Book Launch: Responsibility and Healthcare

written by Ben Davies and Gabriel De Marco

Many illnesses that risk death or serious harm are at least partly due to behaviours such as smoking, lack of exercise, or extreme sports. The WHO notes that the global prevalence of preventable, noncommunicable diseases is rising, and accounts for a large proportion of deaths worldwide. Some argue that patients with such illnesses are responsible for them. Is that right? And if so, should healthcare providers treat patients differently on the basis of health-related behaviours? Should a healthcare system, for example, offer discounts to those who engage in healthy behaviours? Would it, at least, be permissible to do so? Or, when determining how to allocate limited resources, would a healthcare system be justified in taking patients’ responsibility into account – for instance, by giving such patients lower priority for certain treatments?

Such questions form the core of an ongoing debate about responsibility and healthcare. Together with Julian Savulescu and Neil Levy, we have edited a volume where a range of authors address these questions and others. Thanks to funding by The Wellcome Trust, the book is fully open-access. It also has a substantial introduction: as well as situating the book’s 14 chapters in context, and in relation to each other, the introduction aims to give a comprehensive overview of the current academic debate on responsibility and healthcare.

The chapters of the book delve into a variety of issues in political philosophy and ethical theory: When is a distribution of resources just or fair? Should individuals have to meet all the costs of their choices, or is there a limit on how much any individual can be expected to bear? What are the responsibilities of institutions, government and society for individuals’ health-related lifestyle choices? They also engage with questions in philosophy of action and moral psychology: What does it mean for agents to be responsible for their actions, their lifestyles, and their health-related outcomes? And responsibility for health involves cognitive science: What are we actually like as agents? When we make health-affecting decisions such as having a cigarette or failing to vaccinate, do we actually meet the conditions for responsibility laid out by our best philosophical theories?

When these questions are addressed, they are often addressed independently, yet the answers are interrelated. For instance, whether a policy that holds patients accountable is justified depends not only on what amounts to a fair distribution of goods, but also on whether patients’ health and health-related behaviour is sufficiently under their control to justify holding them accountable for it. And the proper design of policies that help to improve our agency with respect to these behaviours and outcomes will depend on what we are like as agents. Similarly the details of such policies, if they are justified, will depend on what sorts of things we can be responsible for, and to what extent we can be responsible at all.

Questions of responsibility in medicine do not end with those receiving treatment, and the book looks beyond the traditional focus of patient responsibility. Some other questions concern a different sort of responsibility, which has more to do with obligations of individuals, either generally, or arising out of particular roles. Medical professionals, including doctors, have various responsibilities to their patients, for instance. The doctor-patient relationship has been conceived in various ways with different understandings of the responsibilities each party holds. It also raises important questions: given the inherent uncertainty in medical decision-making, how should doctors and patients jointly approach health-related choices, and who is responsible when a mutually agreed decision goes wrong? What are the limits to doctors’ responsibilities, given the critical nature of their profession? Further, the state and society as a whole have responsibilities to individual citizens, residents and members. How should we think about those responsibilities, both at a general level and in extraordinary situations such as pandemics?

This collection brings together work by world-renowned experts in these topics, in order to push the debate forward by elucidating our understanding of these questions, their possible answers, and how they are related. A table of contents is listed at the end of this post.

This is the first collection to focus on the topic of responsibility in healthcare, and one of the few which brings together such a wealth of philosophical expertise to tackle ethical issues in healthcare policy; including experts in population ethics, moral psychology, and philosophy of action. We hope this collection will be of interest to academics, students, and those involved in matters of policy. In particular, we think it will be relevant for those involved in bioethics, medical ethics, population ethics, moral psychology, philosophy of action, and political philosophy. The introduction aims to make it easier for those without a background in this debate to engage with the chapters, and so although the book covers a variety of issues, it does so in a way which should be accessible to those new to the topic.

Table of contents

Introduction: Responsibility and Health Care – An Overview, Ben Davies, Gabriel De Marco, Neil Levy, Julian Savulescu

1. Should Responsibility Affect Who Gets a Kidney? Lok Chan, Walter Sinnott-Armstrong, Jana Schaich Borg, Vincent Conitzer
2. Against Retributivism in Health Care, Jeanette Kennett
3. Moral Responsibility Scepticism, Epistemic Considerations and Responsibility for Health, Elizabeth Shaw
4. On Prevalence and Prudence, Nir Eyal
5. Responsibility, Healthcare, and Harshness, Gabriel De Marco
6. Informed Consent and Morally Responsible Agency, Dana Kay Nelkin
7. Responsibility for ill-health and lifestyle: Drilling down into the details, Neil Levy
8. Obesity and responsibility for health, Rekha Nath
9. Habitual Health-Related Behaviour and Responsibility, Rebecca CH Brown
10. Fighting Vaccination Hesitancy: Improving the Exercise of Responsible Agency, Daniel Miller, Anne-Marie Nussberger, Nadira Faber, Andreas Kappes
11. Taking Responsibility for Uncertainty, Richard Holton, Zoë Fritz
12. Physician, heal thyself: do doctors have a responsibility to practise self-care? Joshua Parker, Ben Davies
13. Progressive Reciprocal Responsibility: A Pre-emptive Framework for Future Pandemics, Julian Savulescu, Peter Marber
14. Inequalities in Prospective Life Expectancy: Should Luck Egalitarians Care?, Shlomi Segall