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Should We Hold the Obese Responsible?: Some Key Issues

  • MORTEN EBBE JUUL NIELSEN and MARTIN MARCHMAN ANDERSEN

Abstract:

It is a common belief that obesity is wholly or partially a question of personal choice and personal responsibility. It is also widely assumed that when individuals are responsible for some unfortunate state of affairs, society bears no burden to compensate them. This article focuses on two conceptualizations of responsibility: backward-looking and forward-looking conceptualizations. When ascertaining responsibility in a backward-looking sense, one has to determine how that state of affairs came into being or where the agent stood in relation to it. In contrast, a forward-looking conceptualization of responsibility puts aside questions of the past and holds a person responsible by reference to some desirable future state of affairs and will typically mean that he or she is subjected to criticism, censure, or other negative appraisals or that he or she is held cost-responsible in some form, for example, in terms of demanded compensation, loss of privileges, or similar. One example of this view is the debate as to whether the obese should be denied, wholly or partially, free and equal access to healthcare, not because they are somehow personally responsible in the backward-looking sense but simply because holding the obese responsible will have positive consequences. Taking these two conceptions of responsibility into account, the authors turn their analysis toward examining the relevant moral considerations to be taken into account when public policies regarding obesity rely on such a conception of responsibility.

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Notes

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2. See Segall S. Health, Luck and Justice. Princeton, NJ: Princeton University Press; 2010; Knight C. Luck Egalitarianism: Equality, Responsibility, and Justice. Edinburgh: Edinburgh University Press; 2009.

3. See note 1, Lund et al. 2011.

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5. Hurley S. Justice, Luck, and Knowledge. Cambridge, MA: Harvard University Press; 2003.

6. See note 5, Hurley 2003.

7. For a contemporary philosopher who defends agent causality, see Kane R. Free will: New directions for an ancient problem. In: Fischer JM, ed. Free Will: Critical Concepts in Philosophy, Vol. III: Libertarianism, Alternative Possibilities, and Moral Responsibility. New York: Routledge; 2005.

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10. See note 9, Fischer, Ravizza 1998.

11. See note 5, Hurley 2003.

12. Matravers M. Responsibility and Justice. Malden, MA: Polity Press; 2007.

13. Sharkey, K, Gillam, L. Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of Medical Ethics 2010;36:661–5; Brownell, KD, Kersh, R, Ludwig, DS, Post, RC, Puhl, RM, Schwartz, MB, Willett, WC. Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs 2010;3:378–86.

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16. See note 2, Segall 2010 and Knight 2009.

17. See note 1, Lund et al. 2011.

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21. See note 19, Fleck 2012.

22. See, e.g., Dawson, A. The future of bioethics: Three dogmas and a cup of hemlock. Bioethics 2010;24:218–25. doi:10.1111/j.1467-8519.2010.01814.x.

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25. The most recent comprehensive formulation of a public-reason-based form of liberalism comes from Gaus G. The Order of Public Reason: A Theory of Freedom and Morality in a Diverse and Bounded World. Cambridge: Cambridge University Press; 2011.

26. See, from a critical perspective, Sher G. Beyond Neutrality. Cambridge: Cambridge University Press; 1997, at 38.

We would very much like to thank Nils Holtug of the Philosophy Department of the University of Copenhagen for helpful comments to this article.

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