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Making Patients Pay for Their Life-Style Choices

Published online by Cambridge University Press:  10 December 2009

Robert L. Schwartz
Robert L. Schwartz
Affiliation:
Professor of Law at the University of New Mexico and Visiting Professor of Law, University of Tasmania, Australia
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Extract

Smokers impose a terrible cost on all of the rest of us. Those who choose to smoke are more likely than nonsmokers to suffer from cancer, heart disease, and a host of other diseases that require intensive and expensive medical intervention. Although they may suffer these diseases, we all pay for their habit through higher healthcare costs, which are reflected in higher insurance premiums, higher taxes, and fewer healthcare resources available for nonsmokers. It is simply unfair for smokers to impose this cost on the rest of us; they should bear this self-induced cost themselves.

Type
The Caduceus in Court
Information
Cambridge Quarterly of Healthcare Ethics , Volume 1 , Issue 4 , Fall 1992 , pp. 393 - 400
Copyright
Copyright © Cambridge University Press 1992

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References

Notes

1. The best account of this perplexing issue is found in Dworkin, G., “Taking risks, assessing responsibility,” Hastings Center Report 1981; 26(Oct.), where it is part of a symposium on “Voluntary Health Risks and Public Policy.” For an interesting popular account of the issue in the context of health insurance (and a fine response) see G. Will, “Who should insure our lifestyle choices,” The Washington Post, 1988 Aug. 11, A21, and J. Fernandez, “The folly of basing health insurance on lifestyle choices” (letter), The Washington Post, 1988 Aug. 20, A21.Google Scholar

2. See, e.g., Durenburger, D. Financing health care for an aging population. The Washington Post 1987 Apr. 14, Z14.Google Scholar

3. See, e.g., Mansour, Allen V., 681 F. Supp. 1232 (E.D. Mich. 1986), addressing a state Medicaid policy denying liver transplants to alcoholics.Google Scholar

4. For an interesting account of some of the business responses to unhealthy lifestyle behaviors, see Cordtz, D., “For our own good,” Financial World, 1991 Dec. 10, 48.Google Scholar

5. For an account of this system, see Annas, G. “The prostitute, the playboy, and the poet: rationing schemes for organ transplantation,”. American Journal of Public Health 1985,75:187.CrossRefGoogle ScholarPubMed

6. See Cohen, C., Benjamin, M.Alcoholics and liver transplantation. Journal of the American Medical Association 1991;265:1299.CrossRefGoogle ScholarPubMed

7. See Cohen, C., Benjamin, M.Alcoholics and liver transplantation. Journal of the American Medical Association 1991;265:1299.CrossRefGoogle Scholar

8. Manning, W, Keeler, E, Newhouse, J, et al. The taxes of sin; do smokers and drinkers pay their way?. Journal of the American Medical Association 1989;261:1604.CrossRefGoogle ScholarPubMed

9. Leichter, H.Public policy and the British experience. Hastings Center Report 1981;32(Oct.).CrossRefGoogle Scholar

10. See Cohen, H. The evolution of the concept of disease. In: Caplan, A., Engelhardt, H., McCartney, J. eds. Concepts of Health and Disease: Interdisciplinary Perspectives. 1981:209.Google Scholar

11. 1 Cor. 3:16–17 (New American Standard Bible). See also 1 Cor. 6:19–20.Google Scholar

12. Even in the absence of the formal consideration of moral worth, racism is pervasive in our health-care system. See, e.g., P. Held, “Access to kidney transplantation: has the United States eliminated income and racial difference?” Archives of Internal Medicine 1988;148. One can only imagine what the consequences would be if moral worth were a formally permitted factor in determining who should receive what kind of medical care.Google Scholar