Reasonable Avoidability, Responsibility and Lifestyle Diseases

In “Health, Luck and Justice” Shlomi Segall argues for a luck egalitarian approach to justice in health care. As the basis for a just distribution he suggests a principle of Reasonable Avoidability, which he takes to imply that we do not have justice-based reasons to treat diseases brought about by imprudent behavior such as smoking and over-eating. While I seek to investigate how more precisely we are to understand this principle of Reasonable Avoidability, I also object to it. First, I argue that Segall neither succeeds in showing that individuals quite generally are responsible for behaviors such as smoking and over-eating, nor that responsibility is ultimately irrelevant for the principle of Reasonable Avoidability. Second, I object to an argument of Segall’s, according to which the size of the health-care costs related to smoking and obesity is irrelevant for whether society reasonably can expect individuals to avoid smoking and obesity. Finally, I come up with a suggestion for how to modify the principle of Reasonable Avoidability so that it can answer my objection