Why would it be fair or unfair to provide higher-priority healthcare to someone who actively works to maintain good health compared to someone who neglects their health?

[u/lolikroli]

Let's say we have two individuals. The first individual has always put effort into maintaining good health. They consistently prioritise getting exercise, even when they would rather watch movies or play video games. They also ensure they maintain a healthy diet, resisting their cravings for fast food.

The second individual, however, despite having every opportunity to lead a healthy lifestyle, has chosen to lead the opposite lifestyle. They have never exercised and have followed a terrible diet.

Both individuals end up requiring the same medical care at the same time. The hospital that can provide this care has limited capacity and must prioritise one individual over the other. Would it be fair for the hospital to prioritise the first individual based on the effort they made to maintain good health?

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[u/3sums]

Similar considerations happen when it comes to organ donors, but not out of moral judgment - but rather from practical considerations in expected outcomes.

All else held equal, someone with a better chance for 5 or 10 year outcomes is more likely to receive organs from a donor. But these are certainly not the only considerations - chances of success, matching criteria, other health conditions, time spent on a waitlist, all get factored in.

One reason that medicine and public health is kept at arms length from moral judgment is that people need to trust medical institutions in order for them to be effective.

Public health arms will try to promote healthy behaviour as a preventative method, but once it gets to medical interventions, more pragmatic considerations take over. Triage systems, for example.

Two more reasons to avoid moral judgment is 1, an individuals health is often genetic which is beyond their control, and 2, that poverty is strongly associated with worse health outcomes, and socio-economic status at birth does tend to be reasonably predictive of socio-economic status. So the conditions that influence people to make healthier VS less healthy decisions are frequently beyond their control, and therefore it would not be fair to blame someone who, on face value, makes less healthy decisions.

To adapt your example: someone who has a lower income probably lives with reduced access to parks or green spaces where they may be able to exercise. Reduced financial stability might also mean less stable schedule to keep regular exercise as part of their lifestyle, increased stress and lower income drives some to seek food for psychological comfort, convenience, and affordability rather than healthiness. They are likely to have denser living arrangements and use more public transit resulting in increased exposure to things like COVID, colds, flus, etc. All of those things contribute to a vicious cycle of worse health, reduced employability, and increased economic instability.

To summarize: the reality is that moral judgment is kept at arms length from medical decisions for trust reasons, and decisions about health are not about moral blame because many of the aspects of health are beyond the control of the individual.

[u/lolikroli → u/3sums]

Thank you! Do you by any chance know any good reads that would go into greater length on the topic, about place of morality and ethics in medicine?

[u/3sums → u/lolikroli]

Oh gosh, I actually don't - I came by my knowledge through a bioethics seminar and my undergrad degree; but you could look into books on bioethics. A lot, I imagine, will be very academic in style, so bit of a choose your own adventure there.

Worth getting a basic grasp of utilitarianism, Kant's categorical imperative, and virtue ethics, as well as consent and bodily autonomy, as these are typically the theoretical ethical systems applied in bioethics.

But a huge chunk of bioethics is about the material realities relevant to decision-making, so when it comes to things such as organ donation, infectious disease management, and public health policy, a robust understanding of the related fields is essential.