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为何责任敏感型医疗体系并无失礼之处。

Why a responsibility sensitive healthcare system is not disrespectful.

作者信息

Tsiakiri Lydia

机构信息

Department of Political Science and the Centre for the Experimental-Philosophical Study of Discrimination (CEPDISC), Aarhus University, Aarhus, Denmark.

出版信息

Med Health Care Philos. 2025 Jun;28(2):315-325. doi: 10.1007/s11019-025-10262-x. Epub 2025 Mar 14.

Abstract

The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context. Under this reality, would it be justified to hold people responsible for their taken lifestyle decisions, or would it constitute an instance of unjustified disrespectful treatment? From a respect-based standpoint, one could argue that a responsibility-sensitive healthcare system morally disrespects the imprudent ones engaging in disadvantageous differential treatment to their detriment. In contrast, however, we might also have luck egalitarian reasons that explain why this differential treatment is not unjust. Luck egalitarianism is a responsibility-sensitive theory of distributive justice, which argues that it is bad if some people are worse off than others through no voluntary fault of their own. In this paper, I clarify the concerns about disrespect raised against the luck egalitarian viewpoint and offer possible respect-based reasons for why this might not be the case grounded in deontological concepts. First, I employ a revised Double-effect case to support responsibility-sensitive rationing. In the last part of the paper, these are further supported through the Kantian Formula of Humanity supplemented by the concept of duties.

摘要

非传染性疾病的流行、相关医疗成本的增加以及近期的突发公共卫生事件,更有力地凸显了医疗背景下早已存在的分配正义困境。在这种现实情况下,让人们为自己做出的生活方式选择负责是否合理,或者这是否构成一种不合理的不尊重待遇?从基于尊重的角度来看,有人可能会认为,一个对责任敏感的医疗体系在道德上不尊重那些行为不谨慎的人,因为这种体系对他们进行了不利的差别对待,损害了他们的利益。然而,相比之下,我们也可能有运气平等主义的理由来解释为什么这种差别对待并非不公正。运气平等主义是一种对责任敏感的分配正义理论,它认为,如果有些人比其他人处境更差并非出于他们自身的自愿过错,那就是不好的。在本文中,我阐明了针对运气平等主义观点提出的关于不尊重的担忧,并基于义务论概念提供了一些基于尊重的理由,说明情况可能并非如此。首先,我运用一个经过修正的双重效应案例来支持对责任敏感的资源分配。在本文的最后一部分,通过康德的人道公式并辅以义务概念,对这些观点进行了进一步支持。

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本文引用的文献

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Taking Responsibility for Responsibility.对责任负责。
Public Health Ethics. 2019 Feb 11;12(2):103-113. doi: 10.1093/phe/phz001. eCollection 2019 Jul.
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Personal responsibility within health policy: unethical and ineffective.个人在卫生政策中的责任:不道德且无效。
J Med Ethics. 2018 Jan;44(1):53-58. doi: 10.1136/medethics-2016-103478. Epub 2016 Sep 22.

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