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阶段依赖性辩护:个人责任在公平医疗保健中的作用。

Phase-dependent justification: the role of personal responsibility in fair healthcare.

作者信息

Bærøe Kristine, Cappelen Cornelius

机构信息

Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.

Department of Comparative Politics, University of Bergen, Bergen, Norway.

出版信息

J Med Ethics. 2015 Oct;41(10):836-40. doi: 10.1136/medethics-2014-102645. Epub 2015 Aug 12.

Abstract

The main aim of this paper is to examine the fairness of different ways of holding people responsible for healthcare-related choices. Our focus is on conceptualisations of responsibility that involve blame and sanctions, and our analytical approach is to provide a systematic discussion based on interrelated and successive health-related, lifestyle choices of an individual. We assess the already established risk-sharing, backward-looking and forward-looking views on responsibility according to a variety of standard objections. In conclusion, all of the proposed views on holding people responsible for their lifestyle choices are subjected to reasonable critiques, although the risk-sharing view fare considerably better than the others overall considered. With our analytical approach, we are able to identify how basic conditions for responsibility ascription alter along a time axis. Repeated relapses with respect to healthcare associated with persistent, unhealthy lifestyle choices, call for distinct attention. In such situations, contextualised reasoning and transparent policy-making, rather than opaque clinical judgements, are required as steps towards fair allocation of healthcare resources.

摘要

本文的主要目的是审视让人们为与医疗保健相关的选择负责的不同方式的公平性。我们关注的是涉及责备和制裁的责任概念,我们的分析方法是基于个人相互关联且相继的与健康相关的生活方式选择进行系统讨论。我们根据各种标准异议评估已确立的关于责任的风险分担、回顾性和前瞻性观点。总之,所有关于让人们为其生活方式选择负责的提议观点都受到合理批评,尽管总体而言风险分担观点比其他观点表现得要好得多。通过我们的分析方法,我们能够确定责任归属的基本条件如何沿着时间轴发生变化。与持续不健康的生活方式选择相关的医疗保健方面的反复复发需要特别关注。在这种情况下,情境化推理和透明的政策制定,而非不透明的临床判断,是朝着公平分配医疗资源迈出的步骤。

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