Personal Accountability and Health Care Reform Professor Joan McGregor Lincoln Professor of Bioethic

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Personal Accountability and Health Care
ReformProfessor Joan McGregorLincoln Professor
of BioethicsArizona State University

• Regis University
• Center for Ethics and
• Leadership in the Health Professions
• October 4, 2008

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John H. Knowles, Deadalus 1977

• The Cost of sloth, gluttony, alcoholic
  intemperance, reckless driving, sexual frenzy,
  and smoking is now a national, and not an
  individual, responsibility.
• What is meant by making individuals more
  accountable or responsible for their health?

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Moral judgment of personal responsibility for
health

• Responsibility different senses
• 1. Role responsibility
• 2. Causal responsibility
• 3. Liability responsibility

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Liability responsibility and blameworthiness

• To be at fault
• Under what conditions is a person at fault for a
  state of affairs
• Ascriptions of fault must be fair
• Fairness requires that the person at least acted
  voluntarily to bring about the condition
• Understood what he or she was doing
• Not deceived
• Not forced
• The results were foreseeable
• The agent had reasonable alternatives to the
  choices he or she made

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What health conditions would it be fair to hold
individuals responsible for?

• Consider cases where the healthy behavior does
  not necessarily originate in the defective
  character of the individual but in circumstances
  that are external to that character.
• Ambiguous cases where it is not clear that the
  character of the individual is defective but the
  choices result in higher health costs

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Different rationales for policy of assigning
personal responsibility for health

• 1. Fairness
• 2. General Utility
• 3. Paternalism

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Samuel Butler Erewhon 1871

• whereon it came out that illness of any sort was
  considered in Erewhon to be highly criminal and
  immoral, and that I was liable, even for catching
  cold, to be had up before the magistrates and
  imprisoned for a considerable period--an
  announcement which struck me dumb with
  astonishment
• Prisoner at the bar, you have been accused of
  the great crime of labouring under pulmonary
  consumption, and after an impartial trial before
  a jury of your countrymen, you have been found
  guiltyThat sentence must be a very severe one.
  It pains me much to see one who is yet so young,
  and whose prospects in life were otherwise so
  excellent, brought to this distressing condition
  by a constitution which I can only regard as
  radically vicious but yours is no case for
  compassion this is not your first offence you
  have led a career of crime, and have only
  profited by the leniency shown you upon past
  occasions to offend yet more seriously against
  the laws and institutions of your country. You
  were convicted of aggravated bronchitis last
  year and I find that though you are now only
  twenty-three years old, you have been imprisoned
  on no less than fourteen occasions for illnesses
  of a more or less hateful character in fact, it
  is not too much to say that you have spent the
  greater part of your life in a jail.