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Cardiology in focus
Personal responsibility for cardiac health: what are the ethical demands?
  1. Rebecca C H Brown,
  2. Julian Savulescu
  1. Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
  1. Correspondence to Professor Julian Savulescu, Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, Oxford University, Oxford, UK; julian.savulescu{at}philosophy.ox.ac.uk

https://doi.org/10.1136/heartjnl-2020-317518

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    Responsibility

    The concept of responsibility, commonplace and untroubling in many areas of life, provokes controversy when it comes to health and healthcare. We frequently assign responsibility to agents in a variety of contexts: sporting achievements, criminal actions, valued friendships and performance at work. Yet, discussion of whether or not people are responsible for an illness they suffer as a result of actions they have taken (or not taken) soon risks looking like ‘victim blaming’.

    There are three related but different concepts. Causal responsibility for an outcome refers to the part one plays in bringing about an outcome. Moral responsibility for that outcome requires that one caused, at least in part, that outcome but also that one had knowledge of the possibility and control over one’s actions. Moral responsibility thus requires that an outcome is foreseeable and avoidable. Blameworthiness is a function of moral responsibility and the degree of harm. We will discuss moral responsibility for health.

    There are three broad approaches which often arise in response to questions about whether or not people are responsible for their health (see table 1).

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    Table 1

    Summary of models of responsibility

    Personal-responsibility model

    This assumes that, since it is common to think that people’s health-related behaviour (what they choose to eat, how much they drink, how often they exercise and whether they smoke) is often within the agent’s control, they are indeed responsible for those behaviours. Exceptions may be made where a lack of control—for instance, due to addiction—can be established, in which case an agent may be excused from responsibility. If agents are responsible, we may be justified in holding them responsible (eg, rewarding or punishing them) for their behaviour. There are two general justifications for this. The first is consequentialist: patients will do better (have better health outcomes) if they adopt healthier behaviours. Consequentialism …

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    Footnotes

    • Contributors RCHB drafted the initial manuscript and JS critically revised the manuscript.

    • Funding This study was funded by Wellcome Trust (grant numbers WT104848 and WT203132).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Provenance and peer review Commissioned; internally peer reviewed.