The Heart Attack Grill, in Phoenix, Arizona, has a medical theme, in keeping with its name. Waitresses dress in skimpy nurses’ uniforms; customers, who come to gorge themselves on super-high calorie fare like Double Bypass Burgers and lard-fried french fries, wear hospital gowns over their clothes and are referred to as patients. The menu features no diet drinks. The new “model” for the Grill is Blair River, a former high school wrestler who stands 6 feet 8 inches tall and weighs 600 pounds (he’s also a financial adviser at the University of Phoenix.) River now has a $100-an-hour contract to pose for ads and TV commercials for the establishment, including a recent YouTube video which invites anyone over 350 pounds to eat for free. And, apparently, if you are over 500 pounds, they pay you.

If you are a citizen in good standing in San Francisco, you are presumably gasping in horror and outrage. That city, as you may have heard, recently banned McDonald’s Happy Meals because it doesn’t think parents have the ability or the common sense to supervise their children’s diets, and want to make sure all kids in the Bay area grow up to appreciate a municipal government that champions their choice to end the life of an unwanted embryo, but won’t allow them to buy their own child a box of fast food with a toy inside. Unhealthy eating, in San Francisco, is no longer a choice at all, or soon will not be. [For the record, I bought my son exactly two Happy Meals in his life. Oddly, the plastic figure of the Hamburglar locked in combat with Darth Maul and the tiny Shrek magnet game did not enthrall him; I’m pretty sure he left then at the restaurant.] Obviously, the same trend is not in evidence in Phoenix.

The most ethical of the two cities in this regard? Phoenix, of course, and it’s no contest. If someone wants to have a Double-Bypass Burger or six, it is not as if the Heart Attack Grill is hiding the implications for one’s future health. Indeed, this is an especially ethical restaurant: there are hundreds of thousands of eateries that offer equally artery-clogging meals that don’t make you dress in hospital garb. The Heart Attack Grill’s gallows humor about what it serves is a lot more effective, it seems to me, than putting little labels on cigarette packages. The San Francisco City Council might consider making all non-Vegan establishments put their waitresses in nurse outfits. In fact, they might.

Eating at the Heart Attack Grill won’t hurt you, like anything else, if you don’t do it to excess. People who enjoy pigging out should be able to do it when they have the inclination without you or me or Nancy Pelosi’s pals blocking the door. Yes, risking your health is irresponsible to the people you owe duties to, like your family, but there are thousands of risks we choose, including not exercising or exercising too much, eating too much or dieting too often, driving while tired, and working too hard.  It is our responsibility to make the right calculations. The Heart Attack Grill provides enjoyment for some, and reminds all of the risks in the process, with humor. To those who say “Ick! No tofu?” I say, go eat somewhere else. In fact, go to San Francisco, where the ethical value of autonomy—permitting others freedom to do what they choose—isn’t on the list of ethical values. It has been replaced by the false value of “letting people do whatever they want as long as it isn’t something we find unhealthy.” What is the name for that? Presumption? Arrogance? Paternalism? Whatever one calls it, it isn’t ethical.

To anticipate the arguments of Bill Maher et al., no, I don’t think opposing the food police is inconsistent with supporting anti-drug laws, not one bit. Drug use and addiction has a well-documented history of destroying families, businesses, relationships and societies. By its nature it does not encourage moderation, and it is especially tempting and destructive for kids. A meal at The Heart Attack Grill is still a meal, and people have to eat. People don’t have to get stoned. Driving while stuffed doesn’t tend to get people killed. There are always lines that have to be drawn, and when it comes to personal autonomy, drug use is a reasonable and ethical place to draw it.

And yes, I recognize that as health care becomes more and more a government and community financed cost, there is an increasing government interest in keeping people healthy, which includes persuading them to be thin. It is an unavoidable consequence of making me pay for your life style, and vice-versa, and one that has been insufficiently explored in policy debates. A system that balances autonomy with accountability would make the individual who chooses to ride a motorcycle without a helmet bear more of the economic burdens of the preventable injuries when he crashes, rather than prohibit him from making the (stupid) choice to ride unprotected. I would extend the same principle to those who end up needing real nurses because they choose get served too often by the fake ones at the Heart Attack Grill, and begin to look like Blair River.

It’s still an ethical restaurant.

[ Thanks to Tim LeVier for the tip.]