Do Patients Have Responsibilities in a Free-Market System? a Personal Perspective

Abstract

The current debate that surrounds the issue of patient rights and the transformation of health care, social insurance, and reimbursement systems has put the topic of patient responsibility on both the public and health care sectors' agenda. This climate of debate and transition provides an ideal time to rethink patient responsibilities, together with their underlying rationale, and to determine if they are properly represented when being called 'patient' responsibilities. In this article we analyze the various types of patient responsibilities, identify the underlying motivations behind their creation, and conclude upon their sensibleness and merit. The range of patient responsibilities that have been proposed and implemented can be reclassified and placed into one of four groups, which are more accurate descriptors of the nature of these responsibilities. We suggest that, within the framework of a free-market system, where health care services are provided based on the ability to pay for them, none of these can properly be justified as a patient responsibility.

Co-Responsibility: a New Horizon for Today’s Health Care?

“…Generally, since the seventies, the discussion on responsibility has been a binary debate between the advocates of individual responsibility on the one hand and the pleads for social responsibility and the importance of circumstances on the other hand [10,16,24,57]. Although recently, in literature the accent has shifted from personal responsibility towards a more extended notion of shared, social or community responsibility [46], and despite criticisms from Neil Mc Laughlin [26,27] and others and pleads to stop blaming the patient and his unhealthy behavior, health insurances or organizations do in fact keep on punishing the individual for his lifestyle diseases as if the individual in the only responsible actor in society.…”

“…Let us therefore illustrate the opportunities of the idea of coresponsibility with one particular case, the so-called 'risk behavior'. When it comes down to risk behavior, again the whole discussion is about autonomy and the responsibility of the individual for its own health [10]. The a priori choice to limit our scope to individual autonomy and responsibility not only narrows in advance the horizon of the discussion, it leads to a debate which necessary will get stuck in its own binary logic: this or that, me or the other.…”

Progress in medicine: autonomy, oughtonomy and nudging

“…If we for instance think about the debate on so‐called ‘risk behaviour’, the whole discussion is about the maximization of the autonomy and the responsibility of the individual for his/her own health [18]. As such there is nothing wrong with this debate, but we should also put other important aspects at the forefront.…”

Patients have unwritten duties: experiences of patients with type 1 diabetes in health care

“…According to the current literature, patients have duties towards themselves, healthcare professionals and society, and they have a role as patients as well as citizens . Patients' duties towards themselves include looking after their own health . They have a duty to seek health advice, follow given instructions and ensure they access healthcare provision …”

“…Patients' duties towards healthcare professionals include telling the truth, respecting staff and keeping appointments . Patients' duties have also been described from the point of view of society.…”