Luck Egalitarianism, Individual Responsibility and Health

Abstract

Luck Egalitarianism has frequently been discussed in the recent literature because of the potential impact of this theory on health financing. Luck Egalitarianism puts forth a theory of distributive justice which says that the fundamental aim of equality is to compensate people for undeserved bad luck such as being born with poor native endowments, having difficult family circumstances or suffering from accidents and illness. On the other hand, if individuals face ill health because of faults of their own, then society has no duty to supply health services to them. Many arguments for and against this theory have been raised since it was first introduced. The proponents of Luck Egalitarianism focus on the concepts that free choice and respecting the autonomy of the individual determine whether health services are deserved. The criticisms against the concept of Luck Egalitarianism are that it is harsh to the needy and abandons the wretched, discriminates against the disabled, is against basic humanitarian principles, is incompatible with human dignity, and is in dissonance with real life. We agree with the basic proposition of Luck Egalitarian theory, which states that “inequalities deriving from unchosen features of people’s circumstances are unjust and therefore should be compensated for”. Our agreement leads us to an opposite conclusion. We propose that the “unchosen features of people’s circumstances” include more than personal disadvantages. The social features to be included in the context of inequalities deriving from unchosen features of peoples circumstances are, socioeconomic status (SES), access to social determinants of health, and the ethnic, cultural and religious identity of individuals. Our other propositions are the mutable character of choices which makes individual responsibility of preferences implausible; the problematic causal relationship between responsibility and ill-health; the disregard of the motives behind decisions; problems with implementation in real health service circumstances; and the contradictory nature of Luck Egalitarianism for principles of medical ethics. These arguments draw attention to possible ethical and practical consequences of implementation of health policies arising from Luck Egalitarian view for patients and for health care providers. In this paper, we will first define Luck Egalitarianism. Then, we will discuss arguments for and against the theory in the literature. Our final task is to suggest additional criticisms of the theory and justify them.

Keywords

• Distributive justice, fundamental causal theory, group norms, health inequalities, individual responsibility, luck egalitarianism, medical ethics, social determinants of health

Kaynakça

1. 1. Lippert-Rasmussen K. Justice and Bad Luck. The Stanford Encyclopedia of Philosophy 2009; Avaliable from: http://plato. stanford.edu/archives/fall2009/entries/justice-bad-luck.
2. 2. Wikler D. Personal and Social Responsibility for Health. Ethics & International Affairs 2002;16:47-55. [CrossRef]
3. 3. Arneson RJ. Luck Egalitarianism and Prioritarianism. Ethics 2000;110:2. [CrossRef]
4. 4. Arneson RJ. Luck Egaliratianism Interpreted and Defended. Phil Topics 2004;32:1-2. [CrossRef]
5. 5. Anderson ES. What’s the Point of Equality. Ethics 2005;109:287- 337. [CrossRef]
6. 6. Brown A. Luck Egalitarianisn and Democratic Equality. Ethical Perspect 2005;12:293-339. [CrossRef]
7. 7. Scheffler S. Choice, Circumstance, and the Value of Equality. Politics, Philosophy & Economics 2005;4:5-28. [CrossRef]
8. 8. Andersen MM. Health, personal responsibility, and distributive justice. Ph.D. thesis, Københavns Universitet, Det Humanistiske Fakultet, København 2013;15-28.

9. 9. Daniels N. Just Health. 1st ed. Cambridge: Cambridge Unv. Press; 2008.
10. 10. Link BG, Phelan JC. Social Conditions as Fundamantal Causes of Disease. J Health Soc Behav 1995;35:80-94. [CrossRef]
11. 11. Link BG, Phelan JC, McKeown. The Idea That Social Condition Are Fundamental Causes of Disease. Am J Public Health 2002;92:730-2. [CrossRef]
12. 12. WHO. Closing the gap in a generation Health equity through action on the social determinants of health. 2008. ISBN 9789241563703. Avaliable at: http://www.who.int/social_determinants/thecommission/finalreport/en/
13. 13. Phelan JC, Link BG, Tehranifar P. Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence and Policy Implications. J Health Soc Behav 2010;51: 28-30. [CrossRef]
14. 14. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. Fundamental Causes of Social Inequalities in Mortality: A Test of the Theory. J Health Soc Behav 2004;45:265-85. [CrossRef]
15. 15. Marmot, MG. Fair Society Healthy Lives. Inequalities in Health Concepts, Measures, and Ethics’. 1st ed. Oxford University Press; 2013.
16. 16. Whitehead, M. The Concept and Principles of Equity and Health. WHO Regional Office for Europe Copenhagen 1990.
17. 17. Roemer JE. A pragmatic Theory of responsibility for the Egalitarian Planner. Philosophy and Public Affairs 1993;22: 146-66.
18. 18. Margaret MC. Lecture on Behavioral economics and defining household well-being 2013 (December 2nd, Harvard University School of Public Health)
19. 19. Wikler D. Persuasion and Coercion for Health: Ethical Issues in Government Efforts to Change Life. Milbank Mem Fund Q Health Soc 1978;56:303-38. [CrossRef]
20. 20. Hausman MD, Welch B. Debate: To Nudge or Not to Nudge. J Political Philos 2010;18:123-36. [CrossRef]
21. 21. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 6th ed. New York: Oxford University Press; 2009:241-8,336- 42,356-60.
22. 22. Albertsen A, Knight C. A framework for luck egalitarianism in health and healthcare. J Med Ethics 2015;41:165-9. [CrossRef]