Responsibility for ill-health and lifestyle: drilling down into the details

Whether agents are morally responsible for their need for scarce resources is a difficult and fraught issue. In this chapter, I aim to explore some unappreciated difficulties for the attribution of moral responsibility for needs that arise from the fact that in typical cases, ill-health arises from lifestyle: not, that is, from one bad decision, but from a long-term pattern of actions. First, I hope to build on Brown and Savulescu’s (2019) programmatic exploration of what they call the diachronic condition on moral responsibility for ill-health. I will show that the diachronic condition fractionates in multiple ways, depending on how ill-health is caused as well as on the theory of moral responsibility at issue. Second, I aim to show that it is much harder to satisfy the diachronic condition on moral responsibility for ill-health than is widely assumed. I will argue that we usually cannot be confident that a particular agent (or a class of agents: say alcoholics) is responsible for their ill-health, and that—I will suggest—should make us hesitant to ascribe responsibility to them. Finally, I turn to an assessment of responsibility as a tie-breaker between patients. We might think that we need something far short of a reasonable doubt standard for responsibility to serve in this role. Perhaps a balance of probabilities standard can justify our using it. I will argue that even if we have the right to confidence on this standard, this may not be enough for responsibility to serve as a tie-breaker between agents in the context of the allocation of scarce resources.