Abstract

This chapter discusses whether patients should face penalties for unhealthy lifestyle choices. The idea that people should be held responsible for their bad health decisions is often associated with “luck egalitarianism”. This chapter explains the connection between responsibility-sensitive health care policies and luck egalitarianism and outlines some criticisms that have been made of luck egalitarianism in this context. It then highlights the implications of moral responsibility scepticism for luck egalitarians and other proponents of similarly responsibility-sensitive approaches to health care. Theorists who have discussed the practical implications of moral responsibility scepticism have focused primarily on criminal punishment and, in that context, have often invoked an epistemic argument, maintaining that there are at least serious doubts about whether people are morally responsible (in the sense required for retributive punishment) and that, in view of this uncertainty, retributive punishment is unjust, given the serious harm it inflicts on offenders. This chapter argues that this type of reasoning also implies that we should not take patients’ responsibility for their poor health into account when deciding whether to give these patients treatments and that the health system should not impose significant penalties on individuals for harming their own health. Culpability-based desert seems to stand a better chance of helping luck egalitarians (and others with related views) to justify responsibility-sensitive health care policies compared with some alternative approaches. However, this chapter casts doubt on the idea that responsibility-sensitive health care policies based on this kind of desert are justifiable, focusing on doubts about whether people are morally responsible for harming their own health, whether harming one’s own health is morally wrong, and whether significant penalties for harming one’s health would be proportionate.