Voluntary risks to health. The ethical issues.

The discovery that health status is affected by personal life-styles and apparently voluntary health risks poses new problems. It has potential impact on clinical practice, health insurance, and theories of health and disease. Five major problems need attention. First, are these health-risk behaviors really voluntary? Five responses are explored: several other models (the medical, psychological, social structural, and multicausal models) all challenge the assumption of voluntary behavior. Second, are some sufficiently in the public interest that they ought to be subsidized? Third, does justice require that persons bear the costs of truly voluntary health risks? Fourth, what policies should apply to cost-saving, health-risk behavior? Finally, does the voluntary health-risks theme make life too rational and calculating? These issues must be dealt with in future health planning and clinical decision making.