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

Albertsen, Andreas

doi:10.1177/1065912919845077

Cited by 29 publications

(7 citation statements)

References 159 publications

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“…However, as most healthcare systems face difficulties with prioritisation, the idea that personal health responsibility may play a role in allocating scarce resources has gained traction in needs-based systems in recent years [ 5 ]. This idea may be normatively justified with reference to luck egalitarianism—a responsibility-sensitive theory of distributive justice—which claims that distributions are just if ‘[…] people’s comparative positions reflect nothing but their comparative exercises of responsibility’ [ 19 ]. Inequalities that are the result of voluntary choices do not give rise to redistributive claims on others.…”

Section: Standard Objections To Personal Health Responsibilitymentioning

confidence: 99%

On the person in personal health responsibility

2022

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In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.

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Section: Standard Objections To Personal Health Responsibilitymentioning

confidence: 99%

On the person in personal health responsibility

2022

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“…Prominent examples are co-payment for dental health in Germany (Schmidt, 2008); the Dutch inclusion of personal responsibility as a criterion for rationing (Tinghög, Carlsson and Lyttkens, 2010) and practices in Florida, where obesity was recently considered a reason to deny certain treatments (Eyal, 2013). Such policies and the principles that underpin them are, of course, controversial (Feiring, 2008;Nielsen and Axelsen, 2012;Friesen, 2018;Albertsen, 2020). Here, we apply Roemer's approach for analytical purposes.…”

Section: 1mentioning

confidence: 99%

Does the responsibility patients exert determine their opportunities for best clinical practice in the healthcare system?

Hyldgård¹,

Støvring²,

Albertsen³

et al. 2021

Nordic J Health Eco

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Many consider inequality in health unfair if it is caused by inequality within the healthcare system but less unfair when caused by individuals’ health behaviour. However, healthcare systems are challenged when it comes to ensuring equal care for equal need. In Roemer’s equality of opportunity theory, people have equal opportunity for obtaining something if obtaining it reflects their effort instead of their circumstances. Very little is known about how responsibility exerted by patients prior to illness affects the healthcare they are provided by the healthcare system. We aimed to apply Roemer’s theory to an acute care setting where healthcare is most directly in the hands of the healthcare system in order to study the role of patient-exerted responsibility for their opportunities in the healthcare system. We operationalised the responsibility patients exert as Body Mass Index (BMI), smoking and alcohol habits, and their circumstances as demographics, socioeconomics, prognostic factors and year of discharge. Opportunity in healthcare was defined as patients’ attainment of clinical guideline-recommended acute hospital care. In Roemer’s theory, we detected inequality of opportunity as restricted attainment of healthcare was mainly associated with patients’ circumstances, such as lower education, old age or living alone. We also identified a strong association with BMI; being underweight negatively affected patients’ opportunities as it led to suboptimal healthcare, while the opposite was found for being overweight and, in particular, obese. Hence, patient-exerted responsibility affected patients’ opportunities in healthcare, though perhaps in an unexpected way. This improved understanding of inequality may help to focus future research and, in the long term, support clinical and political efforts to achieve equal care for equal needs. Published: Online March 2021.

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“…On such prudence based formulations, luck egalitarianism holds that distributions are just, if and only if, they reflect people's relative exercises of responsibility. [2][3][4] Recently, such interpretations of luck egalitarianism have been applied to healthcare allocation [5][6][7]. Munthe, Furmagelli and Malmqvist argue that luck egalitarianism is not in the appropriate sense futureoriented.…”

Section: Luck Egalitarian Sustainabilitymentioning

confidence: 99%

How the past matters for the future: a luck egalitarian sustainability principle for healthcare resource allocation

Albertsen

2021

J Med Ethics

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While it is plausible that we should take the possible negative dynamics of healthcare allocation decisions into account, we may not need a principle of sustainability for this. Munthe, Furmagelli, and Malmqvist are correct that luck egalitarianism focuses on the past, however, this prominent theory of distributive justice can still take into account the interests of those who will be affected by our allocation decisions. This is the case because present allocation may unjustly affect people in the future. Indeed luck egalitarianism may plausibly consider it unjust if we do not take future people's interests into account.

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

Cited by 29 publications

References 159 publications

On the person in personal health responsibility

On the person in personal health responsibility

Does the responsibility patients exert determine their opportunities for best clinical practice in the healthcare system?

How the past matters for the future: a luck egalitarian sustainability principle for healthcare resource allocation

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