Your Treatment, My Treat? : On Lifestyle-Related Ill Health and Reasonable Responsibilitarianism

Sammanfattning: How should the costs of unhealthy lifestyles be distributed between individual citizens and the state? This study approaches this question by investigating the justifiability of the responsibilitarian idea that people who are responsible for their lifestyle-choices should also be held responsible for the costs that these lifestyle-choices generate.Two main conclusions come out of this investigation. The first is that the basic justification of responsibilitarian health policies can be found in what is called the Civic Blame approach to responsibilitarianism. This approach builds upon a moralized conception of responsibility, accountability responsibility. On this conception, the moral quality of contemporary imprudent people’s behaviour is the essential starting point for establishing that they ‘are responsible’. Consequently, what justifies responsibilitarian health policies on this approach is not that imprudent people cause their own ill health or that they exercise sufficient control over their lifestyle-choices, but that they breach reciprocity-based civic obligations through their health-risking behaviour.The second conclusion is that the emphasis on fairness of blame/differential treatment inherent in the Civic Blame approach imposes two important justificatory constraints. The first is that the response to the breaches of civic obligations must be properly proportional and context-sensitive in order to be fair. This constraint can most likely be handled however, since a response of the right kind can be found by holding imprudent people responsible via Sin-Taxes (rather than via harsher policies). More problematic for responsibilitarians is the second constraint: to show that contemporary imprudent people’s behaviour is morally problematic to begin with, and, thereby, to show that contemporary prudent people’s reactive attitudes to health-risking behaviour are fair.Thus, although the Civic Blame approach outlined in the study provides the basic theoretical building blocks for the justification of responsibilitarian health policies, this approach also provides the tools for critically questioning the justifiability of contemporary health policies of responsibilitarian kind.