The American College of Physicians has offered ethical guidelines for using incentives to promote personal responsibility for health. If you're running a wellness program at your organization, this is must reading.
While the position paper specifically examines a Medicaid pilot project in West Virginia, much of it can be applied to private sector wellness programs.
The paper—"Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond"—emphasizes that efforts to change unhealthy behaviors must be part of an overarching wellness program that uses evidence-based practices to develop nondiscriminatory programs that do not punish patients for unhealthy behaviors.
At play here is the inherent friction between personal responsibility, incentivizing healthy behaviors, and punishing people who don't or can't reach goals such as quitting smoking or weight loss. We know that many of the chronic and expensive ailments that plague this country—diabetes, arthritis, and respiratory and cardiovascular diseases, to name a few—are largely the result of self-inflicted poor health choices around bad diet, tobacco use, and sedentary lifestyle. Why shouldn't the individual be held accountable for his or her poor health decisions? Why should the rest of society be forced to pay for the poor health decisions of others? If the individual isn't responsible for his or her health, who is? These are legitimate questions.
On the other hand, the poor, the old, the undereducated, and minorities are often disproportionately affected by these bad health choices. Are we going to create a caste system that rewards the healthy and punishes the unhealthy? Won't that create a downward spiral of disincentives and discouragement that will only worsen health issues—and the cost—for this unhealthy segment of society? Those are legitimate questions, too.