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Should We Hold the Obese Responsible?: Some Key Issues



It is a common belief that obesity is wholly or partially a question of personal choice and personal responsibility. It is also widely assumed that when individuals are responsible for some unfortunate state of affairs, society bears no burden to compensate them. This article focuses on two conceptualizations of responsibility: backward-looking and forward-looking conceptualizations. When ascertaining responsibility in a backward-looking sense, one has to determine how that state of affairs came into being or where the agent stood in relation to it. In contrast, a forward-looking conceptualization of responsibility puts aside questions of the past and holds a person responsible by reference to some desirable future state of affairs and will typically mean that he or she is subjected to criticism, censure, or other negative appraisals or that he or she is held cost-responsible in some form, for example, in terms of demanded compensation, loss of privileges, or similar. One example of this view is the debate as to whether the obese should be denied, wholly or partially, free and equal access to healthcare, not because they are somehow personally responsible in the backward-looking sense but simply because holding the obese responsible will have positive consequences. Taking these two conceptions of responsibility into account, the authors turn their analysis toward examining the relevant moral considerations to be taken into account when public policies regarding obesity rely on such a conception of responsibility.



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1. See O’Brien, KS, Latner, JD, Halberstadt, J, Hunter, JA, Anderson, J, Caputi, P. Do antifat attitudes predict antifat behaviors? Obesity (Silver Spring) 2008;16 Suppl 2:8792; Allison, DB, Basile, VC, Yuker, HE. The measurement of attitudes toward and beliefs about obese persons. International Journal of Eating Disorders 1991;10:599607; Crandall, CS. Prejudice against fat people: Ideology and self-interest. Journal of Personality and Social Psychology 1994;66:882–94. Lund, TB, Sandøe, P, Lassen, J. Attitudes to publicly funded obesity treatment and prevention. Obesity 2011;19(8):1580–5. Ten Have, M, de Beaufort, ID, Teixeira, PJ, Mackenbach, JP, van der Heide, A. Ethics and prevention of overweight and obesity: An inventory. Obesity Reviews 2011;12(9).

2. See Segall S. Health, Luck and Justice. Princeton, NJ: Princeton University Press; 2010; Knight C. Luck Egalitarianism: Equality, Responsibility, and Justice. Edinburgh: Edinburgh University Press; 2009.

3. See note 1, Lund et al. 2011.

4. Strawson G. The impossibility of moral responsibility. In: Pojman LP, McLeod O, eds. What Do We Deserve? A Reader on Justice and Desert. Oxford: Oxford University Press; 1999, 114–24, at 115–16.

5. Hurley S. Justice, Luck, and Knowledge. Cambridge, MA: Harvard University Press; 2003.

6. See note 5, Hurley 2003.

7. For a contemporary philosopher who defends agent causality, see Kane R. Free will: New directions for an ancient problem. In: Fischer JM, ed. Free Will: Critical Concepts in Philosophy, Vol. III: Libertarianism, Alternative Possibilities, and Moral Responsibility. New York: Routledge; 2005.

8. Frankfurt, HG. Alternate possibilities and moral responsibility. Journal of Philosophy 1969;66:829–39.

9. Fischer JM, Ravizza M. Responsibility and Control: A Theory of Moral Responsibility. Cambridge: Cambridge University Press; 1998.

10. See note 9, Fischer, Ravizza 1998.

11. See note 5, Hurley 2003.

12. Matravers M. Responsibility and Justice. Malden, MA: Polity Press; 2007.

13. Sharkey, K, Gillam, L. Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate. Journal of Medical Ethics 2010;36:661–5; Brownell, KD, Kersh, R, Ludwig, DS, Post, RC, Puhl, RM, Schwartz, MB, Willett, WC. Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs 2010;3:378–86.

14. Smart JJC. Free-will, praise, and blame. Mind 1961;70:291–306; see also Arneson RJ. The Smart theory of moral responsibility and desert. In: Olsaretti S, ed. Desert and Justice. Oxford: Oxford University Press; 2003.

15. Dennett DC. Elbow Room: The Varieties of Free Will Worth Wanting. Cambridge, MA: MIT Press; 1984, at 163.

16. See note 2, Segall 2010 and Knight 2009.

17. See note 1, Lund et al. 2011.

18. Buyx, AM. Personal responsibility for health as a rationing criterion: Why we don’t like it and why maybe we should. Journal of Medical Ethics 2008;34(12):871–4.

19. Fleck, L. Whoopie pies, super-sized fries: “Just” snacks? “Just” des(s)erts? Cambridge Quarterly of Healthcare Ethics 2012;21(1):519.

20. Van Baal, PHM, Polder, JJ, Ardine de Wit, G, Hoogenveen, RT, Feenstra, TL, Boshuizen, HC, et al. Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure. PLoS Medicine 2008;5(2):e29. doi:10.1371/journal.pmed.0050029.

21. See note 19, Fleck 2012.

22. See, e.g., Dawson, A. The future of bioethics: Three dogmas and a cup of hemlock. Bioethics 2010;24:218–25. doi:10.1111/j.1467-8519.2010.01814.x.

23. Radoilska, L. Public health ethics and liberalism. Public Health Ethics 2009 July;2(2):135–45, at 135. doi:10.1093/phe/php010.

24. Rawls J. Political Liberalism. New York: Colombia University Press; 1993.

25. The most recent comprehensive formulation of a public-reason-based form of liberalism comes from Gaus G. The Order of Public Reason: A Theory of Freedom and Morality in a Diverse and Bounded World. Cambridge: Cambridge University Press; 2011.

26. See, from a critical perspective, Sher G. Beyond Neutrality. Cambridge: Cambridge University Press; 1997, at 38.

We would very much like to thank Nils Holtug of the Philosophy Department of the University of Copenhagen for helpful comments to this article.



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