J Med Ethics 31:304-306 doi:10.1136/jme.2004.009258
  • Resource allocation

High need patients receiving targeted entitlements: what responsibilities do they have in primary health care?

  1. S Buetow
  1. Correspondence to:
 S Buetow
 Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand;
  • Accepted 5 July 2004


Patient responsibilities in primary health care are controversial and, by comparison, the responsibilities of high need patients are less clear. This paper aims to suggest why high need patients receiving targeted entitlements in primary health care are free to have prima facie special responsibilities; why, given this freedom, these patients morally have special responsibilities; what these responsibilities are, and how publicly funded health systems ought to be able to respond when these remain unmet. It is suggested that the special responsibilities and their place in public policy acquire moral significance as a means to discharge a moral debt, share special knowledge, and produce desirable consequences in regard to personal and collective interests. Special responsibilities magnify ordinary patient responsibilities and require patients not to hesitate regarding attendance for primary health care. Persistent patient disregard of special responsibilities may necessitate limiting the scope of these responsibilities, removing system barriers, or respecifying special rights.


  • Sources of support: This research was made possible by the salary funding provided by ProCare Health Limited.