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Just health responsibility
  1. H Schmidt
  1. Mr H Schmidt, Research Associate, LSE Health, Assistant Director, Nuffield Council on Bioethics, 28 Bedford Square, WC1B 3JS London;{at}


Although the responsibility for health debate has intensified in several ways between Norman Daniels’ 1985 Just healthcare and Just health: meeting health needs fairly of 2008, comparatively little space is dedicated to the issue in Just health, and Daniels notes repeatedly that his account “says nothing about personal responsibility for health”.

Daniels considers health responsibility mainly in a particular luck-egalitarian version which he rejects because of its potentially unfeasible, penalising and inhumane character. But I show that he nonetheless acknowledges and endorses explicitly other dimensions of health responsibility.

I develop a wider, more nuanced and less punitive concept of health responsibility, which expands Daniels’ brief consideration and is compatible with the overall approach set out in Just health. In its application to preventative medicine and health promotion in particular, the concept is suited to support and complement the notion that “health is special”, which is central in Just health.

The concept of health responsibility as co-responsibility specifies the subjects and objects of health responsibilities. It permits the attribution of responsibility without blame and disconnects the question of assigning responsibility from decisions about entitlement to treatment or different status in prioritisation decisions. This approach secures conceptual plausibility and clarity of the concept of health responsibility, is of use in policy making, and can help reduce political tensions.

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  • Competing interests: None declared.

  • The views expressed in this paper are the author’s alone and must not be attributed to LSE Health or the Nuffield Council on Bioethics.

  • i And one might add that under purely practical considerations it seems very difficult to find groups or clusters of people that are both sufficiently similar and sufficiently large, to describe meaningfully departures from some mean.

  • ii Note that the concept of co-responsibility also features in article 1 of the German Social Security Code (SGB V), although in a somewhat different and narrower sense, as responsibility for health is viewed as shared between the healthcare system and patients.