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J Public Health (Oxf). 2013 Mar;35(1):4-8. doi: 10.1093/pubmed/fdt012.

Social inequality in health, responsibility and egalitarian justice.

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Centre for the Study of Equality and Multiculturalism, Philosophy Section, Department of Media, Cognition and Communication, University of Copenhagen, Njalsgade 80, 14.2.38, Copenhagen 2300, Denmark.


Are social inequalities in health unjust when brought about by differences in lifestyle? A widespread idea, luck egalitarianism, is that inequality stemming from individuals' free choices is not to be considered unjust, since individuals, presumably, are themselves responsible for such choices. Thus, to the extent that lifestyles are in fact results of free choices, social inequality in health brought about by these choices is not in tension with egalitarian justice. If this is so, then it may put in question the justification of free and equal access to health care and existing medical research priorities. However, personal responsibility is a highly contested issue and in this article we first consider the case for, and second the case against, personal responsibility for health in light of recent developments in philosophical accounts of responsibility and equality. We suggest-but do not fully establish-that at the most fundamental level people are never responsible in such a way that appeals to individuals' own responsibility can justify inequalities in health.

[Indexed for MEDLINE]

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