From Sufficient Health to Sufficient Responsibility
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ORIGINAL RESEARCH
From Sufficient Health to Sufficient Responsibility Ben Davies
&
Julian Savulescu
Received: 10 September 2019 / Accepted: 10 July 2020 # The Author(s) 2020
Abstract The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. B. Davies (*) : J. Savulescu Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, St Ebbe’s Street, Oxford OX1 1PT, UK e-mail: [email protected]
J. Savulescu e-mail: [email protected]
Keywords Ethics . Responsibility . Healthcare funding . Sufficiency . Sufficientarianism . Luck egalitarianism
Introduction Many of our choices involve associated risks to our health. We smoke, eat and drink too much, engage in risky sports and professions, or don’t do enough exercise. A recurring theme in discussions of healthcare rationing is the question of whether individuals who are appropriately responsible for their own poor health should be treated differently from those who are not. One way to characterize this question is through a distinction between two different kinds of luck (e.g., Dworkin 1981). Bad “brute luck” covers the misfortunes we cannot control, such as being hit by lightning or contracting a childhood illness. Bad “option luck,” on the other hand, refers to unwanted things that happen as a result of our own free choices: we take a gamble, and it goes wrong. Luck egalitarians (e.g., Arneson 2006; Barry 2008; Segall 2009; Cohen 2011; LippertRasmussen 2016) adopt this distinction. For instance, a standard (though not universal) luck egalitarian claim is that justice demands that people are left no worse off than others due to factors that are not in their control, that is, that we do not allow people to become worse off as a result of bad brute luck. In the realm of healthcare, this implies, ceteris paribus, that if one person is less healthy than others because of factors beyond their
Bioethical Inquiry
control, that demands rectification or compensation.1 If they are wor
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