Abstract

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem.

Highlights

  • In philosophical writing on healthcare, there is considerable discussion of ‘personal responsibility’ in healthcare allocation (Buyx, 2008; Friesen, 2018; Le Grand, 2014; Levy, 2018; Savulescu, 2018; Sharkey & Gillam, 2010; Wikler, 2002)

  • Sometimes called ‘responsibilisation’ (Brown et al, 2019), this debate sits within the broader context of responsibility–­sensitivity in distributive justice, i.e., the extent to which individual entitlements depend on prior free choices

  • Advocates of responsibility–­sensitivity can answer many pragmatic issues raised by the social determinants of health by noting that to the extent that a health need is socially determined, it is not part of someone's choice and not something for which luck egalitarianism should hold them responsible

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Summary

Introduction

In philosophical writing on healthcare, there is considerable discussion of ‘personal responsibility’ in healthcare allocation (Buyx, 2008; Friesen, 2018; Le Grand, 2014; Levy, 2018; Savulescu, 2018; Sharkey & Gillam, 2010; Wikler, 2002). Advocates of responsibility–­sensitivity can answer many pragmatic issues raised by the social determinants of health by noting that to the extent that a health need is socially determined, it is not part of someone's choice and not something for which luck egalitarianism should hold them responsible.

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