Personal Responsibility in Health and Health Care: Luck Egalitarianism as a Plausible and Flexible Approach to Health

• Author: Andreas Albertsen
• DOI: 10.1177/1065912919845077
• Date: 01 September 2020
• Published date: 01 September 2020
• Subject Matter: Articles

https://doi.org/10.1177/1065912919845077

Political Research Quarterly

2020, Vol. 73(3) 583 –595

© 2019 University of Utah

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DOI: 10.1177/1065912919845077

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Article

Introduction

Allocating medical resources in accordance with needs

informs much contemporary thinking regarding the

provision of health care (Jensen and Petersen 2017).

The increased prevalence of noncommunicable dis-

eases has, however, brought to the fore the alternative

rationing criterion of personal responsibility (Golan

2010; Leichter 2003; Minkler 1999; Reiser 1985;

Schmidt 2009; Sharkey and Gillam 2010). The recent

Global Burden of Disease Study illustrates why: half

the major causes of death are noncommunicable dis-

eases (Lim et al. 2013; Murray et al. 2014). Other stud-

ies indicate that these diseases claim large proportions

of health care budgets (Long, Reed, and Lehman 2006;

Rasmussen et al. 2004). Allocating health care resources

based on personal responsibility is part of a wide range

of policies and policy proposals. In Germany, the

degree of out-of-pocket payment related to dental care

increases for those who have failed to meet a specified

frequency for checkups (Schmidt 2008, 209). In West

Virginia, families can be disadvantaged by their health

insurance company if they miss appointments (Daniels

2011, 267). In the Netherlands, personal responsibility

as a rationing criterion is a possibility provided by the

letter of the law (Tinghőg, Carlsson, and Lyttkens 2009,

203). In Florida, obese people can be denied treatment

qua being obese (Eyal 2013). In the United Kingdom, a

number of Clinical Commissioning Groups within the

National Health Service (NHS) have proposed to

restrict elective surgery for patients who either smoke

or are obese (Pillutla, Maslen, and Savulescu 2018). In

many countries, people with alcohol-related end-stage

liver disease must undergo six months of sobriety

before they are allowed on the waiting list for an organ

transplantation (Dom et al. 2015). Others suggest that

this group should be considered ineligible for trans-

plantation (Sample 2005). These proposals seek, in

various ways, to make resource allocation sensitive to

personal responsibility. The underlying thought is that

845077PRQXXX10.1177/1065912919845077Political Research QuarterlyAlbertsen

research-article2019

1Aarhus University, Denmark

Corresponding Author:

Andreas Albertsen, Department of Political Science, School of

Business and Social Sciences, Aarhus University, Bartholins Alle 7,

8000 Aarhus, Denmark.

Email: aba@ps.au.dk

Personal Responsibility in Health

and Health Care: Luck Egalitarianism

as a Plausible and Flexible Approach

to Health

Andreas Albertsen1

Abstract

Allocating health care resources based on personal responsibility is a prominent and controversial idea. This

article assesses the plausibility of such measures through the lens of luck egalitarianism, a prominent responsibility-

sensitive theory of distributive justice. This article presents a framework of luck egalitarianism in health, which

integrates other concerns of justice than health, is pluralist, and is compatible with a wide range of measures for

giving lower priority to those deemed responsible. Applying this framework to oral health, the allocation of livers

among potential transplant recipients and travel insurance demonstrates that this version of luck egalitarianism is

a much more attractive and flexible theory than much of the contemporary discussion allows. This also pertains to

its ability to provide plausible answers to two prominent critiques of harshness and intrusiveness. The discussion

also shows that the luck egalitarian commitment to eliminating the influence of luck on people’s lives is likely to

require substantial redistribution.

Keywords

luck egalitarianism, personal responsibility in health, distributive justice, health justice, individual responsibility in health,

health care justice