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Care for the self


Care for the self:

Personal responsibility and insurability for health care in an era of predictive precision medicine.

Prof. Jos Welie (Creighton, USA)

With response from Prof. Mark Lawler (QUB).

1800, 24th of April, 2018.

The Edgar Graham Room, The School of Law, QUB.



The predictive possibilities generated by precision/personalized medicine (PM) and mediated by new IT platforms are considered an important benefit to patients, enabling them to better manage their own health status, prevent expensive chronic illnesses by timely lifestyle changes, and take control of their own health care. Multinationals like 23andme.com, IBM, and Apple are aggressively promoting this health empowerment. However, once individuals are thus empowered, they can no longer be considered at the mercy of unpredictable diseases. As long as the event of illness is truly bad fortune, it generates a justifiable claim on communal resources for relief. But to the degree that individuals are capable of preventing the illness, it seems reasonable, at least prima facie so, to also hold them responsible for failing to do so, which in turn invalidates the aforementioned claim. Based on this “principle of reasonable avoidability”, insurance providers – both public and private – could fairly link coverage to individual empowerment. This principle has been discussed previously in reference to a variety of conditions, from lung cancer among smokers to head trauma among motor cyclists driving without a helmet. Limitations in insurance policies based on patients’ failure to make the necessary life-style changes have since been reported, and public support favoring a premium discount to those who do not engage in unhealthy behavior is increasing. But the emergence of PM and its promise of vastly improved patient-specific predictive information impart new urgency to the question about individual responsibility vis-à-vis health care coverage.