Moral responsibility for (un)healthy behaviour

TLDR

Chronic lifestyle‑related disease is a major healthcare priority, and growing emphasis on personal responsibility in health care and media coverage underscores the need to understand how responsibility is ascribed in this context. The study aims to examine how social determinants and psychological mechanisms of health behavior challenge common assumptions about individuals’ moral responsibility for their lifestyles. Using Pettit’s notion of freedom as fitness to be held responsible, the authors argue that external factors can undermine an agent’s freedom in action, identification, and vulnerability, thereby affecting moral responsibility.

Abstract

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and psychological mechanisms of health behaviour could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit9s conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent9s control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one9s actions; and whether one9s social position renders one vulnerable to pressure from more powerful others.