In the context of competition for healthcare spending, some theorists have argued that access to healthcare should sometimes be mediated by personal responsibility (the ‘responsibilisation’ of healthcare). Although health(care) is not intrinsically positional, it has what Swift and Brighouse call ‘latent’ positionality, in its instrumental importance for positional goods.
It is a familiar objection to responsibilisation that different people have very different capacities and opportunities to make healthy choices. This paper considers a related worry: where responsibilisation involves denial or delay of healthcare, it may affect individuals’ health and thus, indirectly, their ability to compete for positional goods. In turn, this exacerbates the degree to which they are less able to make healthy choices. Thus, those who are held responsible risk being trapped in a downward spiral.
I end by considering three solutions defenders of responsibilisation might suggest: sufficientarian solutions which set a limit the degree to which patients can be penalized for responsibility; agency-preserving solutions which limit the type of condition for which patients can be penalized; and proposals which limit the number of times that a person can be penalized for their health-affecting choices.
This internal talk is for Oxford Uehiro Centre members and associates.
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