A number of egalitarians have reached the conclusion that inequalities are just provided that they are the outcome of holding people appropriately responsible for their choices, and that only inequalities which can be traced back to the circumstances in which people happen to find themselves are objectionable. But this form of egalitarianism needs to be supplemented with an account of when it is appropriate to hold people responsible for their choices that is properly sensitive to the profound effects of socialisation. (...) Two of the most promising attempts to develop such an account-those of Ronald Dworkin and John Roemer-are found to be problematic in the light of a range of cases where gender socialisation influences values and aspirations. (shrink)

ABSTRACT A number of philosophers have argued that alcoholics should receive lower priority for liver transplantations because they are morally responsible for their medical conditions. In this paper, I argue that this conclusion is false. Moral responsibility should not be used as a criterion for the allocation of medical resources. The reason I advance goes further than the technical problem of assessing moral responsibility. The deeper problem is that using moral responsibility as an allocation criterion undermines the functioning of medicine.

The article addresses the issue of rationing health care services, a topic currently being hotly debated in many countries. The author argues that the aspect of causal responsibility ought to play a decisive role in the allocation of limited medical resources. Starting out from Ronald Dworkin's distinction between option luck and brute luck, the appropriate and meaningful uses of the term causal responsibility are clarified first. A discussion of the conditions which might justify giving lower priority to patients whose illnesses (...) are the result of unhealthy behavior, like e.g. alcohol abuse, follows. Causal responsibility is then viewed in the context of private health insurance and the club model of organ donation. It is argued that individuals themselves are basically responsible for their decisions regarding insurance coverage and membership in organ donors' clubs. Causal responsibility is shown to be a more suitable criterion for rationing scarce medical resources than other criteria which might alternatively be considered, such as patients' age. (shrink)