The National Institute for Health and Clinical Excellence's citizens' council thinks it might be right to offer grossly unhealthy people financial incentives to mend their ways provided these incentives proves less expensive to the state in the long-run than their continued ill health. In the following discussion the only grossly unhealthy people I will consider will be the obese. However I believe all my comments are to some degree applicable to all grossly unhealthy people such as smokers, alcoholics and drug users. Someone might protest if NICE’s citizens' council’s idea is accepted that we must also accept it would be right to pay muggers to mend their ways provided these payments cost the state less than their continued mugging. My protestor might argue such a policy would save the money on policing muggings, the trials of muggers and the imprisonment of offenders. He might further argue some members of the public would be saved the trauma of mugging whilst the rest of us might feel safer on the streets. If we are to reject my protestor’s arguments we must show there is a significant difference between paying such incentives to the grossly obese and muggers. This is easily achieved by simply noting paying incentives to all potential muggers is in reality paying blackmail.
Let us firmly reject the idea of paying blackmail to all potential muggers. However my protestor might refine his argument. He might accept we should not pay all potential muggers. He might now argue if it can be shown giving a small cash incentive to convicted muggers reduces mugging and this incentive is cost effective that we should do so. In the following ‘muggers’ will be taken to mean convicted muggers. It might be objected such an incentive remains a form of blackmail. I believe my protestor can effectively reject this objection. He might point out in this context the incentive is freely offered and not demanded by the convicted muggers. The question I wish to consider is whether, in this revised context, it is possible to show there is a significant difference between giving a small incentive to the grossly obese either to slim or go to a gym and giving muggers a similar incentive to desist from mugging.
If we adopt a purely consequentialist viewpoint of morality it is by no means clear we can find a meaningful difference. From a very simple consequentialist viewpoint based on purely avoiding harm to individuals it might be concluded there is indeed no difference. The harm an obese person does to himself can be equated with the harm a mugger does to his victims. From such a viewpoint all that matters is harm and the fact that an obese person harms himself whilst a mugger harms others is irrelevant. However such a viewpoint involves a too simplistic idea of harm. Mugging damages society and hence indirectly damages others as well as the mugger’s victims. It might be suggested this extra harm means giving incentives to muggers should be given priority over giving incentives to the obese. Clearly such a suggestion seems ridiculous. The reason being it is based on the same simplistic idea of harm. It seems to me the harm done to society must somehow include the wrongness of mugging and that the payment of cash incentives to muggers pays no attention to any such wrongness. Nevertheless even if this wrongness can be weighted into a consequentialist viewpoint, which I personally doubt, it still remains doubtful whether such a viewpoint can pinpoint a significant difference between the payment of a small cash sum to enable someone who is grossly obese go to a gym and giving a similar sum to a mugger to help him desist from mugging.
One of the problems of any consequentialist account of morality is how to deal with dessert. Is it possible to find a significant difference based on dessert? In considering this question I will rely on our intuitive ideas of dessert and will not consider any theory of dessert. Intuitively if someone deserves something he must undertake some action that makes him worthy of this dessert. Intuitively convicted muggers don’t do anything that makes them worthy of the proposed cash incentives. Unfortunately it is far from obvious that the grossly obese do anything that make them worthy of these incentives either. Intuitively it might be argued provided their obesity is self inflicted the obese merit our approbation rather than any ‘deserved’ cash incentives.
If it is impossible to find a significant difference from either a consequentialist viewpoint or that of dessert then perhaps it may be possible to find a difference based on need? The obese need to lose weight muggers don’t need to stop mugging, muggers should stop mugging. It is clear then there is a significant difference between paying a small incentive to the grossly obese in order to help them slim and paying a similar incentive to convicted muggers to encourage them desist from mugging from the viewpoint of need. However even if we accept the above and that we should satisfy needs when possible it does not automatically follow we should incentivise the obese to lose weight. People have many needs and limited resources mean we cannot satisfy the needs of all. Consider a father is grossly obese due to lack of exercise and a diet of jam doughnuts. Let it be assumed his gross obesity means he is a poor father. Let us also consider a good father who eats sensibly and works very hard to support his family. Let it be further assumed this second father is stressed due to his hard work. A small cash incentive could help the first father slim by going to a gym. However the same small cash incentive could also help the second father relieve his stress by going to the same gym. Both fathers have needs but if we can only satisfy the needs of one intuitively we might feel we should satisfy the needs of the second father. The reason for our intuitive feelings seems to be based on dessert.
None of the above means it would be wrong to give the obese some small cash incentive if it can be shown this incentive will help them lose weight and hence improve their health. Indeed I would suggest it would be wrong not to care about the obese. I would agree with Michael Slote when he argues an action is wrong if it exhibits or expresses a lack of caring motivation based on a lack of empathy, see (2007, The Ethics of Care and Empathy, Routledge). However even if we must care about the obese it does not follow we must offer them financial incentives to lose weight even if these incentives are effective. First as noted above if resources are scarce we may feel others are more deserving of these resources. Secondly even if resources are more readily available it might be argued offering the obese incentives to lose weight, when others can do so under their own volition, means we are not treating the obese with the same respect as we do most people. I will not pursue this argument here. It follows whether we should incentivise the obese lose weight in order to improve their health when resources to do so are freely available remains undecided.
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