than “good.” This is not necessarily about actual health, but more about perceptions of health (as defined as things that can be seen or measured). If one takes 15,000 steps per day on his or her pedometer (results of which are shared over social media) and then drops dead of a heart attack, it’s tragic because this person was “healthy.” If he or she was sedentary than one might think “she brought it on herself.” It’s not actual health we’re talking about but what looks like healthy actions and choices. By this thinking, if a person looks older, sicker, or unhappy, then he or is immoral.

There are some things we can do for our health and many things that we can’t control. But when advertising and a moral sense of “the good” tells us that health and longevity are in our control, the stigmatization for not being some unrealistic picture of healthy and long-lived increases. Being unhealthy has not lost the sense of pollution and polluting that it gained in the sanitation and temperance movement a hundred years ago, but now it has the added onus.

So this Thanksgiving I’m not going to think about my health or how much each serving of gravy may be shortening my life. And I won’t be alone as reflection and thanks are not popular this year.