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Much of the treatment for people with long term chronic illness aims at counteracting, as far as possible, their illness’ negative effects on their ability to live life on their own terms. If we focus solely on the healthcare professionals involved, we necessarily have to treat as fixed much of the environment within which this treatment takes place. Those healthcare professionals cannot directly affect that environment. But others can. Making those alterations can affect, sometimes considerably, the treatment’s effectiveness. That raises two questions: 1. Do those outside the health service have any moral obligations to bring about such changes?, and 2. Are there good moral reasons why they should, or should not, be required to do so? This paper addresses these questions. In doing so it sidesteps debates about paternalism (the most common framing for interventions of this type) because the cases I am concerned with here are not, on standard accounts of paternalism, paternalistic.
