Social inequality in health, responsibility and egalitarian justice

Abstract

Are social inequalities in health unjust when brought about by differences in lifestyle? A widespread idea, luck egalitarianism, is that inequality stemming from individuals' free choices is not to be considered unjust, since individuals, presumably, are themselves responsible for such choices. Thus, to the extent that lifestyles are in fact results of free choices, social inequality in health brought about by these choices is not in tension with egalitarian justice. If this is so, then it may put in question the justification of free and equal access to health care and existing medical research priorities. However, personal responsibility is a highly contested issue and in this article we first consider the case for, and second the case against, personal responsibility for health in light of recent developments in philosophical accounts of responsibility and equality. We suggest-but do not fully establish-that at the most fundamental level people are never responsible in such a way that appeals to individuals' own responsibility can justify inequalities in health.

Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy

“…This discussion has ethical as well as economic aspects. From an ethical point of view, it may seem unfair to deny treatment to an individual; on the other hand, individual responsibility requires everybody take the blame for his/her actions (12)(13)(14). From an economic point of view, priority and rationing in health care are necessary because of scarce resources, but there is no consensus on how to implement such rationing (15-21).…”

“…This discussion has ethical as well as economic aspects. From an ethical point of view, it may seem unfair to deny treatment to an individual; on the other hand, individual responsibility requires everybody take the blame for his/her actions (12)(13)(14). From an economic point of view, priority and rationing in health care are necessary because of scarce resources, but there is no consensus on how to implement such rationing (15-21).The rationing measures proposed so far are usually related to appropriateness of care and expected effectiveness of the treatment; in the future, more severe measures such as rationing on lifestyle may become necessary to reduce the financial burden of non-communicable health diseases.…”

Adolescents’ Perceptions and Experiences of Their Responsibilities for Their Alcohol Use—A Group Interview Study

“…As well as being a time when individuals like to experiment with alcohol, adolescence is a period of increasing responsibility [18]. Responsibility has been defined as how someone controls their own choices and personal affairs [19] and how their morals are perceived by others [20]. People are seen as responsible if they are doing what they are required to do and can justify their actions.…”

‘There is no such thing as getting sick justly or unjustly’ – a qualitative study of clinicians’ beliefs on the relevance of personal responsibility as a basis for health prioritisation

“…In recent years, the proposal that personal health responsibility should be taken into account in setting priorities regarding access to treatment has been widely discussed in the academic literature [5][6][7][8][9][10][11][12][13].…”