● Shifts focus from healthcare to health specifically

● Individual responsibility should play role in health

● Gives scenario: patients in exact same health conditions, only difference is that one is a
millionaire
○ Says should NOT give priority to either, when focused on health only
● “Every person’s life has equal worth, and everyone’s health should be equally
important.”
● Moral should be to maintain health and promote health among everyone regardless of
other factors
● Some people disagree because they want to take health outcomes and individual
behavior should be taken into account when considering
○ i.e.) smokers, drinkers, obesity, unprotected sex, etc.
○ Socioeconomic factors correlate with health outcomes
● Scenario: Patient A was a heavy smoker for years, but quit smoking and committed to
living a healthier lifestyle. Patient B has lived healthy for their entire life. Both have same
health condition now and develop same heart disease and need heart transplant
○ health -related only would say both patients should be treated in the same way;
and flip coin for heart transplant
○ Others argue that Patient A should be held responsible for past actions and B
should be rewarded
● luck egalitarianism- basically states that inequalities in situation, such as a person’s
health, are often unjust because of people receiving bad luck (brute luck)
○ Patient A bad luck is called “option luck” because they chose to practice
unhealthy lifestyle prior to getting a disease
■ Not unjust if they suffer consequence because of their choices or bad
habits
■ Does not mean A does not deserve health care at all
○ Patient B bad luck is called brute luck (brute defined as “characterized by an
absence of reasoning or intelligence”) in short if they can’t help something
■ As a matter of justice they need to be compensated
○ Refute: Abandonment objection- we can abandon those that make bad choices
in situations with those subject to brute luck
● Only in scarce medical supply predicament, however, if there are
enough supplies can supply to both patients
■ Very harsh
■ Pluralist response- should not abandon because of moral principles such
as charity, solidarity, humanism, etc.
● Of abandonment and pluralist this is the most unsatisfactory
● Prioritarianism- the ones that have no control over condition and are in worse
situations should have priority
● In treatment, responsibility wouldn’t have impact
■ Responsible for their choices but not for the consequences of them
○ Coin flip for treatment
● All-luck egalitarianism- responsibility of health is from outside of the healthcare,
therefore we should have incentives since everything is a matter of luck
○ Everything is a matter of luck
○ Smokers, like A, could be lucky and not get disease or unlucky and get disease
○ People can’t be responsible for their luck, they have no control over it
○ Refute: Ignores fact that some people can partake in risky behavior some of time
not all of the time, but still have to pay high tax
■ Even if luck is everything, not all outcomes are beyond control
■ Doesn’t consider difference in responsibilities with risky activities
○ Create Incentives
■ i.e.) tax increase, require insurance
■ For Patient A and B they should still receive same health care, but heavy
tax placed on tobacco for heavy smoker
■ Patient A pays compensation for choice prior to circumstance now
● Fair equality of opportunity view- should de discriminative of no one, therefore
everyone has equal chance to receive the same health regardless of factors
○ Patient A and B should get same care
○ Refute: doesn’t argue who is responsible
● Should we be responsible for our choices, not consequences from our choices?
○ Choice really isn’t choice because those with lower socioeconomic status tends
to correlate with practicing bad habits (i.e. bad diet, smoking, drinking)
○ Didn’t have a say so in what class born into, therefore had no say in lifestyle
○ Triple Jeopardy- 1st low socioeconomic class 2nd more likely to suffer because
of their class 3rd given lower priority