Individual responsibility, justice and access to health care
The aim of this thesis is to examine whether it is morally defensible to use lifestyle as one of the criteria for rationing health care. I argue that it is not justifiable to use former lifestyle to select patients for treatment. Chapter one outlines the principles of the NHS and discusses the reality of rationing in health care provision in Britain. I maintain that there is a prima facie legal and moral right to health care and explore whether this right imposes a responsibility on individuals to maintain a healthy lifestyle. Chapter two critically examines some of the criteria, which are used to ration health care. Government policy documents, such as 'The New NHS: Modern.Dependable.' (Department of Health 1997: 13) suggest that patients should be treated 'according to need and need alone.' I argue that the concept of medical need is indeed one of the proper criteria for the distribution of medical resources. However, it is not the only relevant criterion and should be considered along with other factors such as patient choice, clinical and cost effectiveness. Other criteria including age and lifestyle may also be relevant, but in so far as they affect the probable clinical outcomes of treatment. Chapter three clarifies some of the contemporary approaches to distributive justice and explores their implications for the allocation of health care between individuals. I suggest that an eclectic approach should be adopted where consideration is given both to promoting individual choices about lifestyles and protecting the welfare of the community. None of these theories of justice suggest that taking lifestyle into account when allocating scarce resources must be unjust. Chapter four investigates whether individuals should be held responsible for their lifestyle. I argue that some health related behaviour is voluntary and therefore people might be held responsible for the consequences of their behaviour. However, in many cases health related behaviour may not be voluntary, because it may have been unduly influenced by factors beyond the control of the individual. Even if it is voluntary, it may be justifiable or excusable in some cases. I discuss whether risk takers deserve any blame, and maintain that withdrawal or delay of medical treatment as a punishment for former lifestyle is always wrong. Chapter five argues that it is essential for health care professionals to inform people of risks to their health. This does not interfere with their liberty, and allows them to make choices based upon their own values. I also examine whether it is justifiable to use more coercive strategies, such as persuasion, manipulation and legal prohibition in order to encourage people to maintain a healthy lifestyle. Chapter six argues that it is not possible to implement a policy to ration health care partly on the basis of lifestyle in a fair way. I propose an alternative policy, which involves taxation on certain products associated with risk. Chapter seven examines a variety of cases of rationing based on lifestyle. I conclude that rationing according to former lifestyle is not morally defensible.