Why is "self-inflicted illness" a problematic criterion for rationing health care?
Because it requires a proven causal link between behaviour and illness, while most diseases have many causes; because it is unclear where to stop (the stressed manager or surgeon with an ulcer?); and because with addiction it is hard to say how voluntary the behaviour was.
The proposal behind it: demand more personal responsibility and make people bear the cost of deliberately risky behaviour themselves.
The objections:
- Causality. You can only blame someone for an illness if a clear "if X then Y" link is established. But diseases are usually multifactorial: genes, environment, poverty and behaviour all play a part.
- Where do you draw the line? Managers, surgeons or journalists more or less choose the stress of their job, which often leads to stomach ulcers, high blood pressure or sudden hearing loss. Are they to blame too?
- Voluntariness. In addiction illnesses, it is very hard to say how freely the harmful behaviour was chosen.
Related points from the same debate: rationing is often a taboo topic, yet lowering the level of benefits is not unethical in itself (resources are scarce, and every euro spent here is not spent on education or security), as long as a minimum level of health care is guaranteed.
Go deeper:
Noll & Wolf (2017) — the section on ethical lines of conflict in rationing (German).