Responsibility in Healthcare: Empowerment Without Blame?

Whilst responsibility commonly plays a role in a variety of social contexts, the appropriate role for responsibility in healthcare is debatable. Upon its launch in 1948, three core principles were to guide the NHS: that it meet the needs of everyone; that it be free at the point of delivery; and that care be based on clinical need, not ability to pay. Much has changed since then, and now chronic disease is responsible for the majority of the global disease burden. It is thought that chronic disease can often be avoided through the adoption of ‘healthy lifestyles’: quitting smoking, drinking less alcohol, eating healthily and exercising regularly. As a result, there is renewed interest in exploring how responsibility can be used to promote health. Much of this is framed as ‘empowering healthy choices’ rather than ‘punishing bad behaviour.’ This paper explores the possibility of using responsibility in this selective way, and considers the philosophical consistency of ‘holding responsible’ in the context of habitual behaviours.