Is the right to health care absolute or are there conditions attached? And does the right to health care also imply the duty (responsibility) to use that care in a particular way? Collective and unconditional solidarity is now being debated and it seems that increasingly it is being weighed up against the individual’s responsibility for their own health.
The combination of solidarity and responsibility is a difficult one. The citizens wrestled with this issue for three weekends. They did not, however, avoid the question ‘what about the individual’s responsibility for their health’? They addressed it squarely. In the end they gave a nuanced answer: ‘yes, people are responsible for their behaviour, and consequently for their health, but only to a certain extent.’
In the first place it is impossible to distinguish, at the individual level, where ‘circumstances’ stop and ‘personal’ responsibility begins. In concrete terms: can Mrs. Y’s lung cancer be accounted for by her smoking or by the chimney of the incineration plant 300 metres from her home? Was Mr. Z’s heart attack caused by his sedentary lifestyle or has he carried an increased genetic risk of having blocked arteries since birth?
What is more, contextual factors play a decisive role. Not everyone has the same ability, knowledge or opportunities to live a healthy life. This means that there is a collective responsibility to maximise those opportunities for everyone through prevention and information.
Citizens do say that every individual has a responsibility to society. That is because the individual receives health care which is paid for by society. In exchange for this, a person can be expected to make an effort to live a healthy life. Punishing people for their unhealthy lifestyle, however – by reimbursing less of their health care, making them pay higher premiums or simply refusing them access to care – is going too far. Some citizens consider that positively encouraging a healthy lifestyle in the form of premiums may be helpful. Other citizens take the view that not even this is necessary. In general, everyone who lives a healthy life automatically receives a reward: better health.
In other words, citizens have built a bridge between the principle of ‘responsibility’ and the principles of ‘solidarity’ and ‘justice’. People who strive to live a healthy life as an individual show solidarity with society by doing so. This means that solidarity becomes a two-way street.