Cornelius Cappelen

Phase-dependent justification: the role of personal responsibility in fair healthcare

The main aim of this paper is to examine the fairness of different ways of holding people responsible for healthcare-related choices. Our focus is on conceptualisations of responsibility that involve blame and sanctions, and our analytical approach is to provide a systematic discussion based on interrelated and successive health-related, lifestyle choices of an individual. We assess the already established risk-sharing, backward-looking and forward-looking views on responsibility according to a variety of standard objections. In conclusion, all of the proposed views on holding people responsible for their lifestyle choices are subjected to reasonable critiques, although the risk-sharing view fare considerably better than the others overall considered. With our analytical approach, we are able to identify how basic conditions for responsibility ascription alter along a time axis. Repeated relapses with respect to healthcare associated with persistent, unhealthy lifestyle choices, call for distinct attention. In such situations, contextualised reasoning and transparent policy-making, rather than opaque clinical judgements, are required as steps towards fair allocation of healthcare resources.

Could information about herd immunity help us achieve herd immunity? Evidence from a population representative survey experiment:

Aims: Immunisation causes dramatic reductions in morbidity and mortality from infectious diseases; however, resistance to vaccination is nonetheless widespread. An understudied issue – explored here – is whether appeals to collective as opposed to individual benefits of vaccination encourage people to vaccinate. Knowledge of this is important not least with respect to the design of public health campaigns, which often lack information about the collective benefits of vaccination. Methods: Using a between-subjects experimental survey design, we test whether information about the effects of herd immunity influences people’s decision to vaccinate. A representative sample of Norwegians was confronted with a hypothetical scenario in which a new and infectious disease is on its way to Norway. The sample was split in three – a control group and two treatment groups. The one treatment group was provided information about collective benefits of vaccination; the other was provided information about the individual benefits of vaccination. Results: Both treatments positively affect people’s decision to vaccinate; however, informing about the collective benefits has an even stronger effect than informing about the individual benefits. Conclusions: Our results suggest that people’s decision about whether to vaccinate and thus contribute to herd immunity is influenced by concern for others. Thus, stressing the collective benefits of vaccination could increase the effectiveness of health campaigns.

Just wealth transfer taxation: Defending John Stuart Mill’s scheme

This article examines John Stuart Mill’s influential proposal of how to tax wealth transfers. According to Mill, every person should be free to bequeath but not to receive bequest. Mill proposed an upper limit on how much each person could receive from wealth transfers. We discuss three objections against this proposal. The nonseparability objection holds that it is not possible to separate the freedom to give from the freedom to receive. The objection from private property holds that private property includes an unlimited right to dispose of one’s assets and that this right is violated under Mill’s scheme. The objection from incentives holds that Mill’s scheme would have negative effects on people’s willingness to work and save. We argue that these objections can be met and that taxing bequeathed wealth according to Mill’s scheme is more just and more efficient compared to systems that rely less on wealth transfer taxation.

Diversity and welfare state legitimacy in Europe. The challenge of intra-EU migration

ABSTRACT It has convincingly been argued that in the United States, immigration is detrimental to welfare state support. In Europe, on the other hand, there is little evidence for such a negative relationship. This article examines whether a particular type of immigration – rapidly escalating intra-European Union (EU) immigration – reduces public support for the welfare state. We argue that because EU states cannot discriminate against resident EU nationals from other countries in the field of social security, intra-EU immigration will negatively affect attitudes towards welfare spending. To test this expectation, we use data from the European Social Survey of 2008, among other sources. The results of our multilevel analyses document a negative relationship between intra-EU immigration and welfare state support, supporting our hypothesis.

The Law of Jante and generalized trust

A widespread cultural phenomenon – and/or individual disposition – is the idea that one should never try to be more, try to be different, or consider oneself more valuable than other people. In Scandinavia this code of modesty is referred to as the ‘Jante mentality’, in Anglo-Saxon societies the ‘tall poppy syndrome’, and in Asian cultures ‘the nail that stands out gets hammered down’. The study reported here examines how this modesty code relates to generalized trust. We argue, prima facie, that a positive and a negative relationship are equally plausible. Representative samples of the Norwegian population were asked about their agreement with the Jante mentality and the extent to which they have trust in other people. Two population surveys were conducted; one measuring individual level associations and another measuring aggregate level associations. It was found that the relationship between having a Jante mentality and trust is negative, at both levels of analysis and, furthermore, that the Jante mentality – this modesty code assumed to be instilled in Scandinavians from early childhood – is a powerful predictor of generalized trust.