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Individual responsibility as ground for priority setting in shared decision-making
  1. Lars Sandman1,2,
  2. Erik Gustavsson1,3,
  3. Christian Munthe4
  1. 1National Center for Priority Setting in Health-Care, Linköping University, Linköping, Sweden
  2. 2Academy for Care, Work-Life and Welfare, University of Borås, Borås, Sweden
  3. 3Division of Philosophy, Department of Culture and Communication, Linköping University, Sweden
  4. 4Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Professor Lars Sandman, National Center for Priority Setting in Health-Care, Linköping University, Linköping, 581 83 Sweden; lars.sandman{at}liu.se

Abstract

Introduction Given healthcare resource constraints, voices are being raised to hold patients responsible for their health choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over healthcare decisions. More power and control over decisions is usually taken to mean more responsibility for them. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in the healthcare priority setting.

Objective To analyse whether the implementation of shared decision-making would strengthen the argument for invoking individual responsibility in the healthcare priority setting using normative analysis.

Results and conclusions Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength.

  • Autonomy
  • Decision-making
  • Resource Allocation

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