Harvard University Program in Ethics and Health, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02215, USA.
J Med Ethics. 2011 Jun;37(6):357-61. doi: 10.1136/jme.2010.038844. Epub 2011 Feb 18.
The debate on responsibility for health takes place within political philosophy and in policy setting. It is increasingly relevant in the context of rationing scarce resources as a substantial, and growing, proportion of diseases in high-income countries is attributable to lifestyle. Until now, empirical studies of medical professionals' attitudes towards personal responsibility for health as a component of prioritisation have been lacking. This paper explores to what extent Norwegian physicians find personal responsibility for health relevant in prioritisation and what type of risk behaviour they consider relevant in such decisions. The proportion who agree that it should count varies from 17.1% ('Healthcare priority should depend on the patient's responsibility for the disease') to 26.9% ('Access to scarce organ transplants should depend on the patient's responsibility for the disease'). Higher age and being male is positively correlated with acceptance. The doctors are more willing to consider substance use in priority setting decisions than choices on food and exercise. The findings reveal that a sizeable proportion have beliefs that conflict with the norms stated in the Norwegian Patient Act. It may be possible that the implementation of legal regulations can be hindered by the opposing attitudes among doctors. A further debate on the role personal responsibility should play in priority setting seems warranted. However, given the deep controversies about the concept of health responsibility and its application, it would be wise to proceed with caution.
Nationally representative cross-sectional study.
Panel-data.
1072 respondents, response rate 65%.
健康责任的辩论发生在政治哲学和政策制定中。在分配稀缺资源的背景下，它越来越相关，因为在高收入国家，相当大且不断增长的疾病比例归因于生活方式。到目前为止，缺乏对医疗专业人员对健康责任作为优先排序组成部分的态度进行实证研究。本文探讨了挪威医生在多大程度上认为健康责任在优先排序中具有相关性，以及他们认为在这种决策中哪些类型的风险行为是相关的。同意这一点的比例从 17.1%（“医疗保健的优先级应取决于患者对疾病的责任”）到 26.9%（“稀缺器官移植的机会应取决于患者对疾病的责任”）不等。较高的年龄和男性是与接受程度呈正相关的。医生更愿意在优先级设置决策中考虑药物使用，而不是考虑食物和运动方面的选择。研究结果表明，相当一部分人持有与《挪威患者法》规定的规范相冲突的信念。法律规定的实施可能会因医生之间的对立态度而受到阻碍。似乎有必要进一步讨论个人责任在优先级设置中应发挥的作用。然而，鉴于健康责任概念及其应用的深刻争议，谨慎行事是明智的。
全国代表性的横断面研究。
面板数据。
1072 名受访者，回应率为 65%。
