Responsibility and Healthcare

Disease caused by lifestyle is a pressing public health issue. Rising costs from health conditions that seem to be partly due to individual behaviour make issues of resource allocation a priority. Some people think that the right response is to direct resources to those who are not responsible for their disease, at the cost of those who are. Such proposals raise many issues. While resources are limited, the NHS is based on a principle of equal treatment for equal need. Is it right to disrupt this principle in the name of cost-saving? 

Philosophers, psychologists and neuroscientists have also raised questions about the idea of freedom that underpins claims of responsibility, and of our ability to tell when people are responsible for their health. When our choices are shaped by our genes, upbringing and the broader social environment, does it even make sense to hold people responsible for their health? Or will we simply end up focusing on already stigmatised groups who need our support rather than our condemnation? Some have suggested that an inability to take responsibility is itself a health issue. In the future, we might try to enhance patients’ ability to take responsibility, strengthening their capacity for sticking to commitments and exercising willpower. 

Issues of responsibility also apply beyond the question of resource rationing. Holding patients responsible might be seen as a natural partner to respecting patient autonomy. But some people think that there are limits to how far autonomy should be respected in a health care service. Patients sometimes want treatments that are harmful or unnecessary, or refuse treatments that generate considerable public good at little personal cost. Must society really respect such choices in all cases?

Medical professionals also have responsibilities and rights. How should doctors, nurses and other caregivers behave when they object to providing a treatment on moral grounds?How should society and the healthcare system treat them? 

These pressing issues, among others, are the subject of this series of podcasts. The series is part of a broader project, funded by the Wellcome Trust and led by Professor Julian Savulescu, on Responsibility and Health Care.

Should obese people be held responsible for being overweight?

^{Released 10 June 2019}

Suppose an obese person requires a hospital procedure for a condition that is in part linked to their obesity.  Many people might believe that a patient must bear responsibility for being overweight. And, other things being equal, that's a reason to prioritize the needs of another patient first.  So is the concept of responsibility a useful one in determining how to distribute health resources.  Becky Brown is not convinced.

Becky Brown is a philosopher at Oxford's Uehiro Centre for Practical Ethics, University of Oxford. Becky's work focuses on the ethics of health promotion, particularly questions about responsibility for unhealthy behaviour. This research involves considering how philosophical theories can be informed by evidence from the social and medical sciences and vice versa. Ultimately, the aim of this work is to better understand what kinds of approaches to encouraging healthy behaviour are justified.

Listen: Should obese people be held responsible for being overweight?

Should patient autonomy always be respected?

^{Released 24 June 2019}

A fundamental value of modern medicine is patient autonomy.  Doctors should not insist upon a medical procedure or impose a procedure on a patient. The patient's consent - or the consent of a parent or guardian - needs to be obtained.  But are there any exceptions to this basic principle. Alberto Giubilini argues that there are.... 

Alberto Giubilini is a Research Fellow at the University of Oxford, working on the Oxford Martin Programme on Collective Responsibility for Infectious Disease. He is based at the Uehiro Centre for Practical Ethics and at the Wellcome Centre for Ethics and Humanities. He has a PhD in Philosophy from the University of Milan, and prior to joining Oxford he worked in Australia at Monash University, University of Melbourne and Charles Sturt University. He has published on different topics in bioethics and philosophy, including a recent  on The Ethics of Vaccination (Palgrave MacMillan 2019).

Listen: Should patient autonomy always be respected?

Responsibility and Addiction

^{Released 8 July 2019}

Normally, when we say that somebody is addicted to a substance, like a drug, we believe it is because they have lost control - they don't have the ability to resist their desire for it - even if they at some level still believe it is harmful to them.  And to some extent, we are inclined to say, they are no longer responsible for surrendering to this desire.  But Neil Levy says science should force us to reconsider the link between control, responsibility and belief.

Neil Levy is Professor of Philosophy at Macquarie University, Sydney, Australia, and a Senior Research Fellow at Oxford's Uehiro Centre for Practical Ethics, University of Oxford.

Listen: Responsibility and Addiction

What is the link between responsibility and effort?

^{Released 22 July 2019}

Compare the athlete who finds training really tough but does it anyway, with the athlete who takes a substance that makes training easier.  We tend to think that people who strain hard to achieve their goals are more deserving of praise than those for whom it is effortless, or who take advantage of shortcuts.  Hannah Maslen believes this intuition is mistaken.

Hannah Maslen is the Deputy Director of the Oxford Uehiro Centre for Practical Ethics, University of Oxford. Hannah works on a wide range of topics in applied philosophy, from neuroethics, to moral emotions and criminal justice. Hannah is currently the Editor-in-Chief for the journal Neuroethics.

Listen: What is the link between responsibility and effort?

Doctors and their conscience!

^{Released 5 August 2019}

Should doctors be allowed to deny a medical procedure to patients on grounds of conscience?  Some doctors believe abortion to be wrong.  Should they be permitted to turn away a woman who wants a legal abortion? Dominic Wilkinson is both a philosopher and a physician. 

Dominic Wilkinson is Director of Medical Ethics and Professor of Medical Ethics at Oxford's Uehiro Centre for Practical Ethics, University of Oxford, UK. He is a consultant in newborn intensive care at the John Radcliffe Hospital, Oxford, holds a health practitioner research fellowship with the Wellcome Trust, and is a senior research fellow at Jesus College Oxford.

Listen: Doctors and their conscience!

Responsibility and Justice

^{Released 19 August 2019}

If two people have a medical condition that requires treatment and John is responsible for having the condition, but Janet is not, then some people believe that Janet should take priority.  Janet should be treated first.  But benefiting Janet in this way only really makes sense if we are first clear what we mean by John being ‘responsible’ for his condition.  

Ben Davies is a postdoctoral research fellow on Professor Julian Savulescu's Wellcome Trust project on the relevance of personal responsibility to healthcare policy. His primary research focus is on issues in medical resource allocation. He completed his PhD at King's College London in 2015, working on ethical issues related to enhancements targeting human ageing.

Listen: Responsibility and Justice

Interviews by David Edmonds (OUC Distinguished Research Fellow & Consultant Researcher).

The podcast series is a collaboration between Philosophy 24/7 and the Oxford Uehiro Centre for Practical Ethics.

Philosophy 24/7 brings you concise interviews with leading philosophers about pressing moral, political and social questions and is hosted by David Edmonds, a multi-awarding winning BBC journalist, and one half of the duo behind the Philosophy Bites podcast.

We are grateful to the Wellcome Trust for funding the project.

The Practical Ethics Video Series makes the most important and complex debates in practical ethics accessible to a wide audience through brief interviews with high profile philosophers in Oxford.  Video interviews on this and other topics can be found on our YouTube channel.

Featured YouTube interview with Dr Rebecca Brown

Media

Giubilini, A., (2019), Health vs Choice? The Vaccination Debate, Battle of Ideas Festival, Barbican Centre, London (3 November). YouTube

Governments in some countries, like Italy and France, have introduced new measures to compel vaccination against specified diseases, linking proof of vaccination to children’s access to state-provided schooling. These measures are presented as a necessary expression of the public good, of the right of children to be protected from serious and sometimes life-threatening diseases, and of the need to uphold truth against lies. However, the turn to compulsion has led some commentators, even some who support vaccination, to raise questions about these measures. Over 200 years since Edward Jenner’s use of cowpox to provide immunity from smallpox, what should we make of the situation now? Is there a legitimate right for individuals or parents to refuse vaccination? Or are claims for the public good and for the right of children to good health, expressed if necessary through compulsion, more ethically persuasive?

Giubilini, A., (2019), 'The World Vaccination Report: The Evidence', BBC World Service (22 June).

Brown, R., (2019), 'Obese people unfairly denied IVF by cost-cutting NHS, says Oxford academic', The Independent (14 April 2019). [This article is based on Dr Brown's open access paper available on EuropePMC PMC6548064]

Giubilini, A., (2019), 'Italy's attitude towards vaccine is a 'cultural and social problem'', Sputnik Radio (13 March).

Giubilini, A., (2019), 'The Ethics of Vaccination', book launch, Oxford Martin School (5 March). Livestreamed and available to view on YouTube.

Brown, R., (2018), 'Subfertility deserves attention, but not because it is a disease', BioNews comment piece. Philosophers have debated how best to define health and disease for some time. The main two approaches focus on biological nature and social construction. The first identifies disease as biological deviations from the norm. The second argues that societies construct diseases by responding to certain conditions in particular ways, for instance by treating them with medicine. Neither of these definitions is universally accepted. Subfertility provides an example of why it can be so difficult to determine exactly what makes something a disease. (16 July).