1. Maine and Lancaster, Pennsylvania, both want to claim to be the originator of the whoopie pie. The Maine legislature is seeking to make it the state dessert, hardly an affirmative vote for a greater degree of personal responsibility for health. Zezima, K.Laying claim to a treat, and hearing, “not so fast.” New York Times 2011 Mar 12Google Scholar; available at http://www.nytimes.com/2011/03/03/us/03whoopie.html (last accessed 3 Mar 2011).

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5. The egalitarians who are strong advocates of personal responsibility for health are luck egalitarians. Their essential claim is that responsibility must be an integral part of a morally defensible conception of healthcare justice. See Dworkin, R.Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2000Google Scholar, especially chapters 2 and 13.

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15. Ibid., at 2346. McCarthy cites in support of this conclusion Speliotes, EK, Willer, CJ, Berndt, SI, Monda, KL, Thorleifsson, G, Jackson, AU, et al. . Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. Nature Genetics 2010;42:949–60.CrossRefGoogle ScholarPubMed

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23. I argue in the following text that the physician in this case is being expected to implement a policy that is prima facie unjustly discriminatory.

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26. This is what Rawls refers to as “rational autonomy,” that is, citizens think of themselves “as having the moral power to form, to revise, and rationally to pursue a conception of the good” (at 72). Rawls, J.Political Liberalism. New York: Columbia University Press; 1993.Google Scholar

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31. See note 6, Segall 2010. See especially chapters 4 and 5.

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