© 2000 Kluwer Academic Publishers. Printed in the Netherlands. Lifestyle Solidarity in the Healthcare System

Abstract. Encompassing health care systems in modern welfare states embody several forms of solidarity: between the sick and the healthy, the old and the young and between those who take good care of their health on the one hand and fellow citizens who choose to risk their lives by smoking or unsafe sex on the other. The latter form is called lifestyle solidarity. In the Netherlands this type of solidarity has become the object of a debate between medical ethicists. Most medical ethicist seem to want to uphold lifestyle solidarity. Most Dutch citizens agree with them. The Dutch government, however, embarked on a project to change the health care system by transferring state responsibilities to other actors (employers, insurers, individuals). This changing policy may diminish or destroy lifestyle solidarity despite the fact that no one intended this to happen. Key words: risky behaviour, responsibility, health care syste