Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate

Sharkey, Kerith; Gillam, Lynn

doi:10.1136/jme.2009.032102

Cited by 63 publications

(52 citation statements)

References 64 publications

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“…Sharkey and Gillam's3 analysis of the literature concludes with a worry that the debate has become stagnant and repetitive, and requires further development of existing arguments or the introduction of new arguments. In response to their plea, I hope here to expand and develop an existing argument against incorporating responsibility into healthcare policy as well as to offer a critical response to an argument that has been made in favour of such policies.…”

Section: Two New Contributionsmentioning

confidence: 99%

Personal responsibility within health policy: unethical and ineffective

Friesen

2016

J Med Ethics

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This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall.

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Section: Two New Contributionsmentioning

confidence: 99%

Personal responsibility within health policy: unethical and ineffective

Friesen

2016

J Med Ethics

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“…Far from being stagnated, or stalled (as claimed in a recent article in this journal),8 the debate about responsibility for health is flourishing and is also offering alternatives to the luck egalitarian version of the principle of health responsibility 7. In policy, accountability for personal responsibility for health is put to use in several insurance programmes where the eligibility and size of the premiums depend on health behaviours 9.…”

Section: Introductionmentioning

confidence: 99%

On the relevance of personal responsibility in priority setting: a cross-sectional survey among Norwegian medical doctors

Bringedal

Feiring

2011

J Med Ethics

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“…Even if we assume that IR should be applied in healthcare, there are still a number of arguments about its practical applicability, however, and our focus in the following analysis is on these 1 9. These arguments can be grouped under four different headings:

Questioning the applicability of the control claim.

…”

Section: Individual Responsibility (Ir): Entangling Responsibility Anmentioning

confidence: 99%

Individual responsibility as ground for priority setting in shared decision-making

2016

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Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength.

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Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate

Cited by 63 publications

References 64 publications

Personal responsibility within health policy: unethical and ineffective

Personal responsibility within health policy: unethical and ineffective

On the relevance of personal responsibility in priority setting: a cross-sectional survey among Norwegian medical doctors

Individual responsibility as ground for priority setting in shared decision-making

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