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Ethics of patient activation: exploring its relation to personal responsibility, autonomy and health disparities
  1. Sophia H Gibert,
  2. David DeGrazia,
  3. Marion Danis
  1. Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Sophia H Gibert, Department of Bioethics, National Institutes of HealthBethesda, 10 Center Drive, MSC 1156, Bldg. 10, Room 1C118, Bethesda, MD 20892, USA; sophie.gibert{at}


Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients’ confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement.

  • patient activation
  • patient participation
  • health behavior
  • patient-centered care
  • chronic disease

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  • Contributors SHG drafted the manuscript. SHG, DD and MD made substantial contributions to the conception of the work and to critical revisions for important intellectual content. SHG, DD and MD gave final approval of the version to be published.

  • Disclaimer The opinions expressed herein are the authors’ and do not reflect the policies and positions of the National Institutes of Health, the US Public Health Service, or the US Department of Health and Human Services.

  • Competing interests None declared.

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

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