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Phase-dependent justification: the role of personal responsibility in fair healthcare
  1. Kristine Bærøe1,
  2. Cornelius Cappelen2
  1. 1Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
  2. 2Department of Comparative Politics, University of Bergen, Bergen, Norway
  1. Correspondence to Dr Kristine Bærøe, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, P.O. Box 7804, 5020 Bergen 5020, Norway; Kristine.Baroe{at}


The main aim of this paper is to examine the fairness of different ways of holding people responsible for healthcare-related choices. Our focus is on conceptualisations of responsibility that involve blame and sanctions, and our analytical approach is to provide a systematic discussion based on interrelated and successive health-related, lifestyle choices of an individual. We assess the already established risk-sharing, backward-looking and forward-looking views on responsibility according to a variety of standard objections. In conclusion, all of the proposed views on holding people responsible for their lifestyle choices are subjected to reasonable critiques, although the risk-sharing view fare considerably better than the others overall considered. With our analytical approach, we are able to identify how basic conditions for responsibility ascription alter along a time axis. Repeated relapses with respect to healthcare associated with persistent, unhealthy lifestyle choices, call for distinct attention. In such situations, contextualised reasoning and transparent policy-making, rather than opaque clinical judgements, are required as steps towards fair allocation of healthcare resources.

  • Distributive Justice
  • Ethics
  • Political Philosophy
  • Public Policy

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