The Ethical Dead End of Personal Responsibility

On the subject of obesity, one way or another, it takes only seconds. Almost always, the subject of personal responsibility will claim its central role. To some people, it’s even a key tool for allocating scarce medical resources. But with a new paper in the Cambridge Quarterly of Healthcare Ethics, Sven Ove Hansson helps us understand how this tool comes loaded with ethical problems.

Personal Engagement in Personal Health

Hansson describes the need for engaging patients in behavioral changes that have a critical impact on personal health. Smoking, substance abuse, dietary patterns, and physical activity are all behaviors that can can affect health outcomes profoundly. Healthcare professionals are powerless to change these behaviors by prescription.

And so, Hansson says. the task responsibility for changing these behaviors is clear. It lies with patients. Healthcare professionals play only a supporting role, at best, in the task of changing health related behaviors. That supporting role is the bread and butter work of a health coach.

The Problem with Assigning Blame

The ethical problems come when the subject shifts to blame responsibility, says Hansson. Assigning blame for behavior change is unethical for three simple reasons

To begin with, behavior changes can be easily possible for some individuals and impossible for others. On top of that, distinguishing people who can from people who can’t is impossible. And what’s more, it’s not just black and white. The difficulties people face come in an infinite range between the extremes of “can” and “can’t.”

Perhaps most important, though, is the ethical obligation to do no harm. Blaming patients for their suffering will only increase their suffering. It provides no benefit.

So, pointing the finger of blame is simply unethical for a healthcare professional.

Allocating Scarce Medical Resources

Unfortunately, the ethical problems of personal responsibility are growing worse. Hansson points out that policymakers have been focusing more on personal responsibility as a tool for setting medical priorities. This happens in two ways.

First, in countries that lack universal healthcare, personal responsibility becomes an excuse for denying care. White House budget director Mick Mulvaney made that very argument earlier this year, saying:

Everybody agrees that if your kid is born with one of those conditions, we will come together as a community to make sure we can take care of that.

But that doesn’t mean that we want to take care of the person, or should be required to care for the person who sits at home, drinks sugary drinks, and doesn’t exercise, and eats poorly and gets diabetes.

Secondly, even in countries with universal healthcare, personal responsibility can be an excuse for putting people at the end of a queue for receiving care. Certain parts of the UK National Health Service recently began doing just that to people with obesity.

Destroying Trust

Finally, the problem with using personal responsibility to allocate care is simple. Blame inevitably destroys trust between providers and patients. It requires providers to find fault with patients rather than heal them. The threat of blame encourages patients to lie to their providers.

Engaging patients in personal responsibility for their health is essential. But blaming them is an ethical dead end.

Click here for Hansson’s new paper.

Fingers Pointing, photograph © Ian Kennedy / flickr

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December 22, 2017