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This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall.

Original publication

DOI

10.1136/medethics-2016-103478

Type

Journal article

Journal

J Med Ethics

Publication Date

01/2018

Volume

44

Pages

53 - 58

Keywords

Allocation of Health Care Resources, Distributive Justice, Moral Psychology, Public Health Ethics, Public Policy, Behavior Control, Causality, Delivery of Health Care, Dissent and Disputes, Health Behavior, Health Equity, Health Expenditures, Health Policy, Humans, Life Style, Medicaid, Moral Obligations, Morals, Motivation, Personal Autonomy, Resource Allocation, Social Behavior, Social Justice, Social Responsibility, United States, West Virginia