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Commentary: Responsibility-Sensitive Healthcare Funding: Three Responses to Clavien and Hurst’s Critique

Published online by Cambridge University Press:  11 March 2020

THOMAS DOUGLAS
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Extract

Christine Clavien and Samia Hurst1 (henceforth C-H) make at least three valuable contributions to the literature on responsibility and healthcare. They offer an admirably clear and workable set of criteria for determining a patient's degree of responsibility for her health condition; they deploy those criteria to cast doubt on the view that patients with lifestyle-related conditions are typically significantly responsible for their conditions; and they outline several practical difficulties that would be raised by any attempt to introduce responsibility-sensitive healthcare funding. I am sympathetic to the general thrust of their argument, share—at least tentatively—their policy conclusions, and was persuaded by much of the detail of their argument. However, I do have three critical comments.

Type
Special Section: Causality and Moral Responsibility
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 2 , April 2020 , pp. 192 - 195
Copyright
© Cambridge University Press 2020

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Footnotes

Acknowledgment: I would like to thank Rebecca Brown for comments on a draft of this article. I thank the Uehiro Foundation on Ethics and Education for their funding.

References

Notes

1. Clavien C, Hurst S. The undeserving sick? An evaluation of patients’ responsibility for their health condition. Cambridge Quarterly of Healthcare Ethics.

2. For the classic philosophical discussion of this episode, see Bennett, J. The conscience of Huckleberry Finn. Philosophy 1974:49(188):123–34CrossRefGoogle Scholar.

3. For a systematic defense of this view, see Arpaly, N. Unprincipled Virtue: An Inquiry Into Moral Agency. New York: Oxford University Press; 2003 Google Scholar.

4. McCulloch, J, Tweedale, G. Defending the Indefensible: The Global Asbestos Industry and Its Fight for Survival Oxford: Oxford University Press; 2008 Google Scholar.

5. Douglas, T, Van den Borre, L. Asbestos neglect: Why asbestos exposure deserves greater policy attention. Health Policy 2019:123(5):516–9CrossRefGoogle ScholarPubMed.

6. For a critique of responsibility-sensitive healthcare funding that gives greater importance to the dubious moral wrongness of health-risking lifestyles, see Brown, RCH, Maslen, H, Savulescu, J. Against moral responsibilisation of health: Prudential responsibility and health promotion. Public Health Ethics 2019:12(2):114–29CrossRefGoogle ScholarPubMed.

7. The example is inspired by one offered in Savulescu, J. The present-aim theory: A submaximizing theory of reasons? Australasian Journal of Philosophy 1998:76(2):229–43CrossRefGoogle Scholar, at 230.