Abstract

Encouraging and supporting people to take responsibility for their health is a laudable forward-looking goal of a public health system. Holding people responsible for conditions such as diabetes, heart disease, obesity, and addiction, that may have resulted from their past actions, is more controversial, particularly when it is used as a basis to deny or restrict treatment that would otherwise have been provided. In this chapter I will draw upon retributive theories of punishment to argue that restricting access to health care to persons who are deemed to have contributed to their health condition, say by smoking, drinking, poor diet or lack of exercise, is inevitably to engage in a form of retributive blame and punishment and that the system-wide justifications that might be offered for such practices fail. Denial or limitation of treatment on other than medical grounds will frequently constitute excessive rather than proportional punishment for past actions. Moreover, determining and meting out such sanctions is beyond the proper scope of health care professionals and undermines the virtues proper to their roles.