Choices and Consequences

I fear this may be another of those posts that several people I’ve talked to will think is about them. Again, I will start with a disclaimer that this is really about quite a few conversations I’ve had seemingly within a short period of time of one another. It’s not about you – it’s about what these conversations have brought into my conscious thought.

The word consequences has somehow taken on a connotation that isn’t quite… correct. A lot of people think that the word consequence means something like “punishment” or “the bad things that happen when you make the wrong choice”. Consequence actually just means “result” or “that which follows”. There is no judgment on the goodness or badness of the result, simply that there is one.

I maintain the position that all decisions have consequences. If I get out of bed, the consequences are different than if I spend the day in bed. If I wear a red shirt, the consequences are different than if I wear a white shirt. There’s nothing inherently wrong with any of the choices I’ve presented here, but when I make these choices, things are going to happen that equally lack moral implication.

I support, very strongly, the right of people to make choices for themselves when their choices affect only themselves. When the choices affect other people, the issue starts to get grey and I only support limits on the choices when a bad choice can have nothing but detrimental effects for those around the person making the choice. I do not claim that all of my positions are “right”, but I do feel I do the best I can with an ethical quandary. I think that the principle that most guides me is that I feel I do not have the right to decide for other people what is right and wrong for them.

This is an attitude I try to take into my work with patient advocacy. Make no mistake – I have an absolute view of what is right and wrong for me, what is right and wrong for my husband, and what is right and wrong for close friends and relatives. That said, I fully exercise my freedom to decide what is right for me, I lean heavily on my husband to decide in the way that I think is right for him, and less heavily on close friends and family.

I lean heavily on my husband because I have a lot of information about him – what his health actually looks like, how his lifestyle plays into his health, what he wants his health to look like, what I need his health to be like given that I am his partner, what his feelings are on the risks and benefits of certain treatments, etc. There are still parts that are unknown to me about his decision making process, but I know that he does what I tell him because he believes, in the end, that I have our best interests at heart. I also know that if I weren’t around, he wouldn’t take care of himself. It’s not him specifically, it’s just that I’ve heard time and time again from other wives, doctors, and even from my husband himself that men categorically just aren’t all that concerned about health unless there is something immediately affecting their ability to do what they want. They discount the future because it’s not immediately obvious how what they are doing today affects what will happen down the road.

I lean less heavily on other people I know and care about because I have less information about their feelings on the issues I listed above. Their health affects me to some degree. If, for example, my brother and his wife decide to completely disregard their own health and start taking dangerous recreational drugs (a decision I know they won’t make – this is just a hypothetical example), I will end up raising their two children. This affects my life. I feel that gives me a right to make suggestions, but not to dictate how these other people choose to live their lives. In the end, I want these people to live a life that properly balances the costs and benefits of each choice they have. I want them to be happy. And I want them to remain in my life for as long as it is mutually desirable.

Here’s the catch – I don’t always know how my close friends and family weigh the costs and benefits of each of their choices. As far as strangers are concerned, I know absolutely nothing. For some people, raising the risk for a certain disease by even a small amount is too much. They will do everything in their power to avoid increasing their risk, and often, they will do what they can to reduce the risk. For other people, the inability to eat certain foods that they like is far more detrimental than actually dying of complications from diabetes or heart disease.

While I have a hard time understanding positions that are different from my own, I know that I wouldn’t want someone who values health less than I do to tell me what choices I can make to guard it. I know that someone who values food more than life itself wouldn’t want me stopping them from choosing what makes them happy. Here’s the bottom line – we each have just one life. We have to spend each day deciding how much we can sacrifice, how much we want certain things, and it has to come out to the right balance for ourselves. Some people want to be nothing but happy all the time, and do what they want regardless of how it affects others around them. Some people care about how the others around them feel, and that factors into the balance they choose. As much as this is not a pc thing to say, some people function best when they have something to be unhappy about, so they make choices that the rest of us view as sub-optimal.

I would be lying if I said that I don’t get frustrated when someone makes what I view as the “wrong” choice. I also hate not doing something about it, but trying to impose my will on someone else is actually counterproductive. When someone tries to bully me out of my choices, it only makes me want to shut down and dig my heals in further. When someone calls me names like “stupid” or “moron”, I immediately decide that they are telling me about themselves and ignore all that is said after that. I would rather be led to a new decision than to be dragged into it. This is the difference between an internal compass and an external one. If you are telling me that I am making wrong choices, but I cannot inherently see why my choices are problematic, I am going to continue behaving the way I did before, but I’ll just make sure you don’t find out about it. If you can give me information that makes me want to change my internal view, then I will change my behavior. It’s that simple.

It works that way for most people.

I’ve found over the course of my life that when people make decisions I don’t understand, it’s usually because we’ve been exposed to different information. The example I most commonly encounter currently is the issue of purposely eating gluten when you know you have a problem with it. I cannot understand why anyone would value bread enough to give up health for it. For the people to whom food is more valuable than health, we will never come to a similar conclusion. I have learned though, that people who value health but continue to eat gluten when they know for sure it’s a problem for them, it’s usually that they don’t know what I know. They don’t know that you aren’t just getting a stomach ache or a fever or a rash. They haven’t attended the autoimmune conferences that I have in which I learned that inflammation is the root of most chronic disease. They don’t know that continuing to eat something you have an allergy to raises your risk for diabetes, heart disease, autoimmune disease, cancer…

If I encounter someone who is making “bad” (I use that word in quotes because this is my value system, and is not necessarily applicable to others) choices, instead of shaming them, I try to educate. For the gluten example, I teach them that what’s really happening inside your body is just like a chemical burn. You get areas that are literally hot and inflamed, and you get scars. You overwork your immune system, and overworked cells (just like overworked people) make mistakes, leading to all the other long-term consequences. I back up my position by pointing them to the primary research.

More often than not, the people who share my value system eventually make a similar decision to the one I have, to not deliberately cheat themselves out of health for a piece of cake. There will always be differences in the degree – I mean, I’ve been tempted once or twice to go to freaking Krispy Kreme and just eat a box of donuts, because they are that good. I didn’t do it, though, because I thought about the consequences of that choice. I will have a stomach ache. I will lose a day (at least) of my life stuck in bed. I will increase my risk of the already prevalent heart disease that runs in my family. I will be one step closer to the diabetes that has been threatening me since I was a teenager. If I didn’t know the consequences, I’d be way more likely to eat the donuts. It’s so much easier to make the “right” choice when I have a reason to do so. Other people might be a little more lenient – maybe have something they shouldn’t because it’s just once, and the problem is really just the accumulation of damage over a lifetime, and the occasional mistake isn’t going to kill you. It’s their choice. I can only inform, not force.

My overarching point is this: You have the right to make decisions for yourself. You can be expected to weigh in on other people’s decisions that affect you, but your total control level is lessened. You cannot make someone else do something by brute force and expect it to stick (or expect them to continue liking you). And really, when you are judging someone else (and we all do it) – ask yourself: What makes me the moral authority on this subject? Does this person’s choice affect me? Do I know enough about this person’s value system to accurately assess why he makes the choices he does? Can I make my point effectively without insulting the other person and achieving the exact opposite of my desired result?

Food for thought.