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July 11, 1980

Voluntary Risks to Health-Reply

Author Affiliations

Kennedy Institute of Ethics Georgetown University Washington, DC

JAMA. 1980;244(2):134. doi:10.1001/jama.1980.03310020016011

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In Reply.—  I am sympathetic with Dr Gillette's concern that social and political forces may prevent meaningful government action against voluntary health risks. This kind of concern I incorporate into what I call the social structural model. Social institutions (economic, political, and others) may be real and important factors in the causal chain that makes the behaviors less than voluntary.The core of the argument, however, was to separate paternalistic interventions that would have as their goal the prevention of the behavior per se and nonpaternalistic interventions that would provide greater equity in the distribution of the costs of the risky behavior. Thus, I am sympathetic with Dr Gillette's observation that many of the behaviors give pleasure to certain persons. I never classified any of these activities as undesirable. They are merely potentially costly. If they are truly voluntary behaviors and truly risky behaviors, then equity requires that the individual