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Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate
  1. Kerith Sharkey1,
  2. Lynn Gillam1,2,3
  1. 1Centre for Health and Society, University of Melbourne, Parkville, Australia
  2. 2Children's Bioethics Centre, Royal Children's Hospital, Parkville, Australia
  3. 3Murdoch Children's Research Institute, Parkville, Australia
  1. Correspondence to Kerith Sharkey, c/o Associate Professor Lynn Gillam, Centre for Health and Society, Melbourne School of Population Health, Level 4, 207 Bouverie Street, University of Melbourne, Victoria 3010, Australia; kerithsharkey{at}


The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive ‘high tech’ medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals.

  • Allocation of healthcare resources
  • allocation of organs/tissues
  • health care for specific diseases/groups

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  • Competing interests None.

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

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