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Personal and Social Responsibility for Health

Published online by Cambridge University Press:  28 September 2012

Daniel Wikler
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Abstract

Everyone wants to be healthy, but many of us decline to act in healthy ways. What bearing, if any, should these choices have on the ethics of clinical practice and health policy? Should risk-takers have the same claim on scarce resources, such as organs for transplant, as those whose plight is due to no choices of their own? And is there any reason not to impose fees and taxes on risk-takers, be they smokers or mountain climbers, to defray the added expense of the care they may need? In health resource allocation aimed at reducing the burden of disease, should we regard certain burdens as individual responsibilities: for example, dealing with stigma, or caretaking for family members?

Socioeconomic status (SES) and health expectancy are strongly linked. To the extent that this results from risk-taking by the poor, is reduction of SES-linked health inequalities a morally important social goal? International public health aims at improving health on a population level. The World Health Organization has been criticized for failing to distinguish genuine health risks from personal lifestyle choices, as when it speaks of a tobacco-related “epidemic” as if cigarette use were a contagious disease like malaria. Should personal responsibility for health be taken into account in setting the agenda for global public health, and in measuring progress by countries in improving health. This paper addresses applications of the notions of personal and social responsibility for health. It also looks at the vulnerability of the notion of personal responsibility for health to intentional manipulation by self-interested parties in health policy debates.

Type
Articles
Information
Ethics & International Affairs , Volume 16 , Issue 2 , September 2002 , pp. 47 - 55
Copyright
Copyright © Carnegie Council for Ethics in International Affairs 2002

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References

1 Lalonde, MarkA New Perspective on the Health of Canadians: A Working Document 1974 OttawaReport of the Government of CanadaGoogle Scholar); and Surgeon General of the United States Healthy People: Report on Health Promotion and Disease Prevention 1979 Washington, D.C.Government Printing OfficeGoogle Scholar).

2 Knechtle, Stuart et al. Liver Transplantation for Alcoholic Liver Disease Surgery 1992 112 no. 4694703Google ScholarPubMed; Sherman, DavidWilliams, RogerLiver Transplantation for Alcoholic Liver Disease Journal of Hepatology 1995 23 no. 4474–79CrossRefGoogle ScholarPubMed; and Ubel, Peter ABaron, JonathanAsch, DavidSocial Responsibility, Personal Responsibility, and Prognosis in Public Judgments about Transplant Allocation Bioethics 1999 13 no. 15768CrossRefGoogle ScholarPubMed.

3 Scruton, Roger The Risks of Being Risk-Free Wall Street Journal Europe January 7, 2000Google Scholar; and Scruton, RogerWHO, WHAT, and WHY: Trans-National Government, Legitimacy, and the World Health Organization 2000Occasional Paper No. 113London, Institute of Economic AffairsGoogle Scholar). In 2002 the Guardian revealed that Scruton was on the payroll of a multinational tobacco company, which hired him to place pro-smoking articles in British newspapers and magazines.

4 Scruton, , “The Risks of Being Risk-Free.”Google Scholar

5 IbidGoogle Scholar

6 Roemer has gone the furthest in addressing the assignment of responsibility for health from a luck-egalitarian perspective. His elegant proposal, which avoids the harsher implications of other theories that combine equality and responsibility, is discussed along with other philosophical considerations in Roemer, John E A Pragmatic Theory of Responsibility for the Egalitarian Planner Philosophy & Public Affairs 1993 22 no. 2146–66Google Scholar; and Roemer, John EEquality and Responsibility Boston Review 1995 20 no. 2Google Scholar.

7 Boyer, PaulNissenbaum, StephenSalem Possessed: The Social Origins of Witchcraft 1974 CambridgeHarvard University Press 11 ffGoogle Scholar.

8 Lynch, J WKaplan, G ASalonen, J TWhy Do Poor People Behave Poorly? Variation in Adult Health Behaviors and Characteristics by Stages of the Socioeconomic Lifecourse Social Science and Medicine 1997 44 no. 6809–19CrossRefGoogle ScholarPubMed.

9 Ubel, Baron, Asch, Social Responsibility, Personal Responsibility, and Prognosis in Public Judgments about Transplant AllocationGoogle Scholar

10 Marchand, SarahWikler, DanielPowah, Julia Tao Lai Equality and the Distribution of Health in Cross-Cultural Perspectives on the (Impossibility of Global Bioethics 2002 DordrechtKluwer Academic PublishersGoogle Scholar); Marchand, SarahWikler, DanielLandesman, BruceClass, Health, and Justice Milbank Quarterly 1998 76 no. 3449–67CrossRefGoogle ScholarPubMed; see also Daniels, NormanKennedy, BruceKawachi, IchiroIs Inequality Bad for Our Health 2000 BostonBeacon PressGoogle Scholar).

11 MacDonald, HeatherThe Burden of Bad Ideas: How Modern Intellectuals Misshape Our Society 2000 ChicagoIvan R. DeeGoogle Scholar); and Satel, SallyPC, M.D.: How Political Correctness is Corrupting Medicine 2000 New YorkBasic BooksGoogle Scholar).

12 Lantz, P MHouse, J SLepkowski, J MWilliams, D R et al. Socioeconomic Factors, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of U.S. Adults Journal of the American Medical Association 1998 279 no. 31703–708CrossRefGoogle Scholar.

13 Scanlon, ThomasMcMurrin, Sterling M The Significance of Choice in The Tanner Lectures on Human Values 1988 vol. 8 Salt Lake CityUniversity of Utah PressGoogle Scholar).

14 Crawford, RobertReverby, SusanRosner, David Individual Responsibility and Health Politics in the 1970s in Health Care in America: Essays in Social History 1977 PhiladelphiaTemple University PressGoogle Scholar); and Crawford, RobertYou Are Dangerous to Your Health: The Ideology and Politics of Victim Blaming International Journal of Health Services 1977 7 no. 4663–80CrossRefGoogle ScholarPubMed. See also Wikler, DanielStalker, DouglasGlymour, Clark Holistic Medicine: Concepts of Personal Responsibility for Healthin Examining Holistic Medicine 1985 Buffalo, N.Y.Prometheus PressGoogle Scholar).