Moral ambition is, in principle, an admirable trait, but soaring ambition, especially when it is unmodulated by practical wisdom, can wreak considerable harm. In other words, the impulse to do good can fail to respect the bounds of reason and thereby undermine the welfare of the very people it seeks to serve.
The Reading Room
Individual Moral Responsibility for Violence: A Decrepit Concept?
This danger is further compounded when it is unfurled before the minds and hearts of impressionable young people such as students in the professions, many of whom have not read the books or had the life experiences that would help them appreciate the folly of excessive moral ambition.
Consider a 2018 article in the American Medical Association’s Journal of Ethics entitled, “Clinicians’ Need for an Ecological Approach to Violence Reduction.” Its first author, Bandy X. Lee, MD, was until recently a Yale psychiatrist who in 2017 organized a conference at Yale to consider the mental health of US President Donald Trump and later edited a volume entitled “The Dangerous Case of Donald Trump,” composed of essays concluding that Trump’s condition represented “a state of emergency” that created a duty to warn the public. She was later dismissed from Yale, at least in part for violating the so-called “Goldwater rule,” which prohibits psychiatrists from issuing diagnostic opinions on individuals they have not personally examined.
The article presents an illuminating example of moral overreach, apparently inspired by a line from Dostoevsky’s “The Brothers Karamazov,” which serves as its epigraph: “We are all responsible to all for all.” The authors assert that “structural violence” is far more harmful than any type of direct violence, and that there is an obligation on the part of health professionals who seek to promote health to consider the “adverse effects of structural violence generated by bad policies.” Specifically, they are obliged to protect patients from injustice, which the authors take to mean policies that fail to prevent “avoidable deaths and disabilities.”
The authors regard it as axiomatic that the Hippocratic dictum “First, do no harm” means avoiding direct violence, such as murder, assault, or verbal abuse. The fact that violent conduct is more common among those at the lower end of the economic scale in their view implicates economic inequality as one of the most important injustices that health professionals should be working against. Just as those seeking to improve the health of patients should recognize the importance of health education, healthful living, and healthcare access, so those seeking to reduce violence should accept the words of the wise elder Zosima in The Brothers Karamazov, “For no one can judge a criminal, until he recognizes that he is just such a criminal as the man standing before him” and address the ecology of violence.
In practice, the authors argue, this means acknowledging that “Labeling violence as an individual problem can no longer hold with what we now know; scientific evidence forces us to look at the larger social and economic structures that give rise to waves of violence, locally and throughout the globe.” As an example of such structural violence, the authors cite the Trump administration’s effort to repeal the Affordable Care Act, which, they state, would have caused the loss of health insurance for up to 24 million people and avoidable deaths by 2026 ranging from 28,000 to 96,000. Yet this is but one example of how “Structural violence operates through the institution and acceptance of unjust social structures, such as the denial of health care or the right to fair living conditions to certain segments of the population.”
The thrust of the article is reminiscent of B.F. Skinner’s 1971 book, “Beyond Freedom and Dignity,” in which the behaviorist psychologist argued that notions such as autonomy and responsibility generate more harm than good, by undermining efforts to modify behavior scientifically to produce a better-organized and more well-adjusted society. When we recognize that there is no such thing as free will, he argued, praising and blaming people for their actions makes no longer makes sense. Individuals do not choose to commit violent crimes. Instead, they are conditioned into criminal behavior. To combat violence, we should redesign culture to modify behavior accordingly.
This seems to be in line with what the authors intend when they say that we can no longer label violence an “individual problem.” Relying on individual conscience as a brake on violence, treating violence as the expression of a defect of judgment or character, and categorizing violence as a matter fit for law enforcement, the courts, and a penal system constitute unsustainable approaches, since they are grounded in an outmoded notion of individual responsibility. Individuals are less decision makers than products of social and economic forces over which they exercise little or no control, and the only realistic hope for the future is to begin reshaping those forces.
One difficulty with this position, of course, is the fact that the authors seem to be attempting to construct a rational argument for it. If human actions and the perspectives on which they are based are not in some fundamental way the product of individual choice, then it makes little sense to attempt to persuade others through argumentation. It would be as futile as attempting to convince a would-be criminals, the product of many years of social and economic deprivation, to refrain from committing a crime, thereby implying that they had any choice in the matter.
Another problem with this position is the fact that the relationship between poverty and violence is not consistent. Many people who have lived in poverty never resort to violence. Moreover, some groups of impoverished people are far more likely to act violently than others. Such findings by no means undermine the association between poverty and violence, but they do indicate that factors other than poverty alone must be involved.
Which raises another problem. While it is true that violent conduct is more common among the poor, rich and even very well-educated people have committed grievous acts of violence. For example, Nathan Leopold and Richard Loeb, who in 1924 kidnapped and murdered a 14-year-old boy in Chicago, were the offspring of wealthy families and boasted impressive intellects, Leopold having graduated from the University of Chicago with Phi Beta Kappa honors and Loeb having set the record for the youngest graduate of the University of Michigan before enrolling in Chicago’s law school. In fact, they committed the crime to demonstrate that their superior intellects would enable them to carry out the perfect crime without detection, partly under the influence of Nietzsche’s concept of “supermen.”
Furthermore, as the title of Skinner’s book suggests, ceasing to see individuals as responsible for our choices poses a fundamental threat to the idea of human dignity. If we are merely automata carrying out our social and economic programming, then character, morality, and personal responsibility for actions may become essentially meaningless. The intentions behind actions no longer matter, since they lack any moral significance, and pre-meditated murder ceases to be any more serious a crime than accidental manslaughter. Moreover, the same applies in reverse. The authors of the article would not deserve praise, for in writing it they were simply executing their program. Praise and admiration, too, become essentially meaningless. No sane person wants to live in such a world.