What role, if any, the concept of personal responsibility for health should play in health policy is a burning question. Human beings have long known that their behaviour can cause ill-health, but it is only in the last century that we have come to understand that our behaviour is causally responsible for a substantial amount of the global burden of disease. Partly as a result of these new findings politicians have started to advocate "cost bearing" policies which require people who are responsible for their ill-health to bear some of the costs of their risky health affecting choices. In this respect, policy makers and other stakeholders have stolen a march on philosophers because relatively little work has hitherto been carried out by these academics to determine whether cost bearing health policies are normatively justifiable and practically feasible. As such, the primary goals of my thesis will be to develop a framework for analysing these questions and to provide some substantive answers of my own. The main conclusions that I will draw in thesis is that some forms of cost bearing policies - namely, "risk tax" and "risk insurance" policies - are both practically feasible and normatively reasonable and that these policies can be defended by at least five different normative arguments - including a theory of justice known as "luckist" luck egalitarianism. During the course of my thesis I will also defend the supplemental claims that ill-health is, causally speaking, very much in our own hands and that most people are substantively morally responsible for their risky health affecting choices.
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