Pilot study by Maria Becker (Heidelberg), Svetha Ananth (Heidelberg) and Carina Kiemes (Darmstadt)
Morality plays an important role in everyday life and influences almost all areas of our society, e.g., politics, culture, religion, or education. When people are debating about controversial topics such as climate change, refugees or changes in law, they often refer to moral concepts such as freedom, equality, or charity (but also negative values such as guiltiness or prejudices) to emphasize their opinion and to demand something. Referring to moral concepts serves the purpose of validating the demand as intersubjectively accepted (cf. “jargon of presumption”, Felder 2018). The demand therefore requires no further explanation or justification, as in the following sentence, in which the word “security” is used to support a demand for a cap for refugees: “We should introduce an upper limit for refugees to ensure the security of German citizens.”
By moralizing practices, we mean strategies in which moral values are utilized for describing issues and the required actions. Vocabulary that refers to moral values (such as “freedom”, “security” or “credibility”) is used to enforce a demand that in this way appears inescapable.
In this article, we focus on the moral dimension of health. One could assume that in the domain of medicine and health, topics are rarely discussed with a moral perspective, as health is a sensitive topic and moral judgements are less expected. However, experience from the COVID-19 pandemic has shown that this assumption may be wrong, since in many public and private discourses moral values such as security, responsibility, or loyalty have shown to play a dominant role. We would therefore like to find out whether and how moralizing practices occur when people are talking or writing about topics related to health, and to what extent this takes the scientific literature and relevance into account before stating claims.
We performed a pilot study and collected a dataset from the web consisting of texts from different genres and domains such as tweets, Instagram posts, newspaper articles and blog posts that discuss health issues (e.g., overweight and healthy eating, cancer and smoking, COVID-19 and compulsory vaccination) with a moral perspective. Using corpus linguistic and computational linguistic methods such as collocation analysis, keyword analysis, word distributions and frequencies, we analyzed how people establish and negotiate the moral dimensions of health issues. In the following, we summarize our three main observations and illustrate them with examples from our dataset:
1. Only in very few cases, individuals are held responsible for their state of health. We find only very few examples where individuals are blamed for their state of health, and the instances we find appear in solely two contexts: in the context of dangers of smoking and in the context of sexually transmitted diseases (STD). The latter is illustrated with the following example – a tweet which debates about whether homosexuality or promiscuity is the decisive risk factor for monkeypox:
The risk of contracting monkeypox has nothing to do with #sexuality, but with promiscuity! Vaccinating only homosexual men here is once again stigmatization and excludes promiscuous heterosexuals!
While the tweet tries to change the focus from men having sex with men (homosexual) to those who frequently have different sexual partners (promiscuous), it emphasizes that the two groups are primarily responsible for the spread of monkeypox. Although the early symptoms of the disease resemble other STDs like syphilis, it can spread within any community not just by bodily fluids but also via respiratory droplets. This is different from HIV/ AIDS, which spreads only through contaminated fluid exchange. Therefore, it is important to account for the scientific understanding of disease transmission before targeting specific groups that become vulnerable first.
2. Negative moral values are used to emphasize that patients should not be held responsible for their diseases. As mentioned before, individuals are very seldom blamed for their state of health, and we find many examples in which it is explicitly argued that ill people should not be blamed for their state of health. Here, often negative moral values such as prejudice or guilt (which should be declined) are used to argue that blaming patients for being ill should be stopped. This becomes apparent in the following example, which we took from an interview that was published on the homepage of a social network for cancer patients:
A classic example is a smoker who has been suffering from a cough for a long time. After the diagnosis, he gets hemoptysis, an absolute alarm signal. But for fear of prejudice and reproach, he does not go to the doctor with it. Various psychological studies have also shown that this additional burden greatly reduces the motivation to stand up for oneself or to seek contacts oneself.
We find a similar argument in a comments section of an Instagram post that praises the self-healing power of the human body. Several comments raise the problem that this post implies that one is to blame for the illness or the failure to heal oneself because one does not have the right mindset, as in the next example:
“Your mindset is not right!” conveys a guiltiness that simply does not exist in this case.
Association of symptom similarities, for example those that are associated with the lung to smoking, increases bias towards a particular group of people with no scientific evidence to back up the claims. The cause for hemoptysis (coughing up blood due to injured bronchial tubes, larynx, trachea, or lungs) has been investigated in several study groups. Most of these studies have concluded that there is no significant correlation between smokers to the development of hemoptysis and other malignancies that affect the airways, such as lung cancer (1,2).
3. In most cases, institutions or politics in general are addressed and called to action with the moralizing practices. When someone demands something (using moral values), usually also the person (or group) to whom the demand is addressed is mentioned. In our data, we find that primarily institutions or politics in general are addressed, and in this context often blamed for a specific circumstance, as in the following example which is taken from a blog post on cancer that was published on the platform medwatch:
For one in five cancer deaths, the cause of death is not the disease but the consequences of malnutrition: As long as this is the case, but most tumor patients (along with many others who would decisively benefit from it) are denied nutritional therapy, political action is required. It is the refusal of those responsible in ministries and parliaments that costs human lives.
Malnutrition associated with cancer can lead to poor prognosis and negative treatment outcomes. Most often the lack of nutrition is related to lack of diagnosis, poor appetite as a side effect of chemotherapy or radiation, diarrhea, and fatigue. High incidence of malnutrition-related deaths is reported mainly for esophageal carcinoma that involves the esophagus required for carrying food from the throat to the stomach(3). Therefore, the cause of cancer-related death is multivariate and attributing the one in five statistics (no large study performed to confirm the statistics) to the refusal of government action is a far-fetched argument with many confounding factors.
Through our pilot study we identified that there are several moral concepts that are extended also to health-related discussions, mainly blame, guilt, and prejudice. Interestingly, these were negative concepts in contrast to positive ones such as care and equality. In most cases, these claims arose from poorly understood scientific facts or when conclusions were taken out of context. Therefore, contrary to the belief that health-related discussions and opinions are factual, we found a disconnect between these texts and evidence-based studies.
- Arooj, Parniya et al. “Bronchoscopy in the investigation of outpatients with hemoptysis at a lung cancer clinic.” Respiratory medicine vol. 139 (2018): 1-5. doi:10.1016/j.rmed.2018.04.007
- Mondoni, Michele et al. “Predictors of Malignancy in Patients With Haemoptysis.” Archivos de bronconeumologia vol. 58,8 (2022): 618-620. doi:10.1016/j.arbres.2021.11.002
- Kuwano, H et al. “Hypercalcemia related to the poor prognosis of patients with squamous cell carcinoma of the esophagus.” Journal of surgical oncology vol. 42,4 (1989): 229-33. doi:10.1002/jso.2930420406
 The original data is in German and has been translated by the authors for this publication.