In the article by Kristin Voigt in the April 2013 issue of Cambridge Quarterly of Healthcare Ethics, quotation marks around certain phrases were deleted.

Health policy sometimes hinges on claims about the responsibility borne by people or corporations for health outcomes. We don't want these claims to be arbitrary, so we construe them as discoveries of plain fact. But we're mistaken. They are interwoven with our values and social institutions. Recognizing that they are allows us to debate them more honestly and thoroughly.

The notion of individual responsibility has gained prominence in recent debates about health care. First, responsibility has been proposed as a rationing criterion; second, some policies use rewards and sanctions to encourage individuals to ‘take responsibility’ for their health; finally, acting responsibly within the health care system is portrayed as a requirement of reciprocity. The aim of this paper is two-fold. First, I assess these different kinds of appeal to individual responsibility (...) from the perspective of equality. The literature has identified important concerns about equality and fairness with proposals to use individual responsibility as a rationing criterion; I suggest that there are similar concerns about incentive schemes and reciprocity-based appeals to individual responsibility. The analysis will draw on luck egalitarian accounts of equality, which emphasise the importance of individual responsibility. This allows me to pursue the second objective for paper: to reconsider the luck egalitarian perspective on these different appeals to responsibility. Applying the arguments of recent contributions to the luck egalitarian literature to the health arena suggests that luck egalitarians need not support the use of responsibility as a rationing criterion, and they can also identify problems with incentives and reciprocity-based arguments. However, the language of individual responsibility and its prominence in public debates may have implications for individuals’ health and well-being, which raises challenging issues for luck egalitarians as they attempt to apply their theory to the real world. (shrink)

Rebecca Brown and Julian Savulescu1 focus on individuals’ responsibility regarding health-related behaviours. They rightly argue that paying attention to diachronic and dyadic aspects of responsibility can further illuminate the highly multifaceted concept of personal responsibility for health. Their point of departure is a pragmatic one. They note that personal responsibility ‘is highly intuitive, [that] responsibility practices are a commonplace feature of almost all areas of human life and interpersonal relationship [and that] the pervasiveness (...) of this concept [suggest] the improbability of banishing it entirely’. Indeed, despite—or perhaps even quite independent of—decades of mostly sceptical conceptual analysis of the concept of personal responsibility by philosophers and others, it endures, if not flourishes. These separate dynamics raise the question of how, in years ahead, the debate on responsibility can be furthered most effectively, and how nuanced conceptual distinctions can effectively inform policy and practice. The authors’ table 1 matrix illustrates how different levels of control and knowledge people had at different timepoints might be grouped in categories of low, moderate or high demandingness: for policy makers sympathetic to the authors’ proposal that high levels of demandingness should undermine responsibility attributions, or for advocacy groups seeking to lobby on their behalf, several questions likely arise, including: How should …. (shrink)

The problems of global health are truly terrible. Millions suffer and die from diseases like tuberculosis, HIV/AIDS, and malaria. One way of addressing these problems is via a Global Health Impact labeling campaign. If even a small percentage of consumers promote global health by purchasing Global Health Impact products, the incentive to use this label will be substantial. One might wonder, however, whether consumers are morally obligation to purchase any these goods or whether doing so is (...) even morally permissible. This paper suggests that if the proposal is implemented, purchasing Global Health Impact labelled goods is at least morally permissible, if not morally required. Its argument should, moreover, be of much more general interest to those considering different kinds of ethical consumption. (shrink)

If we are responsible for taking care of our health, are we blameworthy when we become sick because we failed to meet that responsibility? Or is it immoral to blame the victim of sickness? A moral perspective that is sensitive to therapeutic concerns will downplay blame, but banishing all blame is neither feasible nor desirable. We need to understand the ambiguities surrounding moral responsibility in four contexts: (1) preventing sickness, (2) assigning financial liabilities for health care (...) costs, (3) giving meaning to human suffering, and (4) interacting with health care professionals. We also need to distinguish different kinds of blame, explore the interplay of justice and compassion in avoiding unjustified blaming of victims, and work toward a unified moral-therapeutic perspective that encourages individuals to accept responsibility while avoiding destructive forms of blaming. (shrink)

ZusammenfassungDer Aufsatz analysiert den Konnex zwischen Individualisierter Medizin und der Forderung nach mehr gesundheitlicher Eigenverantwortung, der oft als plausibel angenommen wird, wenn der Individualisierten Medizin das Potential zugesprochen wird, das solidarisch finanzierte Gesundheitssystem in Deutschland zu transformieren. Ausgehend von einer logischen Rekonstruktion des Verantwortungsbegriffs, die dessen Operationalisierbarkeit unter anderem an Sanktionsvollmachten der jeweiligen Verantwortungsinstanz bindet, und basierend auf einem terminologisch präzisierten Verständnis von Individualisierter Medizin wird folgende These entwickelt: Die Annahme, im Rahmen Individualisierter Medizin sei eine verlässliche Prädiktion anlagebedingter und (...) zugleich lebensstilabhängiger Erkrankungsrisiken möglich, verpflichtet logisch nicht zur Übernahme der Forderung, Lebensstile mit negativem Einfluss auf persönliche Erkrankungsrisiken seien zu sanktionieren. Weil die Forderung nach mehr gesundheitlicher Eigenverantwortung aus dem Programm der Individualisierten Medizin logisch nicht ohne Hinzunahme normativer Prinzipien abzuleiten ist, kann man dieses Programm selbst gut heißen, ohne sich die politische Forderung nach einem Umbau des solidarisch finanzierten Gesundheitssystems unter dem Vorzeichen gesundheitlicher Eigenverantwortung zu eigen machen zu müssen. (shrink)

Proposals for regulating or nudging healthy choices are controversial. Opponents often argue that individuals should take responsibility for their own health, rather than be paternalistically manipulated for their own good. In this paper, I argue that people can take responsibility for their own health only if they satisfy certain epistemic conditions, but we live in an epistemic environment in which these conditions are not satisfied. Satisfying the epistemic conditions for taking responsibility, I argue, requires regulation (...) of this environment. I describe some proposals for such regulation and show that we cannot reject all regulation in the name of individual responsibility. We must either regulate individuals’ healthy choices or regulate the epistemic environment. (shrink)

Most of the discussion in bioethics and health policy concerning social responsibility for health has focused on society’s obligation to provide access to healthcare. While ensuring access to healthcare is an important social responsibility, societies can promote health in many other ways, such as through sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. Greater attention should be paid to strategies for health promotion other than (...) access to healthcare, such as environmental and public health and health research.Lifestyle plays a major role in most of the illnesses in industrialised nations.1 Six of the 10 leading factors contributing to the global burden of disease are lifestyle related: unsafe sex, high blood pressure, tobacco use, alcohol use, high cholesterol and obesity.2 Lifestyle-related illnesses also contribute to the rising costs of healthcare. Spending on healthcare accounts for about 16% of the gross domestic product in the USA, or US$1.9 trillion.3 Although smoking has declined steadily there since the 1960s, smoking-related medical expenses are still about US$75.5 billion per year.4 Obesity, which has been climbing in the past two decades, accounts for about US$75 billion in healthcare costs there each year.5 Alcoholism and drug addiction in the USA account for annual healthcare costs of about US$22.5 billion and US$12 billion, respectively.6,7 Federal government spending on healthcare relating to HIV/AIDS is over US$13 billion per year.8Given the well-documented relationship between lifestyle, disease burden and healthcare costs, it makes economic and medical sense to hold individuals morally responsible for their health-related choices. While this view has a great deal of intuitive appeal, it also faces numerous objections.9–12 First, holding individuals entirely responsible for their own health conflicts with medicine’s obligation to treat the sick and society’s obligation …. (shrink)

As lifestyle diseases put a heavy burden on health care expenditures, voices are raised and win in sound to hold people responsible for their unhealthy lifestyle. Most of the arguments in favour of responsibility are backward-looking. In this article, we describe the distributional consequences of these backward-looking measures and show that they are very harsh on those who regret a past unhealthy lifestyle. We demonstrate that it is possible to take policy measures which respect individual responsibility (...) but which are at the same time able to grant fresh starts to individuals who regret their past unhealthy lifestyle (which is an application of Fleurbaey (2005)). This ‘forgiving’ policy is confronted with a moral hazard problem, however. In general the regulator does not observe whether individuals really regret their past choices or they just pretend to have changed preferences in order to enjoy the compensatory measures for regretful people. In this article, we argue that the health setting offers interesting opportunities to move beyond this moral hazard problem and offer a solution through the use of redistributive instruments that are conditional on lifestyle changes. (shrink)

When is it fair that some people are less healthy than others due to their own individual choices and preferences? In this paper, I explore two alternative answers. The first is a luck-egalitarian account that holds people responsible for choices that society could have reasonably expected them to avoid. I argue that this account is indeterminate and go on to sketch an alternative proposal based on Rawls’s idea of a “social division of responsibility.” This latter approach connects the (...) notion of responsibility for health to the social conditions under which health-related behaviour is developed. (shrink)

Two kinds of claims of responsibility arise in regard to health and medical care. Claims of one kind are obligation-limiting claims about individuals’ responsibility for coming to need health care. It may be argued, for example, that individuals have no claim to state-sponsored care for injuries they suffer as a result of risky activities such as mountain climbing, sky diving, or smoking. The claim is that because they are responsible for what has happened to them, others (...) are not obligated to pay for their care. In a different context, it is claimed that because patients are, or should be, responsible for the kind of treatment they receive. They therefore need to be informed about the treatment options available to them so that they can decide which of these treatments, if any, they will undergo. The lecture provides an account of responsibility that fits claims of both of these kinds and explains how they are related. (shrink)

Climate change and other harmful large-scale processes challenge our understandings of individual responsibility. People throughout the world suffer harms—severe shortfalls in health, civic status, or standard of living relative to the vital needs of human beings—as a result of physical processes to which many people appear to contribute. Climate change, polluted air and water, and the erosion of grasslands, for example, occur because a great many people emit carbon and pollutants, build excessively, enable their flocks to overgraze, (...) or otherwise stress the environment. If a much smaller number of people engaged in these types of conduct, the harms in question would not occur, or would be substantially lessened. However, the conduct of any particular person (and, in the case of climate change, of even quite large numbers of people) could make no apparent difference to their occurrence. My carbon emissions (and quite possibly the carbon emissions of much larger groups of people dispersed throughout the world) may not make a difference to what happens to anyone. When the conduct of some agent does not make any apparent difference to the occurrence of harm, but this conduct is of a type that brings about harm because many people engage in it, we can call this agent an overdeterminer of that harm, and their conduct overdetermining conduct. In this essay we explore the moral status of overdetermining harm. (shrink)

Wealth and income are highly predictive of health and longevity. Egalitarians who maintain that this “socioeconomic-status gradient” in health is unjust are challenged by the fact that a significant component of it is owed to the higher prevalence of certain kinds of voluntary risk-taking among members of lower socioeconomic groups. Some egalitarians have argued that these apparently free personal choices are not genuinely free, and that those who make them should not be held morally responsible for the resulting (...) harms to their health. I argue to the contrary that such choices usually are fully free, and that those who make them are responsible for their consequences. This does not imply, however, that society cannot also be responsible for those consequences. It is responsible for them if they are statistically foreseeable and avoidable outcomes of unjust public institutions and policies. I show that many of the harms to health that contribute to the voluntary behavioral component of the SES health gradient satisfy that description. Society can therefore be morally responsible for those harms, even though the individuals who suffer them are also fully responsible for them. (shrink)

Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. The Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaisance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. The rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain (...) class='Hi'>health. Jacksonian egalitarianism led to a reaction against the agressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrest control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates. Keywords: "responsibility for health: social, personal, or professional?", "causes of illness", "self-reliant health care", historical influences, responsibility for health, "victim-blaming" CiteULike Connotea Del.icio.us What's this? (shrink)

Bioethics, Volume 36, Issue 3, Page 274-282, March 2022.

One of the ways to address the effects of skilled worker emigration is to restrict the movement of skilled workers. However, even if skilled workers have responsibilities to assist their compatriots, what if other parties, such as affluent countries or source country governments, do not fulfil their fair share of responsibilities? This discussion raises an interesting problem about how to think of individual responsibilities under partial compliance where other agents (including affluent countries, developing states, or other individuals) do not (...) fulfil their fair share of responsibilities. What is fair to expect from them? Taking health worker emigration as a case in point, I discuss whether the individual health workers’ fair share of responsibilities to address basic health care needs decreases or increases when the other parties do not fulfil their share. First, I review the responsibilities that different stakeholders may hold. Second, I argue that there are strong reasons against increasing or decreasing health workers’ fair share of responsibilities in a situation of partial compliance. I also argue that it is unfair for non-complier states to enforce health workers to fulfil their fair share or take up the slack. (shrink)

Lifestyle-induced diseases are becoming a burden on healthcare, actualizing the discussion on health responsibilities. Using data from the National Association for Heart and Lung Diseases ’s 2015 Health Survey, this study examined the public’s attitudes towards personal and social health responsibility in a Norwegian population. The questionnaires covered self-reported health and lifestyle, attitudes towards personal responsibility and the authorities’ responsibility for promoting health, resource-prioritisation and socio-demographic characteristics. Block-wise multiple linear regression assessed the (...) association between attitudes towards health responsibilities and individual lifestyle, political orientation and health condition. We found a moderate support for social responsibility across political views. Respondents reporting unhealthier eating habits, smokers and physically inactive were less supportive of health promotion policies. The idea that individuals are responsible for taking care of their health was widely accepted as an abstract ideal. Yet, only a third of the respondents agreed with introducing higher co-payments for treatment of ‘self-inflicted’ conditions and levels of support were patterned by health-related behaviour and left-right political orientation. Our study suggests that a significant support for social responsibility does not exclude a strong support for personal health responsibility. However, conditional access to healthcare based on personal lifestyle is still controversial. (shrink)

This article presents various developments in Dutch health care policy toward a greater role for individual financial responsibility, such as cost-control measures, priority setting, rationing, and market reform. Instead of the collective responsibility that is characteristic of previous times, one can observe in government policies an increased emphasis on the need for individuals to take care of one’s own health and health care needs. Moreover, surveys point to decreasing levels of public support for “unlimited” (...) solidarity and “irresponsible” health behavior. This article attempts to answer the question of how these policies and public attitudes are limiting the ethical principles of solidarity and equal access to care that have long guided Dutch health care policy making. The authors argue that from a moral point of view, the increased emphasis on individual responsibility is acceptable as long as it does not affect solidarity with those weak and vulnerable groups who are not able to take individual responsibility, such as the demented and mentally handicapped. (shrink)

This chapter examines the case for health care policies aimed at holding obese individuals responsible for their weight and for obesity-related health issues. In particular, it considers the merits of two arguments for policies that would seek to make obese individuals bear some of the higher health care costs associated with being that way. On the fairness argument, it is claimed that such policies would serve the interests of fairness by holding obese individuals to account for irresponsible (...) lifestyle choices that are linked to their higher weight and its associated health risks. On the public health promotion argument, it is claimed that adopting such policies could produce impressive public health benefits: encouraging people to make healthier lifestyle choices, reducing obesity rates, and reducing obesity-related health care spending. Both arguments face serious objections. Contrary to the fairness argument, policies aimed at holding obese individuals responsible for their weight or for related health problems would neither treat people as they deserve to be treated nor make the distribution of health care resources fairer. And contrary to the public health promotion argument, those policies would not produce better health outcomes for society at large. Indeed, they would tend to do just the opposite. Reflection on the shortcomings of those arguments reveals that their conclusion is false: society should not adopt policies aimed at holding obese individuals responsible for their weight or for obesity-related health problems. (shrink)

Using tombstoning (jumping from a height into water) as an example, this article claims that public health policies and health promotion tend to assess the moral status of activities following a version of health maximizing rule utilitarianism, but this does not represent common moral experience, not least because it fails to take into account the enjoyment that various health effecting habits brings and the contribution that this makes to a good life, variously defined. It is proposed (...) that the moral status of health threatening activities should instead be defined by a version of act utilitarianism where both maximizing value and method of calculation are decided by individuals. In this account personal responsibility for health is reduced to the obligation to undertake calculations effectively, comprising of two duties; epistemic and reflective. If there is an individual epistemic duty, it is plausible to suggest that health promotion should present information in a way which facilitates it, but despite the prevalent language of autonomous choice, discussion of health promotion messages, for example, related to drinking and smoking demonstrates that this currently does not happen. Health promotion strategies should seek to encourage reflection about the harm our health effecting behaviour causes others. (shrink)

Antibiotic resistance (AR) is a major threat to public health and healthcare worldwide. In this article, we analyse and discuss the claim that taking actions to minimize AR is everyone's responsibility, focusing on individual moral responsibility. This should not be merely interpreted as a function of knowledge of AR and the proper use of antibiotics. Instead, we suggest a circumstantial account of individual responsibility for AR, where individuals do or do not engage in judicious (...) antibiotic behaviour with different degrees of voluntariness. Furthermore, we suggest a notion of responsibility as a virtue, in which individuals have the opportunity to develop a sensitivity towards the AR theme and, consequently, are capable of engaging, actively and voluntarily, in judicious antibiotic behaviour. The development of such sensitivity depends on the creation of adequate circumstances, that is individual capacities and availability of resources. (shrink)

Some people argue that the distribution of medical resources should be sensitive to agents’ responsibility for their ill-health. In contrast, others point to the social determinants of health to argue that the collective agents that control the conditions in which agents act should bear responsibility. To a large degree, this is a debate in which those who hold individuals responsible currently have the upper hand: warranted appeals to individual responsibility effectively block allocation of any (...) significant degree of responsibility to collective agents. We suggest that a different understanding of individual responsibility might lead to a fairer allocation of blame. Scaffolded agency is individual agency exercised in a context in which opportunities and affordances are structured by others. Appeals to scaffolded agency at once recognize the role of the individual and of the collective agents who have put the scaffolds in place. (shrink)

This paper starts by introducing a tripartite conception of responsibility for health consisting of a moral agent having moral responsibilities and being held responsible, that is blamed, for failing to meet them and proceeds to a brief discussion of the nature of the blame, noting difficulties in agency and obligation when the concept is applied to health‐threatening behaviours. Insights about the obligations that we hold people to and the extent of their moral agency are revealed by interrogating (...) our blaming behavior, and to facilitate this, my own blaming attitudes and actions are analysed in respect of an imagined adult son who seeks thrills by jumping from a pier into the sea, an activity common around coastlines and intended to be analogous in varying degrees to a range of health‐threatening behaviours. I consider my responses to this imagined act in relation to some features of moralism, the excess of morality, concluding that blame can be justified when it is proportionate and within interpersonal relationships. There is evidence that some nurses hold negative blaming attitudes towards groups of patients considered to have caused or contributed to their illness, but this is not justified, not only because of impaired agency, but also because if there is responsibility for health, associated obligations are owed to those who share our lives, and it is those people who are entitled to hold individuals responsible. Nurses who hold negative blaming attitudes towards groups of patients are invited to identify the status of moral agency, the precise natures of their (failed) obligations, and of the patient–nurse relationship. It is concluded that reflection on these matters and the difference between justified blame and moralism demonstrates that blaming behaviour in the context of professional health care is built on nothing stronger than prejudice. (shrink)

Allocating on the basis of need is a distinguishing principle in publicly funded health care systems. Resources ought to be directed to patients, or the health program, where the need is considered greatest. In Sweden support of this principle can be found in health care legislation. Today however some domains of what appear to be health care needs are excluded from the responsibilities of the publicly funded health care system. Corrections of eye disorders known as (...) refractive errors is one such domain. In this article the moral legitimacy of this exception is explored. Individuals with refractive errors need spectacles, contact lenses or refractive surgery to do all kinds of thing, including participating in everyday activities, managing certain jobs, and accomplishing various goals in life. The relief of correctable visual impairments fits well into the category of what we typically consider a health care need. The study of refractive errors does belong to the field of medical science, interventions to correct such errors can be performed by medical means, and the skills of registered health care professionals are required when it comes to correcting refractive error. As visual impairments caused by other conditions than refractive errors are treated and funded within the public health care system in Sweden this is an inconsistency that needs to be addressed. (shrink)

This chapter discusses whether patients should face penalties for unhealthy lifestyle choices. The idea that people should be held responsible for their bad health decisions is often associated with “luck egalitarianism”. This chapter explains the connection between responsibility-sensitive health care policies and luck egalitarianism and outlines some criticisms that have been made of luck egalitarianism in this context. It then highlights the implications of moral responsibility scepticism for luck egalitarians and other proponents of similarly responsibility-sensitive (...) approaches to health care. Theorists who have discussed the practical implications of moral responsibility scepticism have focused primarily on criminal punishment and, in that context, have often invoked an epistemic argument, maintaining that there are at least serious doubts about whether people are morally responsible (in the sense required for retributive punishment) and that, in view of this uncertainty, retributive punishment is unjust, given the serious harm it inflicts on offenders. This chapter argues that this type of reasoning also implies that we should not take patients’ responsibility for their poor health into account when deciding whether to give these patients treatments and that the health system should not impose significant penalties on individuals for harming their own health. Culpability-based desert seems to stand a better chance of helping luck egalitarians (and others with related views) to justify responsibility-sensitive health care policies compared with some alternative approaches. However, this chapter casts doubt on the idea that responsibility-sensitive health care policies based on this kind of desert are justifiable, focusing on doubts about whether people are morally responsible for harming their own health, whether harming one’s own health is morally wrong, and whether significant penalties for harming one’s health would be proportionate. (shrink)

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees’ health and fitness. Previous research has focused on such program’s effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’s health, inadvertently (...) facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees. (shrink)

There is an urgent call for nurses to address climate change, especially in advocating for those most under threat to the impacts. Social justice is important to nurses in their relations with individuals and populations, including actions to address climate justice. The purpose of this article is to present a Global Nurse Agenda for Climate Justice to spark dialog, provide direction, and to promote nursing action for just‐relations and responsibility for planetary health. Grounding ourselves within the Mi'kmaw concept (...) of Etuaptmumk (two‐eyed seeing), we suggest that climate justice is both call and response, moving nurses from silence to Ksaltultinej (love as action). We review the movement for climate justice in nursing, weaving between our own stories, our relations with Mi'kmaw ways of knowing, and the stories of the movement, with considerations for the (w)holistic perspectives foundational to nursing's metaparadigm of person, environment, and health. We provide a background to the work of the Global Nurse Agenda for Climate Justice steering committee including their role at the 26th United Nations Climate Change Conference in Glasgow, 2021, and share our own stories of action to frame this agenda. We accept our Responsibility for the challenges of climate justice with humility and invite others to join us. (shrink)

Compassion fatigue, a secondary traumatic stress [STS] disorder with similar symptoms as post-traumatic stress disorder, is a recognised workplace hazard, particularly for those working in trauma exposed occupations. Here, and by drawing on Australian codes of ethical practice for nurses, social workers and youth workers, we explore how these codes might inform the practice of these Australian health and human services practitioners with respect to compassion fatigue. Drawing on Nikolas Rose’s ideas about responsibilisation and the death of the social, (...) we argue that these codes tacitly reflect a broader research and organisational impetus to responsibilise individuals to prevent compassion fatigue and maintain compassion satisfaction, and we situate this in a broader neoliberal socio-political context also framed by ‘responsibilisation’ in the context of a ‘decaying social’ and by a health and human service sector shaped by new public management. Finally, we begin to explore a preliminary conceptual case for an ecological lens through which to understand ethical responsibility for self-care, maintaining practitioner health and mitigating compassion fatigue. We argue that this lens brings into focus the need for codes to more clearly articulate broader and collective responsibilities for these elements. (shrink)

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical (...) services with limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession. (shrink)

Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual (...) class='Hi'>responsibility as a criterion for the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

This book provides a multidisciplinary analysis of the potential conflict between a government’s duty to protect children and a parent’ right to raise children in a manner they see fit. Using philosophical, bioethical, and legal analysis, the author engages with key scholars in pediatric decision-making and individual and religious rights theory. Going beyond the parent-child dyad, the author is deeply concerned both with the inteests of the broader society and with the appropriate limits of government interference in the private (...) sphere. The text offers a balance of individual and population interests, maximizing liberty but safeguarding against harm. Bioethics and law professors will therefore be able to use this text for both a foundational overview as well as specific, subject-level analysis. Clinicians such as pediatricians and gynecologists, as well as policy-makers can use this text to achieve balance between these often competing claims. The book is written by a physician with practical and theoretical knowledge of the subject, and deep sympathy for the parental and family perspectives. As such, the book proposes a new way of evaluating parental and state interventions in children's’ healthcare: a refreshing approach and a useful addition to the literature. (shrink)

The recent decrease in public confidence in the measles, mumps and rubella vaccine has important implications for individuals and public health. This article presents moral arguments relating to conflicts between individual autonomy and collective responsibilities in vaccination decisions with a view to informing and advising health professionals and improving the effectiveness of education policies in avoiding resurgence of endemic measles. Lower population immunity, due to falling uptake, is hastening the need for greater public awareness of the consequences (...) for the population. Vaccination refusals go hand in hand with responsibilities owed to future generations and society in not knowingly contributing to preventable harms. Issues such as parents’ rights are considered and balanced against: collective responsibilities for public health; permissibility of ‘free-riding’; conflicting duties of health professionals; and possible enforcement of vaccination. It is suggested that the arguments may form a persuasive tool for the practice of health professionals involved in informing and supporting parents’ vaccination decisions. (shrink)

Approximately one in two hundred persons in the Marshall Islands have active tuberculosis. We examine the historical antecedents of this situation in order to assign ethical responsibility for the present situation. Examining the antecedents in terms of Galtung’s dialectic of personal versus structural violence, we can identify instances in the history of the Marshall Islands when individual subjects made decisions with large-scale ecologic, social, and health consequences. The roles of medical experimenters, military commanders, captains of the weapons (...) industry in particular, and industrial capitalism in general are examined. In that, together with Lewontin, we also identify industrial capitalism as the cause of tuberculosis, we note that the distinction between personal versus structural violence is difficult to maintain. By identifying the cause of the tuberculosis in the Marshall Islands, we also identify what needs be done to treat and prevent it. (shrink)

Governments, physicians, media and academics have all called for individuals to bear responsibility for their own health. In this article, I argue that requiring those with adverse health outcomes to bear responsibility for these outcomes is a bad basis for policy. The available evidence strongly suggests that the capacities for responsible choice, and the circumstances in which these capacities are exercised, are distributed alongside the kinds of goods we usually talk about in discussing distributive justice, and (...) this distribution significantly explains why people make bad health choices. These facts suggest that we cannot justifiably hold them responsible for these choices. We do better to hold responsible those who determine the ways in which capacities and circumstances are distributed: they are indirectly responsible for these adverse health outcomes and possess the capacities and resources to take responsibility for these facts. (shrink)

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. (shrink)

Prevention neuroscience investigates the brain basis of attitude and behavior change. Over the years, an increasingly structurally and functionally resolved “persuasion network” has emerged. However, current studies have only identified a small handful of neural structures that are commonly recruited during persuasive message processing, and the extent to which these (and other) structures are sensitive to numerous individual difference factors remains largely unknown. In this project we apply a multi-dimensional similarity-based individual differences analysis to explore which individual (...) factors—including characteristics of messages and target audiences—drive patterns of brain activity to be more or less similar across individuals encountering the same anti-drug public service announcements (PSAs). We demonstrate that several ensembles of brain regions show response patterns that are driven by a variety of unique factors. These results are discussed in terms of their implications for neural models of persuasion, prevention neuroscience and message tailoring, and methodological implications for future research. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, (...) the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The concept of lifestyle-related diseases and individual responsibility for health has played an important role in debates on the fair allocation of increasingly scarce health-care resources. In this article, we examine this discussion through the prism of solidarity. Based on an understanding of solidarity as shared practices reflecting a collective commitment to carry ‘costs’ (financial, social, emotional or otherwise) to assist others, we analyse frequent arguments in the debate and, in particular, the tool of risk-stratification. We (...) then offer a solidarity-based approach to understanding risk in the context of lifestyle-related diseases, and draw a number of conclusions on how health policy informed by solidarity should approach priority setting in health care. (shrink)

Combatting chronic, lifestyle-related disease has become a healthcare priority in the developed world. The role personal responsibility should play in healthcare provision has growing pertinence given the growing significance of individual lifestyle choices for health. Media reporting focussing on the ‘bad behaviour’ of individuals suffering lifestyle-related disease, and policies aimed at encouraging ‘responsibilisation’ in healthcare highlight the importance of understanding the scope of responsibility ascriptions in this context. Research into the social determinants of health and (...) psychological mechanisms of health behaviour could undermine some commonly held and tacit assumptions about the moral responsibility of agents for the sorts of lifestyles they adopt. I use Philip Petit's conception of freedom as ‘fitness to be held responsible’ to consider the significance of some of this evidence for assessing the moral responsibility of agents. I propose that, in some cases, factors outside the agent's control may influence behaviour in such a way as to undermine her freedom along the three dimensions described by Pettit: freedom of action; a sense of identification with one's actions; and whether one's social position renders one vulnerable to pressure from more powerful others. (shrink)

This report provides an overview of training individuals in public health law. This report is designed to broadly outline the issues in order to facilitate discussion at the November 2007 PHLA meeting in Washington, D.C. I found that attorneys and public health practitioners have different approaches to training and practice. Materials and programs that seek to train individuals must be designed to fit within the professional culture of the targeted group. The differences between the two professional cultures can (...) be a barrier to training if not acknowledged in the design of training programs and materials.In a selected overview of materials and programs available, I found that there is an unmet need for responsive materials and programs. I also found that networking and conference opportunities can play an important role in training that should be explored. I also discuss joint degree programs. The report concludes with a series of future recommendations to facilitate discussion. (shrink)

The recent increased prevalence of diseases related to unhealthy lifestyles raises difficulties for healthcare insurance systems traditionally based on the principles of risk-management, solidarity, and selective altruism: since these diseases are, to some extent, predictable and avoidable, patients seem to bear some responsibility for their condition and may not deserve full access to social medical services. Here, we investigate with objective criteria to what extent it is warranted to hold patients responsible for their illness and to sanction them accordingly. (...) We ground our analysis on a series of minimal conditions for ‘practical’ and for ‘moral’ responsibility attribution. By applying these criteria consistently, we highlight that individual responsibility applies to risk-taking life choices rather than stigmatized sickness. We explain that responsibility is a matter of degree, that it varies across life-history, and can be affected by factors beyond the patients’ grasp. We point out that scientific knowledge about the effect of these factors generates responsibilities for other parties such as public health agencies and private industry. The upshot of our analysis is that health policies targeting the ‘liable’ undeserving sick are mostly unwarranted, and tend to increase unequal treatment of already vulnerable groups: the unlucky sick. (shrink)

It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data (...) Practices framework. The framework outlines six principles relevant to the collection and use of personal data—minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion—and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices. (shrink)

Traditional medical ethics, developed to apply to the contingencies of individual fee-for-service medical practice, do not always seem to speak to the problems of the new forms and locations of health care: the medical team, the hospital, the organized health-care profession, and the society as a whole as guarantor of all health care and education. It is the purpose of this issue of The Journal of Medicine and Philosophy to articulate guidelines for describing and attributing (...) class='Hi'>responsibility for health care in these collective providers. This introduction attempts to provide the conceptual apparatus for a discussion of collective responsibility in health care, by the elucidation of the multiple meanings of "responsibility" and the articulation of three standard models for collective responsibility. In the light of these models, the question is put: can the health-care professions and their various subunits and institutions accept and exercise moral responsibility for health care? Its importance is stressed, and its answer left to the contributors. CiteULike Connotea Del.icio.us What's this? (shrink)

As the world's population ages, governments and non-governmental organizations in developed countries are promoting healthy cognitive ageing to reduce the rate of age-related cognitive decline and sustain economic productivity in an ageing workforce. Recommendations from the Productivity Commission, Dementia Australia, Government Office for Science, Presidential Commission for the Study of Bioethical Issues, Institute of Medicine, among others, are encouraging older adults to engage in mental, physical, and social activities. These lifestyle recommendations for healthy cognitive ageing are timely and well supported (...) by scientific evidence but they make implicit normative judgments about the responsibility of ageing individuals to prevent cognitive decline. Ethical tensions arise when this individual responsibility collides with social and personal realities of ageing populations. First, we contextualize the priority given to healthy cognitive ageing within the current brain-based medical and social discourses. Second, we explore the individual responsibility by examining the economic considerations, medical evidence and individual interests that relate to the priority given to healthy cognitive ageing. Third, we identify three key ethical challenges for policymakers seeking to implement lifestyle recommendations as an effective population-level approach to healthy cognitive ageing. The result is a prospectus for future in-depth analysis of ethical tensions that arise from current policy discussions of healthy cognitive ageing. (shrink)

The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant (...) in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish. (shrink)

The responsibility for the COVID-19 pandemic was first ascribed to persons associated with the Huanan Seafood Market. However, many scientists suggest that this pandemic is actually a consequence of human intrusion into nature. This opens up a whole new perspective for an examination of direct and indirect, individual and collective responsibility concerning this particular pandemic, but also zoonotic pandemics as such. In this context, one of the key issues are the consequences of factory-farming of animals, which contributes (...) to circumstances in which zoonotic pandemics emerge. Moreover, it is part of a larger economic system, global capitalism, whose logic implies certain coercion toward its participants to keep it essentially unchanged and therefore to make sure that livestock health remains?the weakest link in our global health chain?. However, even though the precise answer to the issue of moral responsibility for zoonotic pandemics outbreaks in general and the COVID-19 pandemic in particular cannot be given, it is possible to list certain indicators and make a framework helpful in ascribing moral responsibility to certain persons. The paper intends to do so by examining the notion of responsibility and by applying it to the issues mentioned. The results of this analysis show that it is misleading to place moral blame on people involved in actions that directly caused the animal-to-human transmission of a certain virus or on humanity as a whole. (shrink)