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

AuthorAndreas Albertsen
Date01 September 2020
Published date01 September 2020
Subject MatterArticles
Political Research Quarterly
2020, Vol. 73(3) 583 –595
© 2019 University of Utah
Article reuse guidelines:
DOI: 10.1177/1065912919845077
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
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.
Personal Responsibility in Health
and Health Care: Luck Egalitarianism
as a Plausible and Flexible Approach
to Health
Andreas Albertsen1
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.
luck egalitarianism, personal responsibility in health, distributive justice, health justice, individual responsibility in health,
health care justice

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