Who is Responsible?

I was at a Preventive Medicine conference in February of 2011 and the speaker was discussing unhealthy lifestyle choices.  Her theme was that people really weren’t responsible for smoking cigarettes, being overweight or sedentary, or any other unhealthy choice.  Instead, they were victims of their genetics and their environment.

At a conference on Emergency Medicine in January of 2011 another speaker had a similar theme; most people who do not do as the doctor recommends are not responsible for their decisions.  Instead, certain individuals, the medical community and the overall environment are responsible for what other people do.

The Patient Protection and Affordable Care Act of 2010, better known as Obamacare, has a provision encouraging employers to provide incentives to their employees for achieving health milestones.  For example, an employer might have a program giving employees a discount on their health insurance if they stop smoking.  However, the law stipulates that since some people may not be able to reach the health milestone, the employer must not discriminate against them.  Rather, employers must provide the same incentive for those who try to stop smoking but fail as for those who actually succeed.  According to a contact at the Center for Medicare and Medicaid Services, unions representing minorities approached a senator from New Jersey, who inserted this provision into the bill.

In the political campaigns surrounding the mortgage related financial crisis of 2008, candidates bent over backward to blame greedy lenders for manipulating hapless people into purchasing houses that they couldn’t afford.  This was indeed a problem.  However, few suggested that the borrowers themselves bore any responsibility for getting themselves into such debt.  Many borrowers demanded government relief for debts that they incurred, while rejecting the possibility that they bore any responsibility for their predicament.

What has happened to people being responsible for themselves?

The Bible is clear that while people are to help one another, each person is ultimately responsible for his or her own thoughts, words and actions.  Deuteronomy 24:16 states that each person should pay the penalty for their own sins, not for the sins of others.  Ezekiel 18:20 teaches that the righteousness of the righteous will be on himself, as will the wickedness of the wicked.  Galatians 6:5 states that each person should carry his own load.  2 Thessalonians 3:10 instructs “if anyone will not work, neither let him eat.”  Scripture teaches that every one of us is an independent moral agent, capable of obeying or disobeying God, and that we will bear the consequences for our actions (Romans 6:23, 1 Corinthians 10:13).  

The concept that people are independent moral agents capable of freely deciding between alternatives comes from the idea that God is a person, an independent moral agent capable of freely deciding between alternatives.  Since man is created in the image of God (Genesis 1:27), man also has these basic characteristics. 

Increasingly in America, it seems that people believe that “god” is merely an impersonal force generated by some or all living things in the universe.  While Obi Wan Kenobe might have Luke Skywalker believe this, the inescapable conclusion is that if god is not an independent moral agent capable of freely deciding between alternatives, neither are we.  If “god” is merely a summation of life forces that exist, each controlled by the combination of forces that affect them, as river banks control the flow of a river, then humans are also a summation of life forces controlled by influences around us.  Even for those who might reply that the river also influences the river bank, the forces are still impersonal, devoid of conscious action and therefore devoid of responsibility.

If God is a sentient and independent moral creature, we are sentient, independent moral creatures.  If our god is a combination of impersonal life forces somehow generated by the universe, neither sentient nor independent, neither are we.  Thus our underlying construct of the world influences or determines our opinions on human freedom and responsibility.

The Bible teaches that man is composed of two parts, a material part (body) and an immaterial part (spirit or soul).  As a material object, man is forced to do certain things by physical laws.  A man who steps off a cliff will fall; he has no more choice about whether or not to fall than a rock does. Only in this sense can a man claim to have been forced to do something.

The immaterial part of man is not constrained by physical laws.  Gravity does not affect the spirit, and even physical death does not end its existence (Matthew 10:28).  No one can claim to have been forced to behave in a certain way; even those threatened at gunpoint have the option of choosing to be shot.  Throughout history, persecuted Christians in similar situations have chosen death over denying Christ.

There is no evidence that genetics and environment force specific actions; people with genetic and environmental predispositions to alcoholism, for example, often do not become alcoholics.  In her speech, my preventive medicine colleague said that she might be tempted to drink a Starbucks mocha ten times during the day and resist nine times.  She used to idea to argue that she really had no choice because eventually she would give in.  What she may not have realized is that her example undercut her argument; the fact that she was able to resist nine times proved that she was capable of resisting.  In fact, teaching that people are incapable of controlling themselves and are therefore not responsible for their actions destroys much of what medicine tries to do when encouraging healthy behavior change.

In the Emergency Medicine conference, the speaker suggested that some people are responsible for their actions but others are not.  The obvious question is “When do people become responsible?”  Is it at a certain age? A certain education level? A certain socioeconomic class? A certain race?  A certain sex? A certain mental capacity? Many people would argue that the very young and the severely mentally challenged are not responsible for their actions, but identifying an education level, class or race that makes people responsible smacks of elitism, sexism and even racism.  Did she really want to go there?

Another problem with denying responsibility is that it cuts both ways.  If a person does not have to take responsibility for the bad things that they do, they cannot take responsibility for the good things that they do.  A man cannot escape responsibility for driving drunk by saying that he was forced to do so by his genetics and environment, and then later claim responsibility for beating his alcohol problem through his own efforts.  If forces outside ourselves control our bad actions, they also control our good actions.  The physicians in Preventive Medicine and Emergency Medicine who spoke in the conferences mentioned above were highly successful and respected women; leaders in their fields.  If they really believed that people are not responsible for their actions, then they were not responsible either. If they deserved no censure for their failings, they deserved no respect for their accomplishments.

Is there no place for helping others?

When God created Adam and Eve in the Garden of Eden, He did nothing to protect them from eating the forbidden fruit except commanding them to avoid it.  He did not make the fruit ugly and bad tasting; He created it beautiful and good.  He did not place the tree in the far corner of the garden, surrounded by thorn bushes; He put it in the center of the garden in easy view and reach.  God takes human responsibility seriously.

However, our fallen and sinful nature inclines us to sin in a way that Adam and Eve, in their perfect state, were not.  Therefore it is reasonable for us to build safeguards into our lives to avoid sin. It is also reasonable for us to build safeguards into our lives to avoid poor choices of many varieties.

Parents, teachers, and ministers bear the primary responsibility for teaching children that they are responsible for their choices and how to identify wise choices.  Children can disregard the soundest training, but it is undeniable that good training and good examples are better than bad training and bad examples when rearing little ones.  Individuals, including children, suffer the worst consequences from their own choices, but those entrusted with training them will suffer the consequences for their failure to do so.

Similarly, it is reasonable for institutions, public and private, to help people make good decisions and build safeguards against them making bad ones.  Nutrition information on food packaging can be a benefit.  Medical devices that help patients to use them safely are a good idea.  Warnings against smoking and other unhealthy habits can discourage bad choices.  Honest lending practices, enforced by watchful regulators, are important.  Banked highways and seatbelts can prevent injuries in accidents. People in medicine, public health and many fields should be involved in finding ways to help themselves and their fellow Americans make the best choices. 

Since we are responsible for our actions, how do we make better choices, and ultimately do better actions, in the long run?

The New Year is supposed to be a time when people make resolutions to improve their lives, reducing the bad and increasing the good.  Common knowledge suggests that people decide to change and manage to do so until February, when they lose their will power and relapse into their former lifestyle.  The problem, of course, is that people vow to change for the rest of their lives, which is impossible to do since people live moment by moment.  No 30 year old can make healthy choices for 40 years at a time, but he doesn’t have to.  He only has to make healthy choices for the next moment, and the next, and the next.  If he keeps it up, he will have changed his life, and maintained that good change for 40 years, or more.    

My patients sometimes come to me wanting to change a habit such as overeating.  Many come to the appointment in a stew of emotion, making grand promises to reform their lives.  They equate intensity of emotion with willpower and likelihood of success.  Other patients come in seeking ways to make changes, sometimes small and sometimes big, which are sustainable moment by moment, in healthy directions.  The latter group, regardless of the intensity of their emotion, usually succeeds.   I tell them, “The key to changing your life is not to decide hard, with a maximum of emotional fume and fret, but to decide long, with the quiet determination to succeed this moment, and the next, and the next.

One last note.  Everyone will make good choices, and everyone will make bad choices.  Everyone will reap the rewards when they choose well, and everyone will bear the burdens when they choose poorly.  This is a heavy burden to bear.  Some people make one wrong choice and suffer from it for the rest of their lives.   I have taken care of patients whose only sexual liaison ended up in a lifelong sexually transmitted disease like herpes or HIV.  Other patients drank too much, drove home, and killed someone else or paralyzed themselves. The Gospel of Jesus Christ is good news because He is the only One who can make even our bad choices turn out OK, either in this world or the next.  Those who trust in Him can be assured that He will make both their successes and failures work together for His perfect will and their ultimate good (Romans 8:28).

Conclusion

It is vital to help one another, whether in the family, community, or society, but ultimately the responsibility for each person’s thoughts, words and actions falls on that individual.  The man who smokes, is overweight, or buys a house that he cannot afford is responsible for his actions, and he must suffer the consequences.  The man who works hard, earns a good living, and gains respect from his actions and accomplishments deserves credit for his good choices.  Others may contribute to his poor choices, and they bear responsibility for their poor choices.  Others may help a man choose well, but either way, each man is responsible for himself. To teach otherwise is an offense to him as an independent moral creature equal to others.  Teaching that man does not bear responsibility for his actions is also a disincentive to overcome vexing problems, and robs him of the satisfaction of his accomplishments.  Finally, it devalues him as a child of the independent, moral and responsible God.

Hope is not lost for those who feel trapped by their bad choices.  The power of Almighty God as manifest in the Son, Jesus Christ, will make all things, even bad choices, work out to the good for those who love Him and are called according to His purpose.  

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