The role of personal responsibility in fair health care
Could it be fair to use people's life-style choices with potential adverse impact on their health as criteria for priority settings in health care? This question is thoroughly addressed by a new paper recently published online in Journal of Medical Ethics. The paper is written by our research group member Kristine Bærøe together with Cornelius Cappelen.
Despite a huge focus on priority setting in health, the question whether it is fair or not to hold people responsible for their health has not been much discussed in a Norwegian setting. Lifestyle choises like smoking, inactivity and unhealth food have a well-documented negative effect on peoples health. A large poportion of the disease burden, like heart disease and cancers is strongly linked to how people behave and the large majority of norwegians know this. Still, making health priorities based on individual responsibility is seen as unfair. But is it unfair?
In this new paper in Journal of Medical Ethics, associate professor Kristine Bærøe examine the fairness of different ways of holding people responsible for healthcare-related choices. The article is written together with Cornelius Cappelen, post doctor at the Department of Comparativ Politics at the University of Bergen.
Bærøe K, Cappelen C. Phase-dependent justification: the role of personal responsibility in fair healthcare. Journal of Medical Ethics 2015.
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.