Il dibattito in Bioetica - From solidarity to speculation: how actuarial logic undermines the dignity of the patient

This article examines how market-driven healthcare, guided by actuarial assessments, inverts medicine’s ethos by prioritizing financial risk over patient need. Through the case of “Bill”– a healthy individual denied long-term-care coverage due to a genetic predisposition to ALS – I reveal how utilitarian efficiency fosters exclusion rather than support. Drawing on critiques by Illich, Foucault, and MacIntyre, as well as Kantian and personalist ethics, I argue that healthcare must uphold the patient’s ontological dignity rather than reducing individuals to actuarial liabilities. While acknowledging the necessity of resource allocation, I contend that true moral legitimacy demands subordinating economic considerations to solidarity and justice. Moreover, emerging technologies like AI-driven diagnostics stand at a crossroads: they can either intensify selection based on genetic risk or be harnessed for preventive, person-centered care. Ultimately, I call for a reorientation of healthcare around the irreducible dignity of each patient rather than profit-driven imperatives.