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The Ethics of Making Patients Responsible


In their daily clinical work, healthcare professionals generally apply what seems to be a double standard for the responsibility of patients. On the one hand, patients are encouraged to take responsibility for lifestyle changes that can improve their chances of good health. On the other hand, when patients fail to follow such recommendations, they are not held responsible for the failure. This seeming inconsistency is explained in terms of the distinction between task responsibility and blame responsibility. The double standard for responsibility is shown to be epistemologically rational, ethically commendable, and therapeutically advantageous. However, this non-blaming approach to patient responsibility is threatened by proposals to assign lower priority in healthcare to patients who are themselves responsible for their disease. Such responsibility-based priority setting requires that physicians assign blame responsibility to their patients, a practice that would run into conflict with the ethical foundations of the patient–physician relationship. Therefore, such proposals should be rejected.

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3. Kelley made a similar remark in terms of the related distinction between forward- and backward-looking responsibility. See: Kelley, M. Limits on patient responsibility. Journal of Medicine and Philosophy 2005;30:189206.

4. Among 100 patients, there will be 60 who can stop smoking and also do so, 30 who can quit but do not do so, and 10 who are unable to quit. Therefore, 30 of the 40 who did not quit (75 percent) would have been able to do so.

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12. See note 10, Else-Quest et al 2009, at 960.

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18. See note 16, Waller 2005.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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