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Social Responsibility and Healthcare in Finland

The Luck Egalitarian Challenge to Scandinavian Welfare Ideals

Published online by Cambridge University Press:  27 June 2016

Abstract:

This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian—or luck egalitarian—tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

Type
Special Section: Bioethics Beyond Borders
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

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29. See note 5, Takala 2002.

30. The publications surveyed include Duodecim, the leading Finnish general medical journal concentrating on clinical issues, and Journal of Social Medicine (Sosiaalilääketieteellinen aikakauslehti). I surveyed contributions related to lifestyle and individual responsibility from 2007 to 2015.

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37. As argued in Daniels N. Just Healthcare. Cambridge: Cambridge University Press; 1985.

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40. Ronald Dworkin put forward the original systematic formulation of a responsibility-sensitive egalitarian position—equality of resources—in which the currency of equality is resources, and redistributive institutions operate to compensate the outcomes of brute luck that people face concerning their resources: Dworkin R. What is equality? Part 2: Equality of resources. Philosophy and Public Affairs 1981;10:283−345. Later luck egalitarian theorists have focused especially on developing the currency of egalitarianism—e.g., G. A. Cohen stated that the proper currency to be distributed is access to advantage (Cohen GA. On the currency of egalitarian justice. Ethics 1989;99:906−44), and Richard Arneson advocated equality of opportunity for welfare, and later, responsibility-catering prioritarianism (Arneson R. Equality and equal opportunity for welfare. Philosophical Studies 1989;56:77−93).

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42. See note 5, Takala 2002.

43. The criticism is extensively considered by Scheffler S. Responsibility, reactive attitudes, and liberalism in philosophy and politics. Philosophy and Public Affairs 1992;21(4):299−323; see also Scheffler S. Choice, circumstance and the value of equality. Politics, Philosophy and Economics 2005;4(5):5−28.

44. Dworkin explicitly offers his theory of equality of resources as a response to the requirements of personal responsibility in the welfare strategy posed by the nonegalitarian critique, by claiming that egalitarian policies maintain a “culture of dependency” (Dworkin R. Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2000:325−8). Also, Cohen points out that one of the achievements of luck egalitarianism is that it succeeded to demonstrate that egalitarians can incorporate “the most powerful idea in the arsenal of the anti-egalitarian right: the idea of choice and responsibility” (see note 40, Cohen 1989, at 933).

45. See note 44, Dworkin 2000, at 323.

46. See note 43, Scheffler 2005; Scheffler S. What is egalitarianism? Philosophy and Public Affairs 2003;31(1):5−39; Anderson E. What is the point of equality? Ethics 1999;109:287−337.

47. According to Rawls, in order to be able to participate in society and to have the capacity to develop and pursue a rational plan of life, which is constitutive of one’s good, society must distribute certain primary goods that are needed independent of a person’s rational plan of life, viz., basic rights, liberties and opportunities, income and wealth, and the social bases of self-respect. These goods are essential elements that citizens need in order to be free and equal persons. See note 3, Rawls 1971.

48. See note 37, Daniels 1985; Daniels, N. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008.Google Scholar

49. See note 44, Dworkin 2000, at 73–4, 322–4.

50. See note 40, Arneson 1989.

51. See note 40, Cohen 1989.

52. Mason, A. Leveling the Playing Field: The Idea of Equal Opportunity and Its Place in Egalitarian Thought. Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar

53. See note 46, Anderson 1999.

54. The “moralism of responsibility” is discussed by Scheffler as a way of placing the focus of the reasons for poverty directly on the poor themselves, which enables the well-off to feel that they can take credit for their own success without needing to be troubled for the less fortunate. The moralism of responsibility entails that there is something immoral about being poor (see note 43, Scheffler 2005). A similar moralism can be seen in a moralism of health. As Joel Feinberg notes, if the surveillance of morality is extended to the private sphere of life, the detecting authorities will insult individual privacy by monitoring the citizen’s private life. Feinberg J. Social Philosophy. Englewood Cliffs, NJ: Prentice-Hall; 1973, at 40.

55. Mäki-Kuutti A-M. Health discipline in medical television shows [Terveyskuri television lääkärisarjoissa]. Sosiaalilääketieteellinen aikakauslehti—Journal of Social Medicine 2012;49:44–59.

56. The CEO of the Hospital District of Helsinki and Uusimaa, Aki Lindén, comments on a study that indicated that the costs of social and healthcare services accumulate to a small minority of the population—e.g., the elderly, the disabled, child welfare recipients, substance abuse patients, psychiatric service customers, diabetics, and heart and vascular disease patients. See Leskelä RL, Komssi V, Sandström S, Pikkujämsä S, Haverinen A, Olli SL, et al. Social and health service users in the city of Oulu [Paljon sosiaali- ja terveyspalveluja käyttävät asukkaat Oulussa]. Suomen Lääkärilehti—The Finnish Medical Journal 2013;48:3163–9. Lindén questions the rhetoric of the “heavy user” used in discussing the results by pointing out the magnitude of costs brought by, e.g., premature infants, cancer patients, and victims of serious accidents, none of whom are, however, labeled as heavy users. See Lindén A. Opinions. Helsingin sanomat—Helsinki Times 2015 Mar 15.

57. Saarni SI, Anttila H, Saarni SE, Mustajoki P, Koivukangas V, Ikonen TS, Malmivaara A. Ethical aspects of bariatric surgery [Lihavuuden leikkaushoitoon liittyviä eettisiä näkökohtia]. Duodecim 2009;125(20):2280–6.

58. See note 41, Daniels 2011.

59. See note 43, Scheffler 2005.

60. Knight C. Luck egalitarianism. Philosophy Compass 2013;8(10):924–34.

61. See note 41, Voigt 2013.

62. See note 41, Voigt 2013, at 153.