Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

The objective of this article is to explore people’s attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as whether (...) fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people—in one way or another—for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others. (shrink)

This article examines John Stuart Mill’s influential proposal of how to tax wealth transfers. According to Mill, every person should be free to bequeath but not to receive bequest. Mill proposed an upper limit on how much each person could receive from wealth transfers. We discuss three objections against this proposal. The nonseparability objection holds that it is not possible to separate the freedom to give from the freedom to receive. The objection from private property holds that private property includes (...) an unlimited right to dispose of one’s assets and that this right is violated under Mill’s scheme. The objection from incentives holds that Mill’s scheme would have negative effects on people’s willingness to work and save. We argue that these objections can be met and that taxing bequeathed wealth according to Mill’s scheme is more just and more efficient compared to systems that rely less on wealth transfer taxation. (shrink)

If we want to make people more equal, what should we make them more equal in? For example, should it be resources, such as income, or should it be subjective well-being, such as preference satisfaction? The aim of this article is to critically examine the two main answers to this question within a luck egalitarian moral framework, which is a framework that aims to eliminate inequalities caused by non-responsibility factors, while preserving inequalities due to responsibility factors. I argue that the (...) arguments typically presented in favor of equalizing incomes rather than subjective well-being are weak and that within a luck egalitarian moral framework the claim that resources and not welfare should be considered the appropriate basis for interpersonal comparisons is in need of justification.The question of what society should equalize is applied to the issue of what should be the fair level of unemployment insurance compensation: Should we only compensate the involuntary unemployed for the income loss associated with unemployment, or also for the non-pecuniary costs associated with unemployment? The answer to this question, I argue, depends on where the cut between responsibility factors and non-responsibility factors is drawn. (shrink)