Jessica Karia (LSE) - 2022-23 Students

Health, Individual Responsibility and Justice

In a report published in November 2021, significant economic cost has been associated with obesity, and is projected to continue to increase in the eight countries studied across six continents (Okunogbe et al, 2021). In the US, lively debates have been held on whether the unvaccinated against Covid-19 and unmasked citizens should pay higher insurance premiums. The government in Singapore have stated that they may no longer pay the medical bills for Covid-19 patients who are unvaccinated by choice. Even in the UK, where the vast majority of NHS services are free at the point of access irrespective of individual responsibility, this area of discussion still applies in justifying the policy on national insurance contributions (NICs), as well as the additional taxation imposed on potentially harmful consumer goods, such as, cigarettes and sugary drinks.

A strategic function of public health is the setting of priorities and the allocation of resources. The self-harming behaviour raise an important question – to what extent should the state take account of individual responsibility when fulfilling its public health function? Because self-inflicted harm can cause financial burden to rest of society and impacts the amount of medical resources available to others when funds are limited, as a matter of justice, it can be argued that the agents who make such choices ought to have to pay to offset these additional costs. In this thesis, I aim to introduce an alternative theory of justice that overcomes the objections of current theories and, most importantly, is feasible for implementation in pioneering public health policies. The thesis will consider questions on the voluntariness of choices; whether it is justifiable to punish agents who make bad choices due to a background inequality; how to determine whether an agent is responsible for a consequence; and challenging existing arguments on paternalism.

Primary supervisor: Professor Alex Voorhoeve, LSE
Secondary supervisor: Campbell Brown, LSE

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