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Appeals to Individual Responsibility for Health

Reconsidering the Luck Egalitarian Perspective

Published online by Cambridge University Press:  14 March 2013

KRISTIN VOIGT
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Type
Special Section: Open Forum
Information
Cambridge Quarterly of Healthcare Ethics , Volume 22 , Issue 2 , April 2013 , pp. 146 - 158
Copyright
Copyright © Cambridge University Press 2013

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References

Notes

1 In addition to the following references, see Wikler D. Who should be blamed for being sick? Health Education and Behavior 1987;14:11–25; Wikler D. Personal responsibility for illness. In: Van De Veer D, Regan T, eds. Health Care Ethics: An Introduction. Philadelphia: Temple University Press; 1987:326–58.

2 For example, an emphasis on individual responsibility has been identified in recent policy documents in the UK: Smith et al. note that, around 2003, there was a shift from a focus on social and material factors, such as social exclusion or housing, toward “lifestyle choices” as causes of health inequalities and areas on which policy interventions should focus; Smith K, Hunter D, Blackman T, Elliott E, Greene A, Harrington B, et al. Divergence or convergence? Health inequalities and policy in devolved Britain. Critical Social Policy 2009;29:216–42. See also Hunter D. Choosing or losing health? Journal of Epidemiology and Community Health 2005;59:1010–3.

3 E.g., on media representations of obesity, see Saguy A, Gruys K. Morality and health: News media constructions of overweight and eating disorders. Social Problems 2010;57:231–50.

4 Dworkin R. What is equality? Part 2: Equality of resources. Philosophy and Public Affairs 1981;10:283–345; Cohen GA. On the currency of egalitarian justice. Ethics 1989;99:906–44; Arneson RJ. Equality and equal opportunity for welfare. Philosophical Studies 1989;56:77–93.

5 Segall S. Health, Luck, and Justice. Princeton, NJ: Princeton University Press; 2009.

6 For some of these different definitions, see Elford G. Equality of opportunity and other-affecting choice: Why luck egalitarianism does not require brute luck equality. Ethical Theory and Moral Practice; forthcoming.

7 E.g., see note 4, Dworkin 1981.

8 See note 4, Arneson 1989; Arneson RJ. Liberalism, distributive subjectivism, and equal opportunity for welfare. Philosophy and Public Affairs 1990;19:158–94; Arneson RJ. Welfare should be the currency of justice. Canadian Journal of Philosophy 2000;30:497–524.

9 Potential problems arising from this feature of the luck egalitarian approach are discussed in Daniels N. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008, chap. 2.

10 Arneson RJ. Luck egalitarianism—a primer. In: Knight C, Stemplowska Z, eds. Responsibility and Distributive Justice. Oxford: Oxford University Press; 2011:24–50, at 49.

11 See note 5, Segall 2009.

12 Whitehead M. The concepts and principles of equity and health. Health Promotion International 1991;6:217–28, at 219.

13 E.g., World Health Organization. Ethical Considerations in Developing a Public Health Response to Pandemic Influenza. Geneva: World Health Organization; 2007.

14 See note 9, Daniel, 2008.

15 See note 9, Daniels 2008, at 81.

16 Commission on the Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva: World Health Organization; 2008, at 26.

17 Norheim O, Asada Y. The ideal of equal health revisited: Definitions and measures of inequity in health should be better integrated with theories of distributive justice. International Journal for Equity in Health 2009;8:40.

18 See note 17, Norheim, Asada 2009.

19 A possible exception here may be Dworkin, whose approach can be interpreted as requiring that inequalities cannot be unfair if we do not have the means to remedy them; this interpretation is discussed in Williams A. Equality, ambition and insurance. Proceedings of the Aristotelian Society 2004;78:131–50.

20 For further discussion on the moral (ir)relevance of the distinctions made in this discussion, see, e.g., Lippert-Rasmussen K. Are some inequalities more unequal than others? Nature, nurture and equality. Utilitas 2004;16:193–219; Nagel T. Justice and nature. Oxford Journal of Legal Studies 1997;17:303–21; Braveman P, Gruskin S. Defining equity in health. Journal of Epidemiology and Community Health 2003;57:254–8.

21 E.g., Anderson E. What is the point of equality? Ethics 1999;109:287–337; Fleurbaey M. Equal opportunity or equal social outcome. Economics and Philosophy 1995;11:25–55.

22 E.g., see note 21, Anderson 1999.

23 Cappelen AW, Norheim OF. Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics 2005;31:476–80; Cappelen AW, Norheim OF. Responsibility, fairness and rationing in health care. Health Policy 2006;76:312–9.

24 Cohen GA. Rescuing Justice and Equality. Cambridge, MA: Harvard University Press; 2008; see note 4, Cohen 1989.

25 Arneson RJ. Egalitarianism and the undeserving poor. Journal of Political Philosophy 1997;5:327–50; Barry N. Reassessing luck egalitarianism. Journal of Politics 2008;70:136–50.

26 E.g. see note 25, Arneson 1997; see note 5, Segall 2009.

27 Voigt K. The harshness objection: Is luck egalitarianism too harsh on the victims of option luck? Ethical Theory and Moral Practice 2007;10:389–407.

28 Arneson R. Equality of opportunity for welfare defended and recanted. Journal of Political Philosophy 1999;7:488-97:488–9.

29 Barry N. Defending luck egalitarianism. Journal of Applied Philosophy 2006;23:89–107; see note 25, Barry 2008.

30 Marmot MG, Wilkinson RG. Social Determinants of Health. 2nd ed. Oxford: Oxford University Press; 2006.

31 See note 27, Voigt 2007.

32 Stemplowska Z. Making justice sensitive to responsibility. Political Studies 2009;57:237–59.

33 Schmidt H, Gerber A, Stock S. What can we learn from German health incentive schemes? British Medical Journal 2009;339:725–8.

34 Schmidt H, Voigt K, Wikler D. Carrots, sticks, and health care reform—problems with wellness incentives. New England Journal of Medicine 2010;362:e3(1)–e3(3).

35 E.g., Florida Agency for Health Care Administration. Florida Medicaid Reform Application for 1115 Research Demonstration and Waiver; 2005 Oct; available at http://ahca.myflorida.com/medicaid/medicaid_reform/waiver/pdfs/medicaid_reform_waiver_final_101905.pdf (last accessed 13 Feb 2010).

36 For the distinction between prospective and retrospective responsibility, see, e.g., Marckmann G. Eigenverantwortung als Rechtfertigungsgrund für ungleiche Leistungsansprüche in der Gesundheitsversorgung? In: Rauprich O, Marckmann G, Vollmann J, eds. Gleichheit und Gerechtigkeit in der modernen Medizin. Paderborn: Mentis; 2005:300–13; Marckmann G, Möhrle M, Blum A. Gesundheitliche Eigenverantwortung. Der Hautarzt 2004;55:715–20. The distinction between backward- and forward-looking notions of responsibility is used by Feiring E. Lifestyle, responsibility and justice. Journal of Medical Ethics 2008;34:33–6; Kelley M. Limits on patient responsibility. Journal of Medicine and Philosophy 2005;30:189–206.

37 E.g., note 36, Feiring 2008.

38 On this, see also Wikler D. Persuasion and coercion for health: Ethical issues in government efforts to change life-styles. Milbank Memorial Fund Quarterly 1978;56:303–27.

39 Daniels N. Individual and social responsibility for health. In: Knight C, Stemplowska Z, eds. Responsibility and Distributive Justice. Oxford: Oxford University Press; 2011:266–86.

40 See note 39, Daniels 2011, at 285.

41 See note 39, Daniels 2011, at 285.

42 See note 39, Daniels 2011, at 285.

43 Voigt K. Incentives, health promotion and equality. Health Economics, Policy and Law 2012;7:263–83.

44 Department of Health. The Handbook to the NHS Constitution; 2009; available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_093415.pdf (last accessed 1 Sept 2009).

45 NHS. The NHS Constitution: The NHS Belongs to Us All. Interactive version; http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/nhs-constitution-interactive-version-march-2010.pdf (last accessed 3 Jan 2011).

46 Buyx A. Personal responsibility for health as a rationing criterion: Why we don’t like it and why maybe we should. Journal of Medical Ethics 2008;34:871–4.

47 See note 36, Feiring 2008, at 35.

48 A similar argument is provided by Glannon, who suggests that we have a moral responsibility not to heighten the scarcity of organs available for transplant, and that this implies that we should give lower priority to alcoholics when it comes to liver transplants; Glannon W. Responsibility and priority in liver transplantation. Cambridge Quarterly of Healthcare Ethics 2009;18:23–35.

49 NHS. The NHS Constitution: The NHS Belongs to Us All. Interactive version; http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/nhs-constitution-interactive-version-march-2010.pdf (last accessed 3 Jan 2011).

50 Segall S. Unconditional welfare benefits and the principle of reciprocity. Politics, Philosophy & Economics 2005;4:331–54; White S. Liberal equality, exploitation, and the case for an unconditional basic income. Political Studies 1997;45:312–26.

51 See note 50, White 1997.

52 See note 4, Cohen 1989, at 933.

53 This concern is also noted by Scheffler. He emphasizes that conservatives use a simplistic, moralized discourse of individual responsibility that shifts the task of alleviating poverty to the poor. In its attempt to counter the conservative’s use of individual responsibility, luck egalitarians may fall prey to a similar moralism; Scheffler S. Choice, circumstance, and the value of equality. Politics, Philosophy and Economics 2005;4:5–28.

54 Schmidt H. Personal responsibility in the NHS constitution and the social determinants of health approach: Competitive or complementary? Health Economics, Policy and Law 2009;4:129–38.

55 Guttman N, Salmon CT. Guilt, fear, stigma and knowledge gaps: Ethical issues in public health communication interventions. Bioethics 2004;18:531–52; Guttman N, Ressler W. On being responsible: Ethical issues in appeals to personal responsibility in health campaigns. Journal of Health Communication 2001;6:117–36.

56 Richards H, Reid M, Watt G. Victim blaming revisited: A qualitative study of beliefs about illness causation and responses to chest pain. Family Practice 2003;20:711–6.

57 See note 55, Guttman, Ressler 2001, at 121.

58 See note 56, Richards et al. 2003.

59 Popay J. Should disadvantaged people be paid to take care of their health? No. British Medical Journal 2008;337:a594.

60 Chapple A, Ziebland S, McPherson A. Stigma, shame, and blame experienced by patients with lung cancer: Qualitative study. British Medical Journal 2004;328. doi:10.1136/bmj.38111.639734.7C.

61 Wolff J. Fairness, respect and the egalitarian ethos revisited. Journal of Ethics 2010;14:335–50, at 335.