Responsibility, Health Care, and Harshness

Abstract Arguably, agents can be at least partly responsible for their unhealthy lifestyles and/or the health outcomes of said lifestyles. Health care policies that take an agent’s responsibility into account—for example, by reducing priority for treatment, increasing premiums, and so on—face a variety of objections. One of these is the harshness objection: the objection that such policies, and the practices they would justify, are too harsh in the ways that they hold patients accountable. This chapter discusses the harshness objection and evaluates different versions of it. First, I clarify some of the concepts this objection relies on, including “responsibility” and “holding accountable.” Making use of these clarification, I then distinguish between different versions of the objection, which object to different aspects of the policy and practices. Finally, I assess the strength of differing versions of the objection, as well as the strength of some responses to it. I conclude with some thoughts about how such policies will need to be designed to avoid the objection.