The Care of Self as Ground of the Physiological Right

A secular foundation for a right that must hold when affect fails.

I. What the right cannot rest on

The physiological right names what a body is owed for the full functioning of its tissues. It asks that a person be given, and be assured of the means to give themselves, the substances and the conditions the organism was designed to run on. The demand is exacting, and it is a demand for a lifetime.

A first temptation is to ground this demand in the love a person is expected to feel for their own life. If I love my life, I will nourish it. If I care for my body, I will maintain it. If I revere the vitality of what I am, I will not treat it as an afterthought.

This ground does not hold. Many people, some of the time and some of them all of the time, do not feel that love. The affect is unevenly distributed. It fails under fatigue, under grief, under the flattening of modern life, under the mild but persistent depression that a substantial fraction of adults carry without ever naming it. If the right stood only where the love stood, it would leave unprotected the very persons who most need its protection, that is, those in whom the affect of self-care has been eroded by the very conditions the right aims to correct.

A right that fails when affect fails is not a right. It is a lifestyle available to the affectively fortunate.

II. What Western tradition offers, without divinity

Western tradition has thought this exact difficulty. It has thought it, moreover, without recourse to any divine ground, in vocabularies that a secular reader can enter without conversion. Four lineages meet on the same terrain, and it is worth naming each one, because each answers a different reader.

The care of self, from antiquity

The Greek epimeleia heautou, care of the self, was for the philosophical schools of antiquity a practice, not a sentiment. Socrates in the Apology names it as the responsibility Athens ought to be inculcating in its youth. The Stoics, from Epictetus to Marcus Aurelius, made it the axis of an entire moral life. Pierre Hadot, in Philosophy as a Way of Life, retraced the ancient sense of spiritual exercises, a paradox to modern ears because these exercises are spiritual only in the sense that they concern the soul’s orientation toward what is. They comprise the examination of conscience, meditation on the goods, regulation of impressions, attention to the passing state of the body. Michel Foucault, in The Hermeneutics of the Subject (Collège de France, 1981-1982), gave this tradition its most patient modern reading. He distinguished the care of self, which is a continuous practice, from the delphic know thyself, which is a moment of knowledge. The first is primary. It is the constant orientation of a life to itself as an object of attention and cultivation.

This tradition is Western, philosophical, pre-Christian, secular before secularism. It is, in a very direct sense, the antique word for what the physiological right today asks to be installed as a right. This resource has already given the mythological figure of that practice its place under her Greek name, Hygeia, and traced her eclipse by Panacea, the promise of the remedy that cures all (see All Medicine Is Preventive, § III). The philosophical figure is epimeleia heautou. The two meet on the same ground.

The conatus, from Spinoza

Spinoza, in Ethics III, proposition 6, states that each thing, insofar as it is in itself, endeavours to persevere in its being. The conatus is not a psychological desire. It is an ontological tendency, the direction every existing thing takes simply by being. To devote oneself to one’s own perseverance is therefore not a moral supplement one adds to one’s life. It is the lucid alignment with what one already is, under the surface, at the level of one’s very existence. When a person eats what their tissues require, when they take the mineral their nerves need to conduct, they are not performing a piety. They are ratifying, at the level of conscious action, what their conatus does anyway at the level of their being.

Spinoza’s joy, laetitia, is what the mind feels when its power to act increases. The maintenance of the body’s constitutive substances is one of the direct and unmysterious pathways to that increase.

Responsibility to the vulnerable, from Jonas

Hans Jonas, in Das Prinzip Verantwortung (1979), founded an ethics on the obligation we owe to what is vulnerable and dependent on us. His paradigmatic figure is the infant. The infant does not need to be loved in order to oblige. Its very vulnerability, without any prior affect, imposes the obligation. Turn this figure toward the self. The body one inhabits is, in significant respects, an infant to the person who inhabits it. It is vulnerable, it is dependent on an attention only the person can provide, it will not survive without an intake only the person can secure. It obliges in the same manner. Responsibility precedes affect and does not require it.

The formulation is significant for the secular reader because it borrows nothing from any religious tradition. It emerges from a strictly modern philosophical concern, the concern for what industrial capacity has placed at risk. It applies to one’s own body without adjustment.

The person as end, from Kant

Kant, in the Groundwork of the Metaphysics of Morals, wrote the formula that a secular tradition of rationalist derivation has never contested. Act so as to treat humanity, whether in your own person or in that of any other, always at the same time as an end, and never merely as a means. To treat the body one inhabits as an instrument of production, to be run below the ranges its own tissues require, is a violation of this imperative applied to oneself. The imperative is not affect. It is a demand of reason on itself. It obliges the rationalist reader as fully as any of the more recent formulations.

Kantian Achtung, respect, is not a sentiment. It is the recognition, by reason, of the dignity of the rational being. Applied reflexively, it becomes the ground of a self-treatment that no failure of feeling can excuse.

III. Integrity, a word already in the law

The word integrity, in the sense of the intact and undivided condition of what is protected, is already established in the language of law. Physical integrity of the citizen, territorial integrity of the state, moral integrity of the professional, these are recognised categories. The physiological right adds one adjective and one level. The integrity it protects is physiological, the level at which the tissues of the person are supplied with what they need to remain themselves. The vocabulary is already juridical. It requires no importation of an unfamiliar term. It requires only that the law be reminded that integrity has a physiological floor.

IV. The care of self is not the care by self alone

An objection presents itself. If the right rests on the care of the self, does it privatise the demand ? Does it reduce a collective obligation to an individual duty ?

It does the opposite. The care of self, when it becomes a right, ceases to be a matter of individual discipline. It becomes something the person can demand the collective conditions for. The right to physiological integrity implies the right to know one’s own tissue status, the right to obtain the substances one’s tissues require, the right to a food system that does not silently deplete them, the right to a clinical encounter in which the questions of maintenance are legitimate. What antiquity placed on the shoulders of the philosophically minded few, the modern right places on the shoulders of the polity that owes each of its members the means of that care. The infrastructure of fortification, of screening, of nutritional education, of clinical assessment worthy of the name, is the collective face of what the individual practice cannot bear alone.

V. The formula

The physiological right does not depend on the love a person happens to feel for their own life, on a faith they may not hold, on a devotion the age may not permit. It depends on a fact that antiquity named and that modernity has forgotten, that a person is a being whose perseverance in existence is theirs to attend to, and that the community they belong to is a community obliged to make that attention possible.

To care for one’s physiological integrity is neither a luxury, nor a caprice, nor a private devotion. It is the contemporary exercise of a care of self that preceded all medicine, and the application to oneself of the most elementary rule of modern right : never to treat oneself as a mere means.