The Patient’s Responsibility for Optimum Healthcare

Abstract

Although clinicians have an obligation to act in patients’ best interests, patients frequently choose to act in ways that adversely affect health. Consequently, clinicians are often left questioning where the responsibility for optimum care lies.

The criteria for determining responsibility (the Jonas criteria) are as follows: causality, control and foresight. Two types of choices lead to health problems — lifestyle and noncompliance. Patients are responsible to themselves and society for unhealthy lifestyles. Patients are subject to the consequences of unhealthy lifestyles in the form of suffering; society’s consequence is increased costs. Providers are not justified to increase an individual’s consequences because the degree of responsibility cannot be specified, and clinicians should not be deciding who deserves care. Society is justified in setting prospective consequences in the form of taxes, education and prevention.

Noncompliance challenges the clinician’s duty to respect patient autonomy. Respect for autonomy requires clinicians to actively assist patients in making reasoned decisions about treatment and then to accept such decisions. The clinician must simultaneously assess patients’ competence to make decisions, and take increased responsibility for decisions when competence is impaired. Factors that need to be considered in determining an appropriate level of coercion include: the nature and degree of potential harm to the patient and to society from noncompliance; the likelihood of the harm’s occurrence; the intrusiveness of the planned coercive activity and; the degree to which the intervention is likely to be effective.