Table 2

Results for the subthemes regarding the conceptualisation of personal health responsibility

Sub-themes (i)Subthemes (ii)Identified understandings of personal health responsibilityIllustrative quotes
Subject of responsibilityIndividual citizen
PatientPatient‘The patient’s possible self-responsibility for the occurred problem’ (p. 85).60
Object of responsibilityHealth-related behaviourHarmful behaviour‘A lifestyle that reduces the effect of an intervention (…) can be included in the discretionary prioritisation decisions at the clinical level’ (p. 12).57
Individual effort‘The expected individual effort should be given weight (…) This applies particularly to responsibility for own physical training, as for patients with inflammatory rheumatic diseases and lung disorders, and lubrication, as for patients with skin disorders’ (p. 86).58
Health stateHealth impairment‘The question of whether self-inflicted health impairment should have priority-related consequences for the individual patient (p. 86).60
Level of conceptual abstractionPrinciple
CriterionContested criterion‘There are many criteria that belong to the group with more contested criteria (…) such as (…) self-infliction and willingness to cooperate’ (p. 61).55
TemporalityRetrospectiveSelf-infliction‘(T)he question of self-responsibility for illness is relevant when assessing whether or not there should be a co-payment. One could imagine that those who themselves are responsible for their illness must pay more for the services’ (p. 42).61
‘It is a distinct problem when one who has benefited from scarce and costly resources (…) continues to jeopardise her health by maintaining a detrimental lifestyle despite information and advice’ (p. 85).60
ProspectiveWillingness to cooperate‘It is not justifiable to undertake extensive and risky procedures if the patient is not prepared to make the changes in (his/her) living habits which under any circumstance will be a condition for a satisfactory outcome of treatment’ (p. 86).60
Normative justificatory argumentsNon-instrumentalWhen justified with reference to reciprocal fairness‘(T)here will be strong (…) arguments for the health service to be reluctant to use the same scarce and costly resources to repeat the treatment of the same disease. The argument that other patients on the same waiting list, being sick through no fault of their own, should be prioritised, will in such a case easily be regarded as fair’ (p. 85).60
When justified with reference to autonomy‘(A patient) that is not willing to accept help to stop the harmful behaviour (…) should not be prioritised’ (p. 132).57
InstrumentalWhen justified with optimisation of expected benefit‘(T)he expected benefit of a measure (can) depend on whether the patient changes his lifestyle or changes behaviour. If this is the case, it would be natural for healthcare professionals to take this into account in the clinical assessment of the expected benefit of treatment’ (p. 107).59