The essay discusses whether health is ultimately the responsibility of the individual. The essay looks at the problems that health care systems face, in terms of needing to ration scarce resources, and then moves on to look at arguments for an individual vs. societal responsibilities for health. Aristotle’s principle of justice is then applied to the discussion. The issue of social justice in welfare states is then discussed in detail, with particular regard to the issue of freedom. The essay concludes that health is, ultimately, a personal responsibility, given the burden that individuals with self-inflicted health problems place on the welfare state.
The essay will discuss the issue of whether health is ultimately an individual responsibility, looking, firstly, at the economic problems facing the health services of many countries with welfare states and then moving on to discuss the arguments for and against the idea of societal vs. individual responsibility for health. The essay then looks at the idea of social justice, within a welfare state such as Britain, and how this relates to personal freedom, drawing conclusions based on the discussions presented within the essay.
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Healthcare resources are becoming increasingly scarce and rationing is now a reality in many health care systems (Scheunemann and White, 2011; p. 1625). The ethical distribution of scarce resources in health care is problematic, however, as it can be argued that all individuals, regardless of the reasons for their illness, have a right to access healthcare. The NHS (2012) clearly states that, “Anyone who is deemed to be ordinarily resident in the UK is entitled to free NHS hopsital treatment in England”. The constitution of the World Health Organisation (2012) states that “…the highest attainable standard of health is one of the fundamental rights of every human being”, where “right” can be understood as the Government (by virtue of the taxes collected from society) providing guarantees that all individuals in society will be able to access some certain basic level of health care.
Health can, however, be argued to be an individual responsibility. Individual health is affected by many factors, including the presence of hereditary conditions and the lifestyle of the individual: an individual who smokes and is overweight, through lack of exercise or a poor diet, for example, is more likely to become ill than an individual who makes healthier lifestyle choices. As Sharkey and Gillam (2010; p. 662) discuss, there is an argument to be made that patients with self-inflicted illness should receive lower priority access to healthcare than individuals whose illness is not self-inflicted.
As Golan (2010; 683) discusses, Aristotle’s formal principle of justice has a role to play in this debate: Aristotle stated, “equals must be treated equally and unequals must be treated unequally, in proportion to the relevant inequality”, with lifestyles that equate to risk-taking behaviour having the potential to limit an individual’s right to receive priority treatment. Even if the illness was caused by the individual engaging in risk-taking behaviours that affected their health, this cannot necessarily be regarded as a ‘relevant inequality’. It is virtually impossible to prove that an individual’s behaviour was directly responsible for their poor health, making it impossible to argue, ethically, that an individual should receive lower priority treatment if they took part in risky behaviours that more than likely caused their illness.
Even if individuals took part in risky behaviour which more than likely caused their ill health, the principles of social justice dominate, meaning that these individuals have a moral right to access healthcare in societies in which health care is provided to all citizens (Olsen et al., 2003; p. 1163). The fact that these individuals engaged in risky behaviours that probably caused them to develop an illness is not sufficient per se to form the basis of denying these individuals access to health care.
It is important that individual responsibility for health be stressed within the broader context of social responsibility (Minkler, 1999; 122). Ideas of social justice, in regards to health, however, need to be understood within the context of two distinct viewpoints: the Government’s responsibility for providing health care, as a basic human right, and the individual’s responsibility for maintaining their own health, as a responsibility to themselves (to be healthy) and to society (to not become a burden).
In a welfare state such as the UK, where the state aims to play a key role in the protection and promotion of the economic and social well-being of its citizens (Baldock et al., 2011; 361), individuals are accustomed to receiving health care even if they themselves caused their ill health. Welfare states therefore remove the need for individuals to be personally responsible for their own health and well-being. Without personal responsibility, however, there can be no freedom: if an individual needs looking after by another, they are not free, and if one individual has to subsidise the self-inflicted ill health of another, that individual is also not free. Failing to assume personal responsibility for health therefore leads to a two-way loss of freedom.
The corollary to this argument is that in order to be able to exercise freedom, individuals need to have a certain level of health and well-being that allows them to contribute to society. The welfare state, in its purest form, ideally provides for those who are ill and need help, because their illness prevents them from actively contributing to society. The welfare state has, however, in Britain, been abused by ‘benefits cheats’ who claim benefits when they have no valid basis for doing so. These ‘benefit cheats’ cost the NHS money, making the already tight budget even tighter (NHS Business Services Authority, 2008). The issue of how to deal, in a welfare state, with individuals who do not want to contribute to society is complex. Political parties have had a hard time developing effective policy in this area and it is debatable as to whether David Cameron’s Big Society idea, which is based on the Wisconsin model (Alfred and Martin, 2007; p. 3), will be able to help to solve the problem of ‘benefit cheats’ in the long term (Evans, 2008; p. 98).
The issue of whether health is ultimately the responsibility of the individual depends on your particular viewpoint regarding the issue of welfare and how far the state should be responsible for individuals. My own viewpoint is that welfare should be available to those who genuinely need access to this but not for individuals who attempt to take advantage of the welfare system. For me personally, health is an individual responsibility and those who fail to assume this responsibility should be required to assume a portion of the costs of the treatment for their subsequent ill health.
Alfred, M.V. and Martin, L.G., 2007. The development of economic self-sufficiency among former welfare recipients: lessons learned from Wisconsin’s welfare to work program. International Journal of Training and Development, 11, pp. 2-20.
Baldock, J., Mitton, L., Manning, N. and Vickerstaff, S. eds. 2011. Social Policy. Oxford: Oxford University Press.
Evans, M. 2008. Cameron’s competition state. Policy Studies, 31, pp. 95-115.
Golan, O. 2010. The right to treatment for self-inflicted conditions. Journal of Medical Ethics, 36(11), pp. 683-686.
Minkler, M. 1999. Personal responsibility for healthA review of the arguments and the evidence at century’s end. Health Education Review, 26(1), pp. 121-141.
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Scheunemann, L.P. and White, D.B. 2011. The ethics and reality of rationing in medicine. Chest, 140(6), pp. 1625-1632.
Sharkey, K. and Gillam, L. 2010. Should patients with self-inflicted illness receive lower priority in access to healthcare resourcesMapping out the debate. Journal of Medical Ethics, 36, pp. 661-665.
Tinghong, G., Carlsson, P. and Lyttkens, C.H. 2010. Individual responsibility for what– a conceptual framework for exploring suitability of private financing in a publicly funded health-care system. Health Economics, Polict and Law, 5(2), pp. 201-223.
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