The topic of alcohol played an important role in my course Phil 156, Philosophy and Contemporary Issues: Biomedical Ethics, a course enrolling 30 students in the fall of 1997. The problems of alcohol and alcoholism were mentioned as illustrations under a number of topics through the term, but it received its most extensive discussion under the topic of justice in the allocation of medical resources. There are two levels at which the issue of distributive justice in health care arises: the macro level and the micro level. At the macro level, the basic issue is to what extent and how the issue of a person's abuse of alcohol should affect whatever health insurance scheme he or she belongs to. At the micro level, problems arise such as whether someone's alcoholism should be a negative factor in deciding where that person should be placed on a list of persons awaiting a liver transplant, in a situation where those low on the list will probably die before a transplant is available. We illustrated this problem with the Mickey Mantle example, which recurred throughout the course. At both levels, the basic issue is whether or not someone should be held responsible for being an alcohol abuser--is it that person's fault or is it not the person's fault, as the disease model would suggest. This led to a discussion of the question of the nature of responsibility, which has wide reverberations in medical ethics, given the apparent fact that a good portion of serious human diseases and disabilities are due to life-style choices. If health care is to be rationed, as it must, is the responsibility of the patient in bringing about the disease or disability one of the criteria on which it is to be rationed?