The question of whether we are responsible for the harm we cause goes to the heart of who we think we are, and how we believe society should run. Guilt, blame, the existence of evil, and free will itself can complicate this question to the point of near absurdity. And yet, as absurd as it may be, it is unavoidable. Taking a binary approach, whichever path one chooses, can lead to difficulties very quickly. On the one hand, if we are solely responsible for the things we do wrong, some genuinely malevolent parties get off scot-free. On the other, if we locate responsibility entirely outside the individual, we relegate ourselves to sentient flotsam buffeted by currents beyond our control.
In my own medical career, I have seen attitudes shift considerably around the idea that individuals should take personal responsibility for the harm they do to themselves. Self-injurious behaviours such as alcoholism and drug addiction have rightly been reframed as diseases rather than lifestyle choices. In the case of opiate dependence, as the huge numbers of people hooked on prescription painkillers in the United States demonstrates, “bad” behaviour is often caused directly by doctors and pharmaceutical companies. But even with less dramatic examples, there is a growing acknowledgement that personal choice is not the biggest driving factor.
