Her mother got diabetes because she didn’t exercise enough, and her father’s colon cancer was due to a lifetime of fatty foods. If only her sister had drunk more milk when she was younger, she wouldn’t be suffering from osteoporosis now.

She had an explanation for everyone’s illnesses, except her own.

Ms. A was a 61-year-old woman I once interviewed. She was hospitalized for pneumonia: her third case of it this year. I asked if she had thoughts as to what was causing it, and she launched into a speech about bad things happening to good people. In her mind, her smoking habits and emphysema were irrelevant. At even the slightest suggestion they weren’t, she became indignant.

I once read that women judge rape victims more harshly than men do. Why is that? The author writes, and I agree, that it has to do with preserving the women’s own sense of safety. They want to believe, need to believe that the other person was somehow at fault – because otherwise, what is to separate her from me? That there is nothing is an intolerable thought.

I also once read that lung cancer patients feel blamed and scorned, thanks to the perception that theirs is a self-inflicted illness, and that others offer little empathy.

That is, until it happens to them.

I am glad we as a society are focusing more on prevention. On empowering patients to make good choices for their own health. I realize that in order to do that, in order to have it sink in, people need to despise the things they are avoiding. To be scared of them. To stigmatize them. Stigmatization is a powerful motivator.

But when does stigmatization erode our compassion? Can we be proud of our own health choices, without demeaning the suffering of others? Without feeling high and mighty in the face of another’s vulnerability? Without assuming a mask of denial in confessing our own vices?

When something goes wrong, it’s natural to seek blame. People can be especially skilled at coming up with ways to exculpate themselves while reproaching others. Indeed, contributing factors behind an outcome can sometimes be identified. But sometimes they can’t.

Over-stigmatizing the health habits of others treads on dangerous ground. One reason is that health is the result of a complex web of factors, and we live in a reality in which people can do everything “right” and still get sick. Second, and more importantly, even if they do not – no one deserves to suffer. Third, to tackle vices in our own bodies, we must first accept that they are happening. Stigma leads to shame, and shame threatens honesty.

I can’t help you if I don’t know what’s going on.

I want you to know: your smoking habits do not offend me. Tell me why you started, tell me what it does for you, please, tell me everything. Don’t be ashamed; I’m here to help. I’m glad to hear you’ve considered quitting. We can figure out a plan together.

(Note: certain details of the patient's story have been modified slightly to protect her privacy.)