Burden attribution governs who carries the costs that choices and institutions create. It generalizes burden allocation from the individual case to the structural one, and its rule is a matter of placement, not worth: a cost should land as close as reasonably possible to the jurisdiction that generates it, rather than being exported onto participants who had no part in it — the same logic the accounting boundary applies to ecological transfer. Where a choice exports cost, the mechanisms are ordinary ones: taxes, regulation, prevention, and limits on exposing others.
The decisive constraint is what attribution may never become. Someone who smokes may face taxes, restrictions on exposing others, and — under genuine scarcity — allocation that weighs prognosis or expected benefit, all without losing healthcare standing. The question is never are they less deserving? but how much of a self-created burden can fairly be transferred to others?
Consequences should attach to the burden where feasible, not to the worth of the participant.