We are not trying to decide between these debates here, but we note that some of these arguments provide compelling reasons for both and against a role in responsible health practices. Instead, we move on to discussing how traditional concepts of responsibility are ill-suited to guide action in areas of health care where it is often considered important, particularly in the context of “lifestyle-related diseases.” This informal term generally refers to chronic diseases associated with exposure to behavioral risk factors such as smoking, alcohol consumption, lack of exercise, and poor diet. Chronic diseases associated with these risk factors contribute significantly to global mortality and health expenditure, and are a priority area for public health systems.30 We therefore argue that if responsible health care practices are to play a role, a revision of the concept may be necessary so that it can be meaningfully applied in these contexts. Moral responsibility is a daily feature of human societies. Responsible practices govern personal relationships, maintain criminal justice, promote productive work and discourage antisocial behaviour. The assignment of responsibilities may well be an inevitable result of the way human psychology and social interactions are structured. As Strawson argues,7 attributions of responsibility that flow from fundamental human responses to our perception of the behavior of others and subsequent judgments about the appropriateness of praise or blame seem inevitable. We can moderate such reactions based on mitigating factors, but it is difficult to see how we could and should abolish them altogether. These are words that are often used in combination with responsibility. For everything to work, including the law itself, there must be enough room for individual responsibility.
There is a second sense in which responsibility can be diachronic: an officer can take action today that affects how he or she can act tomorrow, next week, or a year from now. Especially when it comes to behaviors that are difficult to change, agents can take steps to change the environments in which their future selves will live to facilitate the modification of these behaviors. In a clinical setting, early decision-making can influence the treatment options available to patients and caregivers later on.35 Entering into employment contracts, such as throwing alcohol or paying for a one-year gym membership, allows a person to influence their future behaviour. Nglish: Translation of responsibility for Spanish speakers If we are ultimately interested in making judgments about the responsibility for health-related diseases, an individual`s responsibility for a single case of behavior unlikely to affect their health will not be very interesting. Instead, we need to focus our examination of the smoker`s behaviour on the responsibility they bear for the repeated behaviour of smoking cigarettes for many years, as this is likely to contribute significantly to their risk of developing heart disease.ii It should be noted that a person deemed diachronically responsible for smoking will ultimately not be held responsible for all the consequences. resulting from smoking (including damage to health). However, we assume that a necessary condition to be responsible for such consequences is that he or she was diachronically responsible for smoking. ↵iii See also Levy`s informative account of how it may turn out that the autonomy of unwitting addicts is undermined over time due to fluctuations in preferences.65 There is no place here to discuss how responsibility and autonomy are linked, but it seems that significantly compromised autonomy could be a reason to relieve someone of responsibility. The appropriate role of personal responsibility in health care continues to be debated.1–6 While some believe that health care should be blind to considerations of responsibility and deserted, others suggest that it is appropriate to consider responsibility when making decisions about health care. We understand the arguments that accountability should not play a role in health care. However, we also recognize that responsible practices are a daily feature of almost all areas of human life and interpersonal relationships. Given that the question of whether responsibility should play a formal role in health care remains unresolved, and that judgments about responsibility are likely to motivate at least some health care policies and practices, we want to explore how theories of responsibility could be significantly adapted to provide insight into people`s responsibility for their health.
Diachronic and dyadic responsibility draws attention to factors (time and agents) that are relevant to identifying who is responsible for what and to what extent. This allows for a finer analysis of responsibility that better reflects the role of actors in their behaviour, which will help to make subsequent decisions about what should flow from attributions of responsibility (in terms of praise, blame, personal relationships, access to social goods, etc.). If adequate recognition of responsibility is a prerequisite for compliance, then ensuring that the diachronic and dyadic dimensions of responsibility are taken into account will allow for more accurate and agent-friendly modeling. Diachronic liability refers to an additional diachronic condition for liability that describes how the other conditions of liability must be met over time for an agent to be considered responsible for his or her conduct. This helps us recognize how conditions of responsibility may change over time and directly address questions about how personal identity is continuous over time and interacts with responsibility. It also recognizes that even during long periods of reduced control, an actor who has had the opportunity to exercise diachronic responsibility can still be held accountable.6 The relevance of this to health is that some would argue that responsible health policies are justified by the intuitive judgment that actions should have consequences.1 27 Such a statement does not require: That one deserves additional punishment for one`s unhealthy behavior, but the moral responsibility for that behavior makes it appropriate to bear the costs (or benefits) that flow from it. For the purposes of our discussion, we assume that the intuition that moral responsibility has presumed relevance cannot be dismissed out of hand, and below we will try to explore how a representation of responsibility might better reflect the temporal and multipersonal dimensions of health responsibility. There is also the added responsibility of dealing with stimulus payment issues. In summary, integrating responsible practices into health care can be considered economical, intuitive and efficient. First, given that responsible practices operate in many areas of life, it seems obvious that they should also work in the context of health.
Second, identifying agents as responsible for certain actions is a very intuitive practice, and people often think and act in terms that assume that agents are morally responsible for an action or attitude, or may be exempted from moral responsibility for some reason: somehow, the identification of responsibility is often implicit in social reasoning. Finally, it can be assumed that moral responsibility is exercised to ensure efficiency by avoiding moral hazard problems and regulating people`s behavior in a way that benefits society. If this is effective, it would save health systems money while improving the health of the population. Other arguments can – and have been – put forward on the basis of claims that it is good in itself to take responsibility, or that it is good for people to get what is deserved, or that, all other things being equal, it is better to treat those who are not responsible for their illness. to those who do (as happiness egalitarians like Segall would claim).27 Depending on the position taken on identity continuity, this aspect of diachronic responsibility could be modeled differently. It could be argued that P t and P t + n are identical, with little or no weakening of identity or responsibility over time. Alternatively, one could model P t and P t + n as non-identical, perhaps completely different, agents. In this case, P t can only be liable for the actions of P t + n to the extent that one agent can be responsible for influencing the behavior of another. If the latter option is chosen, diachronic responsibility may depend on a representation of dyadic responsibility – responsibility distributed among agents – which we present in the next section. What responsibility did the cops take when they killed unjustly? It is not clear whether a person`s responsibility to develop a disease or maintain their health should affect the health care they receive. As this dispute continues, we suggest that if responsibility for health is to play a role, the concept needs to be reconsidered to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one actor. Most philosophical accounts of responsibility are synchronous and individualistic; Here we show what greater consideration of diachronic and dyadic aspects of responsibility might imply and what implications this might have for the assessment of responsibility for health-related behaviour.