title: Drinking in the last chance saloon: luck egalitarianism, alcohol consumption, and the organ transplant waiting list.
abstract: The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive justice. One prominent theory of distributive justice, luck egalitarianism, assesses distributions as just if, and only if, people's relative positions reflect their exercises of responsibility. There is a principled luck egalitarian case for giving lower priority to those who are responsible for their need. Compared to the existing literature favouring such differentiation, luck egalitarianism provides a clearer rationale of fairness, acknowledges the need for individual assessments of responsibility, and requires initiatives both inside and outside of the allocation systems aimed at mitigating the influence from social circumstances. Furthermore, the concrete policies that luck egalitarians can recommend are neither too harsh on those who make imprudent choices nor excessively intrusive towards those whose exercises of responsibility are assessed.
authors.affiliation: Department of Political Science and Government, School of Business and Social Sciences, Aarhus University, Bartholins Alle 7, 8000, Aarhus C, Denmark. aba@ps.au.dk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Albertsen
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D006801:Humans; D016031:Liver Transplantation; D040841:Resource Allocation / Q000379:methods; D012941:Social Responsibility; D014850:Waiting Lists
keywords: Distributive justice; Health inequalities; Liver transplantation; Luck egalitarianism; MELD; Medical ethics; Organ allocation; Organ shortage; Organ transplant waiting list; Organ waiting list; Personal responsibility; Transplantation; Waiting list
references.citation: Alcohol Clin Exp Res. 1994 Apr;18(2):219-21
references.pmid: 8048715
references.citation: Hastings Cent Rep. 2007 May-Jun;37(3):4; author reply 6
references.pmid: 17649893
references.citation: Hepatology. 2007 Mar;45(3):797-805
references.pmid: 17326206
references.citation: Addiction. 2008 Sep;103(9):1414-28
references.pmid: 18422824
references.citation: J Med Philos. 2011 Dec;36(6):529-36
references.pmid: 22218045
references.citation: J Med Philos. 2015 Jun;40(3):342-62
references.pmid: 25870307
references.citation: Hepatology. 1984 Jan-Feb;4(1 Suppl):95S-101S
references.pmid: 6363266
references.citation: J Med Ethics. 2015 Feb;41(2):165-9
references.pmid: 24505116
references.citation: Arch Gen Psychiatry. 2003 Dec;60(12):1256-64
references.pmid: 14662558
references.citation: J Med Ethics. 2008 Jan;34(1):33-6
references.pmid: 18156519
references.citation: Hepatology. 2001 Feb;33(2):464-70
references.pmid: 11172350
references.citation: Transpl Int. 2005 May;18(5):491-8
references.pmid: 15819795
references.citation: Bioethics. 2008 Feb;22(2):77-83
references.pmid: 18251767
references.citation: Alcohol. 2001 Oct;25(2):107-14
references.pmid: 11747980
references.citation: Health Policy. 2006 May;76(3):312-9
references.pmid: 16112248
references.citation: Compr Psychiatry. 2009 Jul-Aug;50(4):299-306
references.pmid: 19486727
references.citation: Camb Q Healthc Ethics. 2012 Jan;21(1):5-19
references.pmid: 22152454
references.citation: Alcohol Clin Exp Res. 1997 Feb;21(1):93-100
references.pmid: 9046379
references.citation: Hastings Cent Rep. 2007 May-Jun;37(3):4-5; author reply 6
references.pmid: 17650560
references.citation: Clin Mol Hepatol. 2013 Jun;19(2):105-15
references.pmid: 23837134
references.citation: Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii13-viii22
references.pmid: 17890257
references.citation: Hastings Cent Rep. 2007 Jan-Feb;37(1):41-7
references.pmid: 17348263
references.citation: Liver Transpl. 2004 Jul;10 (7):898-902
references.pmid: 15237374
references.citation: JAMA. 1991 Mar 13;265(10):1299-301
references.pmid: 1995978
references.citation: J Clin Nurs. 2009 Jul;18(14):1994-2002
references.pmid: 19374690
references.citation: Alcohol Res Health. 2003;27(3):257-68
references.pmid: 15535454
references.citation: Transpl Int. 2001 Jun;14(3):176-9
references.pmid: 11499907
references.citation: J Med Ethics. 2015 Oct;41(10):836-40
references.pmid: 26269464
references.citation: Camb Q Healthc Ethics. 2009 Winter;18(1):23-35
references.pmid: 19091142
references.citation: J Med Ethics. 1994 Mar;20(1):26-30
references.pmid: 8035435
references.citation: Addiction. 1997 Sep;92(9):1189-93
references.pmid: 9374019
references.citation: Hastings Cent Rep. 1981 Oct;11(5):26-31
references.pmid: 7309497
references.citation: Hepatology. 1990 Feb;11(2):159-64
references.pmid: 2307394
references.citation: Med Sci Law. 2011;51 Suppl 1:S2-6
references.pmid: 22021628
references.citation: Alcohol Health Res World. 1997;21(3):218-26
references.pmid: 15706772
references.citation: JAMA. 1991 Mar 13;265(10):1295-8
references.pmid: 1995977
references.citation: World J Gastroenterol. 2010 Sep 21;16(35):4377-93
references.pmid: 20845504
references.citation: J Med Ethics. 2005 Aug;31(8):476-80
references.pmid: 16076974
references.citation: J Med Philos. 1998 Feb;23(1):31-49
references.pmid: 9555633
references.citation: Camb Q Healthc Ethics. 2013 Apr;22(2):146-58
references.pmid: 23507177