A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem.

中文翻译：

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责任与递归问题

围绕在医疗保健分配中使用“个人责任”作为分配标准的想法出现了相当多的文献，其中一个人对自己的健康需求负有适当责任可能证明接受医疗保健的附加条件是合理的，甚至可能完全限制访问，有时称为“责任”。这一讨论最突出但不完全集中在“运气平均主义”上，即偏离平等的观点只有通过适当的自由选择才能得到证明。分配正义中一个表面上独立的问题涉及健康与其他社会产品之间的双向关系：健康缺陷通常会削弱一个人在其他领域获得优势的能力，而这反过来又常常对健康产生进一步的负面影响。本文概述了健康与其他社会产品之间的后一种关系在何种程度上加剧了责任支持者的现有问题（“严厉反对”），而标准回应无法解决这一问题。由于一个人的先前责任而对医疗保健的获取设置重要条件可能会使他们陷入或恶化负面循环，在这种循环中，健康状况不佳和相关的机会缺乏相互加强，从而更有可能做出更多糟糕但最终负责任的选择。最后考虑了这个问题的三种可能的解决方案。由于一个人的先前责任而对医疗保健的获取设置重要条件可能会使他们陷入或恶化负面循环，在这种循环中，健康状况不佳和相关的机会缺乏相互加强，从而更有可能做出更多糟糕但最终负责任的选择。最后考虑了这个问题的三种可能的解决方案。由于一个人的先前责任而对医疗保健的获取设置重要条件可能会使他们陷入或恶化负面循环，在这种循环中，健康状况不佳和相关的机会缺乏相互加强，从而更有可能做出更多糟糕但最终负责任的选择。最后考虑了这个问题的三种可能的解决方案。