J Med Ethics 35:224-228 doi:10.1136/jme.2008.027151
  • Clinical ethics
    • Paper

Financial incentives for patients in the treatment of psychosis

  1. G Szmukler
  1. Professor G Szmukler, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF; g.szmukler{at}
  • Received 23 August 2008
  • Revised 3 December 2008
  • Accepted 19 December 2008


Poor medication adherence in patients with a psychosis is associated with relapse. It has been proposed that outcomes might be improved by using financial incentives for treatment adherence (FITA). However, a strong moral intuition against this practice has been found. This paper examines the ethics of FITA.

Three arguments are presented, which if accepted would severely restrict or even prohibit the practice. These are based on (1) “incommensurable values”, where FITA denigrates an aspect of “respect for the person”, (2) “exploitation”, where unfair advantage is taken of the patient, and (3) “fairness”, where it is difficult to draw a line between those who should and should not be offered payment. A number of practical impediments are also considered.


  • Competing interests: None.

  • Provenance and peer review: Not commissioned; externally peer reviewed.