The willingly unhealthy, (fat, smokers, and perhaps even insufficient exercisers) impose externalities by consuming more publically funded healthcare, so it might be a good idea to deprioritize them, or just cut the publically funded bit after fulfilling some criteria, like high enough BMI.
This would increase the cost of high-risk lifestyles and potentially reduce their incidence.
The discussion below centers only on organs, which I think misses the point, but it's still interesting.
The most promising argument in favor of deprioritizing those with “unhealthy” lifestyles is the Restoration Argument, which goes as follows (Harris 1985; Smart 1994; S. Wilkinson 1999).
- Some people (risk-takers) knowingly and voluntarily have unhealthy and/or dangerous lifestyles.
- Risk-takers are more likely to need transplant organs than the general population (non-risk-takers).
- Transplant organs are in short supply.
- Because of (2) and (3), if we allocate on the basis of clinical need or clinical outcomes alone, non-risk-takers will be harmed by the risk-takers’ lifestyle choices; the non-risk-takers’ chances of getting a transplant organ will be lower because of the risk-takers’ increased demands on the system.
- To allow the non-risk-takers to be harmed by the risk-takers would be unfair. Why should non-risk-takers have to pay the price for risk-takers’ lifestyle choices?
- In order to avoid this unfairness, risk-takers’ entitlements should be reduced such that there is no harm to the non-risk-takers.
Even this argument faces difficulties though. One practical problem is that risk-taking may not generate additional healthcare costs or demand for organs. Indeed, some kinds of risk-taking behavior (motorsports perhaps) could even increase the supply of high-quality cadaveric organs available for transplant.
S. Wilkinson (1999) takes this fact as a point of departure for a deeper critique of the Restoration Argument. He claims that, if it turned out (as is likely) that smokers cost the U.K.’s National Health Service less than non-smokers (because on average they die younger) then proponents of the Restoration Argument would be committed to the unpalatable conclusion that smokers should be given not lower but higher priority than other patients. Otherwise, smokers would be harmed by the non-smokers’ deliberate attempts to extend their own lives by avoiding smoking. His argument is about financial resources but very much the same would apply to organs in relevantly similar situations of scarcity.
Wilkinson concludes that this objection seriously weakens the Restoration Argument. Either it is simply a reductio ad absurdum of the Restoration Argument, in which case the argument must be rejected wholesale. Or at least its defenders will need to appeal to something like moral or social value in order to avoid the argument’s unacceptable consequences—thus making it vulnerable to some of the problems with appealing to the social value noted above (Walker 2010; S. Wilkinson 1999)
