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On Reasonable Avoidability and Lifestyle Diseases

quarta-feira 27 de Julho de 2011, por Martin Marchman Andersen

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Epidemiological research is pointing to a number of diseases being associated with particular lifestyle characteristics, such as smoking, drinking, lack of exercise and over-eating. Within egalitarian and especially luck egalitarian theory it is therefore obvious to raise questions on whether the individual person with such lifestyle characteristics, is responsible for the statistically higher risk of getting such diseases and therefore e.g. should be held cost-responsible for the hospital-expenses they bring about.

In his book Health, Luck and Justice, Shlomi Segall argues for a luck egalitarian approach to distributive justice in health and health care. More precisely, he suggests that what is unjust is “… for individuals to be worse off than others due to outcomes that it would have been unreasonable to expect them to avoid” (henceforth: reasonable avoidability, RA). He notes that some people have less healthy lifestyles than others, and by not taking good care of their health, he argues, people with risky lifestyles place unnecessary burdens on the health care system. He maintains therefore that we can reasonably expect individuals to exercise, not to smoke, drink, overeat, and the like, and justice thus requires individuals with risky behaviors to bear the related costs. In order not to abandon the imprudent, however, he suggests a model of meeting basic needs to support the luck egalitarian distribution of health and health care. Through a model of ex ante taxation, however, alcohol, tobacco, fatty food etc. should be taxed proportionally to covering the expenses related to the diseases they bring about (hospital expenses etc.). So how are we to understand this?

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por Martin Marchman Andersen

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