Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity (...) for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around. (shrink)

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these (...) philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities. (shrink)

Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in (...) a relevant way and should receive compensation. Employing the ideal that people should be made equal as measured by equivalent resources, they purport to show the fairness of such an arrangement through a hypothetical scenario. Relaxing the implicit assumptions of this scenario brings forth several unattractive consequences of the fresh-start idea. The main problem is that in striving to ensure that people’s past choices do not affect their own opportunities, the authors must accept that these choices put heavy strains on the opportunities available to other people. Furthermore, the luck egalitarian position is more compelling than they admit. (shrink)

Luck egalitarianism is a responsibility-sensitive theory of distributive justice. Its application to health and healthcare is controversial. This article addresses a novel critique of luck egalitarianism, namely, that it wrongfully discriminates against those responsible for their health disadvantage when allocating scarce healthcare resources. The philosophical literature about discrimination offers two primary reasons for what makes discrimination wrong (when it is): harm and disrespect. These two approaches are employed to analyze whether luck egalitarian healthcare prioritization should be considered wrongful discrimination. Regarding (...) harm, it is very plausible to consider the policies harmful but much less reasonable to consider those responsible for their health disadvantages a socially salient group. Drawing on the disrespect literature, where social salience is typically not required for something to be discrimination, the policies are a form of discrimination. They are, however, not disrespectful. The upshot of this first assessment of the discrimination objection to luck egalitarianism in health is, thus, that it fails. (shrink)

In this paper I analyze a view that is increasingly spreading among philosophers and even physicians. Many of them believe that it is right to apply the principle of responsibility for illness in the allocation of health care. I attempt to show that this idea is unacceptable.

Although the responsibility for health debate has intensified in several ways between Norman Daniels’ 1985 Just healthcare and Just health: meeting health needs fairly of 2008, comparatively little space is dedicated to the issue in Just health, and Daniels notes repeatedly that his account “says nothing about personal responsibility for health”. Daniels considers health responsibility mainly in a particular luck-egalitarian version which he rejects because of its potentially unfeasible, penalising and inhumane character. But I show that he nonetheless acknowledges and (...) endorses explicitly other dimensions of health responsibility. I develop a wider, more nuanced and less punitive concept of health responsibility, which expands Daniels’ brief consideration and is compatible with the overall approach set out in Just health. In its application to preventative medicine and health promotion in particular, the concept is suited to support and complement the notion that “health is special”, which is central in Just health. The concept of health responsibility as co-responsibility specifies the subjects and objects of health responsibilities. It permits the attribution of responsibility without blame and disconnects the question of assigning responsibility from decisions about entitlement to treatment or different status in prioritisation decisions. This approach secures conceptual plausibility and clarity of the concept of health responsibility, is of use in policy making, and can help reduce political tensions. (shrink)

:Influenced by the people-centered integrated care model, Healthy China 2030 was drafted recently with a special concern given to patient engagement. Although there are three levels of engagement, patients are more likely to be empowered and activated through an individualistic approach. Thus, engaging patients at the household level appear to have been overlooked so far. Supported by ethical values and practical evidence, this article attempts to address the importance of engaging patients at the household level in shaping the Chinese healthcare (...) system with the PCIC model orientation, and thus recommends four strategies for empowering and activating patients at the household level in the Chinese context. (shrink)