The paper defends the idea of a responsibility sensitive healthcare system building on the Doctrine of Double Effect, the Kantian Formula of Humanity, and the concept of perfect duties.

DOI: https://doi.org/10.1007/s11019-025-10262-x 

Abstract: The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context. Under this reality, would it be justified to hold people responsible for their taken lifestyle decisions, or would it constitute an instance of unjustified disrespectful treatment? From a respect-based standpoint, one could argue that a responsibility-sensitive healthcare system morally disrespects the imprudent ones engaging in disadvantageous differential treatment to their detriment. In contrast, however, we might also have luck egalitarian reasons that explain why this differential treatment is not unjust. Luck egalitarianism is a responsibility-sensitive theory of distributive justice, which argues that it is bad if some people are worse off than others through no voluntary fault of their own. In this paper, I clarify the concerns about disrespect raised against the luck egalitarian viewpoint and offer possible respect-based reasons for why this might not be the case grounded in deontological concepts. First, I employ a revised Double-effect case to support responsibility-sensitive rationing. In the last part of the paper, these are further supported through the Kantian Formula of Humanity supplemented by the concept of duties.