Luck Egalitarianism, Individual Responsibility and Health

Abstract

Basic ethical theories have various attitudes towards right to health. Utilitarian ethical theory states that it is ethically obligatory to act in a way which would create the most utility/ happiness for the majority of the population. Thus, utilitarian perspective regards rights to health as a tool to achieve utility/happiness of the majority. In this view, health is not recognized as a fundamental human right with intrinsic ethical value but rather a means to the utmost good which is utility/ Luck Egalitarianism has frequently been discussed in the recent literature because of the potential impact of this theory on health financing. Luck Egalitarianism puts forth a theory of distributive justice which says that the fundamental aim of equality is to compensate people for undeserved bad luck such as being born with poor native endowments, having difficult family circumstances or suffering from accidents and illness. On the other hand, if individuals face ill health because of faults of their own, then society has no duty to supply health services to them. Many arguments for and against this theory have been raised since it was first introduced. The proponents of Luck Egalitarianism focus on the concepts that free choice and respecting the autonomy of the individual determine whether health services are deserved. The criticisms against the concept of Luck Egalitarianism are that it is harsh to the needy and abandons the wretched, discriminates against the disabled, is against basic humanitarian principles, is incompatible with human dignity, and is in dissonance with real life. We agree with the basic proposition of Luck Egalitarian theory, which states that "inequalities deriving from unchosen features of people's circumstances are unjust and therefore should be compensated for". Our agreement leads us to an opposite conclusion. We propose that the "unchosen features of people's circumstances" include more than personal disadvantages. The social features to be included in the context of inequalities deriving from unchosen features of peoples circumstances are, socioeconomic status (SES), access to social determinants of health, and the ethnic, cultural and religious identity of individuals. Our other propositions are the mutable character of choices which makes individual responsibility of preferences implausible; the problematic causal relationship between responsibility and ill-health; the disregard of the motives behind decisions; problems with implementation in real health service circumstances; and the contradictory nature of Luck Egalitarianism for principles of medical ethics. These arguments draw attention to possible ethical and practical consequences of implementation of health policies arising from Luck Egalitarian view for patients and for health care providers. In this paper, we will first define Luck Egalitarianism. Then, we will discuss arguments for and against the theory in the literature. Our final task is to suggest additional criticisms of the theory and justify them.

Personality and perceptions about the use of personal responsibility for illness as a health care rationing criteria.

“…Several arguments have been put forward both in favor of and in opposition to the idea of holding individuals responsible for their choices (see Albertsen & Knight, 2015; Brown, 2013; Cappelen & Norheim, 2005; Levy, 2018; Sharkey & Gillam, 2010, for reviews). The arguments in favor of such an assumption mainly focus on the concepts of deserving, wronging people, respect for human autonomy, and individual responsibility (Ekmekçi & Arda, 2015). Furthermore, there is evidence that following a healthy lifestyle is also a determinant of the recrimination of unhealthy behaviors, followed by others (Borges & Pinho, 2017; Rogge & Kittel, 2016).…”

“…Furthermore, there is evidence that following a healthy lifestyle is also a determinant of the recrimination of unhealthy behaviors, followed by others (Borges & Pinho, 2017; Rogge & Kittel, 2016). Notwithstanding the many supporters of this distributive theory, several arguments have also been presented against it (Andersen et al, 2013; Brown, 2013; Callahan et al, 2000; Ekmekçi & Arda, 2015; Ho, 2008; Sharkey & Gillam, 2010). One of the main obstacles to this responsibility-sensitive theory that has raised many ethical concerns is the difficulty of knowing to what extent risk behaviors contributed effectively to the illness.…”

Dispositional and situational attributions for why the rich live longer than the poor

“…Understanding attributions for unequal health is particularly interesting, we think, in the context of theories of justice and how they apply to health. One approach to distributive justice in health is the position of luck egalitarianism, a key proposition of which is that any variation in outcomes between people should not be driven by luck but by the choices people make (Ekmekci & Arda, 2015). A luck egalitarian would argue that health care should act to prioritize those whose ill‐health arises for reasons that are not their fault, but that society does not owe a person any help or care if ill‐health arises because of imprudent choices or behavior.…”

Do fair and just systems require compensation for the disadvantages of the natural lottery? a discussion on society's duties on the provision of gene therapy

“…The natural lottery is beyond individuals' control. No one can choose their nationality, religion, ethnicity, or socio-cultural environment [15]. The individual responsibility argument is endorsed by the sheer bad luck perspective, which implies that equal opportunity can be achieved if the inequalities in talents and abilities as well as means resulting from an initial social position are compensated for.…”