• Ethics

In a welcome broadening of the discussion surrounding responsibility in healthcare, Rebecca Brown and Julian Savulescu propose that standard philosophical accounts of responsibility are too narrow to be useful. Although these accounts of course differ with respect to the exact conditions they posit as necessary and sufficient for responsibility, they are nonetheless relatively united in their focus on a single individual at a single moment in time. Suppose a subject S performs an action a at a time t that has harmful consequences for their health. Is S responsible for a and derivatively their condition? Brown and Savulescu argue that answers to this question that fail to consider both what S was or was not doing at times other than t and what people other than S were doing to encourage or discourage S from performing a cannot do justice to actions which are habitual and socially influenced—such as unhealthy patterns of eating, exercise and substance use. Given that it is precisely these kinds of patterns of behaviour that typically inflame the discussion of responsibility in healthcare, Brown and Savulescu’s insistence on the need for a diachronic and socially contextualised account of responsibility is essential—if we are to consider the issue of responsibility in healthcare at all.

But should we and, if so, why? With respect to this question, Brown and Savulescu hope to sit on the fence. This is both because they recognise the complexity and balance of arguments for and against the view …