Phase-dependent justification: the role of personal responsibility in fair healthcare

Abstract

The main aim of this paper is to examine the fairness of different ways of holding people responsible for healthcare-related choices. Our focus is on conceptualisations of responsibility that involve blame and sanctions, and our analytical approach is to provide a systematic discussion based on interrelated and successive health-related, lifestyle choices of an individual. We assess the already established risk-sharing, backward-looking and forward-looking views on responsibility according to a variety of standard objections. In conclusion, all of the proposed views on holding people responsible for their lifestyle choices are subjected to reasonable critiques, although the risk-sharing view fare considerably better than the others overall considered. With our analytical approach, we are able to identify how basic conditions for responsibility ascription alter along a time axis. Repeated relapses with respect to healthcare associated with persistent, unhealthy lifestyle choices, call for distinct attention. In such situations, contextualised reasoning and transparent policy-making, rather than opaque clinical judgements, are required as steps towards fair allocation of healthcare resources.

Priority setting and personal health responsibility: an analysis of Norwegian key policy documents

“…For the purpose of this study, health responsibility was understood as a multidimensional concept. Based on refs 2 3 7–22, we synthesised and developed a conceptual framework to aid the analysis of personal health responsibility, constituted by five dimensions (figure 1).…”

“…Second, the actions and behaviours of the individual must be the actual cause of ill health 23. Given the importance of exogenous contributing factors beyond individual control, such as genetic predispositions and biological factors, the causation objection explains why determining the extent to which the patient’s healthcare needs are caused by lifestyle is difficult 21 42 46…”

“…Other objections concern the practical implementation of personal health responsibility. The harshness objection states that it would be too harsh to make treatment conditional on the individual’s own health responsibility because the public has a moral obligation for taking care of individuals in need even when the illness is perceived as self-inflicted 21 22 47. The intrusiveness objection points to the fact that the process of ascription of responsibility may be experienced as an invasion of the individual private sphere that could bring about feelings of shame and distrust 21 26 42.…”

“…The harshness objection states that it would be too harsh to make treatment conditional on the individual’s own health responsibility because the public has a moral obligation for taking care of individuals in need even when the illness is perceived as self-inflicted 21 22 47. The intrusiveness objection points to the fact that the process of ascription of responsibility may be experienced as an invasion of the individual private sphere that could bring about feelings of shame and distrust 21 26 42. Finally, given the relationship between socioeconomic status and health-related behaviours,43 the inequity objection holds that the attribution of personal health responsibility could disproportionately harm the worst-off, reinforcing inequities 26.…”

Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list

“…These critiques are often taken as good arguments in luck egalitarianism in the context of healthcare(Baerøe & Cappelen, 2015;Feiring, 2008; Hausman, 2013, pp. 100-101;Mailly, 2005; Venkatapuram, 2011, p. 198) …”