The moral and the healthy: identical, overlapping or orthogonal?

The pathogenic paradigm which underlies almost all current Western medical research and practice focuses on concrete diseases and is devoted, at least in theory, to the relief of suffering from these diseases. Clearly, the relief of suffering is a humane, moral pursuit. I have posed the salutogenic paradigm as a major challenge, urging the importance of research directed to the understanding of the mystery of and clinical work directed to the facilitation of movement toward the health end of a health ease/dis-ease continuum. I have proposed the Sense of Coherence (SOC) concept as a key answer to the salutogenic question. As this model is increasingly welcomed, I have become increasingly sensitive to the ethical dangers raised by it, or by any orientation, such as the WHO definition of health, which has salutogenic elements. This paper is devoted to examining these ethical problems. The first follows from the need to define the concept of health. The temptation is to confuse health well-being with other aspects of well-being, reflecting the value judgments of the definer. Such confusion becomes dangerous when the definer holds power over others. The second problem, which has two coordinate parts, is even more serious. It arises out of the search for health-promoting factors. It pressures one to assume that a. what is functional, useful and positive for health is morally good; and b. what is morally good is functional for health. (And, of course, the converse assumptions about moral evils.)