Personal Responsibility in Health and Health Care: Luck Egalitarianism as a Plausible and Flexible Approach to Health

Abstract

Allocating health care resources based on personal responsibility is a prominent and controversial idea. This article assesses the plausibility of such measures through the lens of luck egalitarianism, a prominent responsibility-sensitive theory of distributive justice. This article presents a framework of luck egalitarianism in health, which integrates other concerns of justice than health, is pluralist, and is compatible with a wide range of measures for giving lower priority to those deemed responsible. Applying this framework to oral health, the allocation of livers among potential transplant recipients and travel insurance demonstrates that this version of luck egalitarianism is a much more attractive and flexible theory than much of the contemporary discussion allows. This also pertains to its ability to provide plausible answers to two prominent critiques of harshness and intrusiveness. The discussion also shows that the luck egalitarian commitment to eliminating the influence of luck on people’s lives is likely to require substantial redistribution.