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The Evolving Idea of Social Responsibility in Bioethics

A Welcome Trend

Published online by Cambridge University Press:  26 February 2015

Abstract:

This article discusses the notion of social responsibility for personal health and well-being in bioethics. Although social responsibility is an intrinsic aspect of bioethics, and its role is increasingly recognized in certain areas, it can still be claimed that bioethics in general is committed to an individualistic theoretical framework that disregards the social context in which decisions, health, and well-being are situated. The philosophical premises of this framework regard individuals as rational decisionmakers who can be held accountable for their health conditions and who should be the primary objects of intervention in attempts to reduce lifestyle-associated chronic diseases. There are, however, social determinants of health that challenge this conclusion. Because their impact can be controlled, to a certain extent, by social and public policy decisions, their existence shows the inadequacy of the purely individualistic approach. I suggest, accordingly, that bioethics would benefit, both academically and societally, from a more social perspective. Bioethical studies that acknowledge, from the start, the social determinants of health would be more amenable to constructive multi- and interdisciplinarity, and a more balanced account of responsibility would further the contribution of sound bioethical work to sensible public policies.

Type
Special Section: Philosophical Bioethics—Its State and Future
Copyright
Copyright © Cambridge University Press 2015 

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References

Notes

1. Cappelen, AW, Norheim, OF. Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics 2005;31(8):476−80CrossRefGoogle ScholarPubMed; Buyx, AM. Personal responsibility for health as a rationing criterion: Why we don’t like it and why maybe we should. Journal of Medical Ethics 2008;34(12):871−4CrossRefGoogle Scholar; Feiring, E. Lifestyle, responsibility and justice. Journal of Medical Ethics 2008;34(1):33−6.CrossRefGoogle ScholarPubMed

2. World Health Organization. The World Health Report: Reducing Risks, Promoting Healthy Life. Geneva: WHO; 2002.Google Scholar

3. See note 1, Feiring 2008.

4. Daniels, N. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008Google Scholar; Wikler, D. Personal and social responsibility for health. Ethics & International Affairs 2002;16(2):4755.CrossRefGoogle ScholarPubMed

5. See note 4, Daniels 2008; Wilkinson, RG, Marmot, MG. Social Determinants of Health: The Solid Facts. Copenhagen: WHO Regional Office for Europe; 2003.Google Scholar

6. Jonsen, AR. Social responsibilities of bioethics. Journal of Urban Health 2001;78(1):21−8.CrossRefGoogle ScholarPubMed

7. Walters, W. The “active society”: New designs for social policy. Policy & Politics 1997;25(3):221−34.CrossRefGoogle Scholar

8. Clarke, J. New Labour’s citizens: Activated, empowered, responsibilized, abandoned? Critical Social Policy 2005;25(4):447−63CrossRefGoogle Scholar; Brown, RC. Moral responsibility for (un)healthy behaviour. Journal of Medical Ethics 2013;39(11):695−8.CrossRefGoogle ScholarPubMed

9. Smith, KE, Hunter, DJ, Blackman, T, Elliott, E, Greene, A, Harrington, BE, et al. Divergence or convergence? Health inequalities and policy in a devolved Britain. Critical Social Policy 2009;29(2):216−42CrossRefGoogle Scholar; Hunter, DJ. Choosing or losing health? Journal of Epidemiology and Community Health 2005;59(12):1010−12.CrossRefGoogle ScholarPubMed

10. Ter Meulen, R, Jotterand, F. Individual responsibility and solidarity in European health care: Further down the road to two-tier system of health care. The Journal of Medicine and Philosophy 2008;33(3):191−7CrossRefGoogle ScholarPubMed; Ter Meulen, R, Maarse, H. Increasing individual responsibility in Dutch health care: Is solidarity losing ground? The Journal of Medicine and Philosophy 2008;33(3):262−79.CrossRefGoogle ScholarPubMed

11. Ubel, PA, Jepson, C, Baron, J, Mohr, T, McMorrow, S, Asch, DA. Allocation of transplantable organs: Do people want to punish patients for causing their illness? Liver Transplantation 2001;7(7):600−7CrossRefGoogle ScholarPubMed; Dolan, P, Tsuchiya, A. The social welfare function and individual responsibility: Some theoretical issues and empirical evidence. Journal of Health Economics 2009;28(1):210−20CrossRefGoogle ScholarPubMed; Stegeman, I, Willems, DL, Dekker, E, Bossuyt, PM. Individual responsibility, solidarity and differentiation in healthcare. Journal of Medical Ethics 2014;40(11):770–73.CrossRefGoogle Scholar

12. Saguy, AC, Gruys, K. Morality and health: News media constructions of overweight and eating disorders. Social Problems 2010;57(2):231−50.CrossRefGoogle Scholar

13. Sachs, L. Causality, responsibility and blame—core issues in the cultural construction and subtext of prevention. Sociology of Health & Illness 1996;18(5):632−52CrossRefGoogle Scholar; Sikorski, C, Luppa, M, Glaesmer, H, Brahler, E, Konig, HH, Riedel-Heller, SG. Attitudes of health care professionals towards female obese patients. Obesity Facts 2013;6(6):512−22.CrossRefGoogle ScholarPubMed

14. Brown, A. If we value individual responsibility, which policies should we favour? Journal of Applied Philosophy 2005;22(1):2344CrossRefGoogle Scholar; Morrisette, S, Oberman, WD, Watts, AD, Beck, JB. Health care: A brave new world. Health Care Analysis 2013 Mar 14. Epub ahead of print. DOI 10.1007/s10728-013-0244-5.Google Scholar

15. See note 14, Brown 2005.

16. The original systematic formulation of a responsibility-sensitive egalitarian position was formulated by Ronald Dworkin (Dworkin, R. What is equality? Part 2: Equality of resources. Philosophy and Public Affairs 1981;10:283345Google Scholar); further developed by, e.g., Richard Arneson (Arneson, R. Equality and equal opportunity for welfare. Philosophical Studies 1989;56:7793CrossRefGoogle Scholar) and G. A. Cohen (Cohen, GA. On the currency of egalitarian justice. Ethics 1989;99:906−44CrossRefGoogle Scholar); and lately represented by, e.g., Andrew Mason (Mason, A. Leveling the Playing Field: The Idea of Equal Opportunity and Its Place in Egalitarian Thought. Oxford: Oxford University Press; 2006).CrossRefGoogle Scholar

17. Dworkin (Dworkin, R. Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2000, at 324Google Scholar) admits that the difference between choice and circumstance is a matter of degree, and that it might be difficult to identify whether a particular outcome, e.g., unemployment, is the result of chance or choice. Arneson (see note 16, Arneson 1989, at 79−82) mentions that the notion of preferences ought not to be simplified straightforwardly into the category of choices, because of the circumstantial origin of such preferences. Cohen (see note 16, Cohen 1989, at 922−34) argues that the conceptions of personality and expensive tastes cannot, in principal, be placed merely in the category of choice. And Mason (see note 16, Mason 2006, at 188−93) strongly emphasizes the influence that the different social structures have on “voluntary choices” as limiting elements of responsibility.

18. See note 1, Cappelen, Norheim 2005; Cappelen, AW, Norheim, OF. Responsibility, fairness and rationing in health care. Health Policy 2006;76(3):312−19CrossRefGoogle ScholarPubMed. For a review of the constructive potential of luck egalitarian applications for taking into account personal responsibility in healthcare policy, see Voigt, K. Appeals to individual responsibility for health: Reconsidering the luck egalitarian perspective. Cambridge Quarterly of Healthcare Ethics 2013;22(2):146−58CrossRefGoogle ScholarPubMed. For a critical review of the issue, see Daniels, N. Individual and social responsibility for health. In: Knight, C, Stemplowska, Z, eds. Responsibility and Distributive Justice. Oxford: Oxford University Press; 2011:266−86.CrossRefGoogle Scholar

19. See note 1, Feiring 2008.

20. See note 1, Buyx 2008.

21. See note 6, Jonsen 2001; Wikler, D. Presidential address: Bioethics and social responsibility. Bioethics 1997;11(3−4):185−92CrossRefGoogle ScholarPubMed; Benatar, SR. Bioethics: Power and injustice: IAB presidential address. Bioethics 2003;17(5−6):387−99CrossRefGoogle ScholarPubMed; Whitehouse, PJ. The rebirth of bioethics: Extending the original formulations of Van Rensselaer Potter. American Journal of Bioethics 2003;3(4):26−31.CrossRefGoogle ScholarPubMed

22. See note 21, Whitehouse 2003.

23. See note 6, Jonsen 2001, at 23.

24. Azétsop J, Rennie S. Principlism, medical individualism, and health promotion in resource-poor countries: Can autonomy-based bioethics promote social justice and population health? Philosophy, Ethics and Humanities in Medicine 2010;5(1); available at www.peh-med.com/content/5/1/1 (last accessed 18 May 2014); Guttman, N, Ressler, WH. On being responsible: Ethical issues in appeals to personal responsibility in health campaigns. Journal of Health Communication 2001;6(2):117−36.CrossRefGoogle ScholarPubMed

25. Minkler, M. Personal responsibility for health? A review of the arguments and the evidence at century’s end. Health Education & Behavior 1999;26(1):121−40.CrossRefGoogle Scholar

26. See note 24, Azétsop, Rennie 2010.

27. See note 24, Azétsop, Rennie 2010; note 9, Smith et al. 2009.

28. See note 4, Daniels 2008.

29. Dupras, C, Ravitsky, V, Williams-Jones, B. Epigenetics, and the environment in bioethics. Bioethics 2014;28(7):327–34.CrossRefGoogle ScholarPubMed

30. See note 24, Azétsop, Rennie 2010.

31. See note 21, Whitehouse 2003.

32. See note 6, Jonsen 2001.

33. See note 6, Jonsen 2001, at 26−7.

34. For a thorough analysis of the argumentation involved in making better people, see Häyry, M. Rationality and the Genetic Challenge. Cambridge: Cambridge University Press; 2010.CrossRefGoogle Scholar

35. E.g., Savulescu, J. Procreative beneficence: Why we should select the best children. Bioethics 2001;15(5−6):413–26CrossRefGoogle ScholarPubMed; Harris, J. Enhancing Evolution: The Ethical Case for Making Better People. Princeton, NJ: Princeton University Press; 2007.Google Scholar

36. See note 21, Wikler 1997. Norman Daniels was an influential initiator of the philosophical discussion relating healthcare and distributive justice. Daniels, N. Just Health Care. Cambridge: Cambridge University Press; 1985.CrossRefGoogle ScholarPubMed

37. See note 4, Daniels 2008; note 6, Jonsen 2001; note 21, Wikler 1997, Benatar 2003, and Whitehouse 2003; Resnik, D. Responsibility for health: Personal, social, and environmental. Journal of Medical Ethics 2007;33(8):444−5.CrossRefGoogle ScholarPubMed

38. See note 21, Wikler 1997.

39. See note 6, Jonsen 2001.

40. See note 21, Whitehouse 2003.

41. International Bioethics Committee. Report of the International Bioethics Committee of UNESCO (IBC) on Social Responsibility and Health. Paris: Unesco; 2010.Google Scholar

42. See note 36, Daniels 1985. Daniels draws his analysis from Rawls J. A Theory of Justice. Cambridge, MA: Belknap Press of Harvard University Press; 1971.

43. See note 4, Daniels 2008.

44. See note 18, Daniels 2011.

45. For social scientific studies about the relation of one’s socioeconomic position and course of life, see note 5, Wilkinson, Marmot 2003; Lynch, JW, Kaplan, GA, Salonen, JT. Why do poor people behave poorly? Variation in adult health behaviors and characteristics by stages of the socioeconomic lifecourse. Social Science and Medicine 1997;44(6):809–19CrossRefGoogle ScholarPubMed; Wilkinson, RG, Pickett, K. The Spirit Level: Why More Equal Societies Almost Always Do Better. New York: Bloomsbury Press; 2009.Google Scholar

46. See note 29, Dupras et al. 2014.

47. See note 4, Wikler 2002.

48. An important issue not discussed in this article is that the normative conception of health and well-being ought to be pluralistic enough. Overly intrusive standards of health are likely to result in ill-being in terms of moralistic decisions about various lifestyles, stress, discrimination, and wasted resources on excessive monitoring. As Daniels (see note 18, Daniels 2011) argues, more pluralistic approaches in health policy advance the public good of liberty, diversity, and even toleration and solidarity.