SUMMARY

National Health Systems, by means of which the universal right to health care is effective, are the outcome of a certain conception of political justice; namely, that the political institutions should guarantee that the relevant criterion for the allocation of health care is needed and not the willingness to pay or economic capacity. When establishing a public health care system, the State intervenes in order to diminish the adverse effects of natural lottery. Be it as it may, we should inquire the extent to which the State ought to take care of those individuals who are irresponsible as regards their own health: is it fair to deny them medical care? Or placing them at the end of the assistance queue? Or taxing them for their risky behaviour?

In this article I argue that the exercise of personal autonomy plays a significant role in justifying and framing such systems (namely in specifying the scope of the benefits it brings to every citizen) but also in the allocation of health care resources already available. For reasons having to do with distributive justice, the health care authority might take into account the lifestyle consciously embraced by the patient in order to deny or delay certain treatment in favour of another patient who has no such record of imperilled behaviour. Some requirements for such an allocation decision should be met: the patient should be advised of the risks of his behaviour, and the causal relation between such habit and the illness ought to be firmly established.

Political institutions have a wide range of means to make patients responsible for their elections. This is the coherent response to taking individual self-determination seriously. From those various means, I defend that those who engage in risky behaviours should contribute more to finance the public health care system.