A July 10 editorial in the British Medical Journal exhibits a moral confusion typical of our age. The editorial considers whether alcoholics should receive liver transplants when their livers fail. Is it a waste of medical time, effort, and money? This is a controversial question, the authors observe, because some believe that alcoholic liver disease is self-induced and that therefore sufferers do not deserve a transplant.

But the authors deny that alcoholic liver disease is self-induced; after all, they argue, “clear genetic and environmental influences exist.” Yet they go on to say that alcoholics who get new livers generally stop drinking. Fewer than 10 percent of such patients drink more than moderately, only 5 percent of transplants fail because of renewed drinking, and the abstinence rate of alcoholics who have undergone transplantation is about six times that of alcoholics who have undergone conventional “treatment.”

Thus their own data virtually prove that, contrary to received notions of addiction, alcoholics can control their drinking, if motives—including fear—are strong enough (unless a liver transplant in itself exerts a hitherto unknown physiological effect that decreases the appetite for alcohol). Fright and the hospital experience encourage sobriety. The problem of alcoholism, in other words, lies in the psychological, spiritual, and moral realm. Though the environment may exert a force, one has the freedom to resist it, unlike an impersonal force such as gravity.

If alcoholic liver disease is self-inflicted, as the authors’ own evidence argues, why are they so anxious to deny the obvious? I think that they feel obliged to acquit those suffering from alcoholic cirrhosis of the self-infliction charge, because, according to the crude sentimentality of our modern moral sensibility, only victims are worthy of a full measure, indeed an infinite measure, of sympathy. Everyone else can—and should—go to the devil. But since it would be harsh to send so many people thither, we must pretend that almost everyone is a victim.

It is possible, however, to look at the whole question differently. Yes, alcoholic liver disease is self-inflicted: but we know that man is a fallen creature, and that none of us is without his weaknesses. That a man has done harm to himself, or even to others, is not a reason for withdrawing all sympathy from him—which would be a hard doctrine indeed. It does not follow, therefore, that a man guilty of self-inflicted harm deserves no assistance. Moreover, the post-transplant sobriety of alcoholics suggests that redemption is possible, that a man can change his ways. This outlook is much more encouraging, and better fits the facts, than one that sees man as the victim of “genetic and environmental influences.”

In short, the traditional religious view is in some respects more accurate than the supposedly scientific, secularist view. And I say this as a secularist.


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