Responsibility and Healthcare

Collective Responsibility for Infectious Disease

The Oxford Martin Programme on Collective Responsibility for Infectious Disease: Bringing together zoology, history, philosophy, psychology and medicine, our four-year project addresses the central research question: What is the role of collective responsibility in the genesis of and appropriate response to the threat of infectious disease? Our principal aim is to generate disease-specific policy recommendations for collective action on influenza, malaria, antibiotic resistance and vaccine-preventable childhood infections.

Individual Responsibility and Healthcare

Julian Savulescu’s Wellcome Trust Senior Investigator Award: Responsibility and Healthcare. This project addresses questions such as: What is moral responsibility and does it matter in healthcare? Should treatment decisions and the allocation of resources take into account whether patients are responsible for their condition? Is it the physician’s role to encourage patients to take responsibility for their health? Does addiction undermine responsibility?

We are conducting a number of research projects on this topic. For example, right now we working with Wilmington Healthcare to understand how medical doctors think about healthcare and responsibility, looking at whether and how trained medical professionals think that patient responsibility should be incorporated into healthcare decisions.

Practical Ethics and Responsibility Competition

Announcing details of an exciting new video competition for 16-18 year olds!

"How am I responsible for the environment? Should there be limits on how we can punish people who do wrong? If very ill patients want to die, should doctors be held responsible if they help them? Who is responsible for the global spread of infectious diseases?" 

If these and other questions about our responsibilities towards each other, our planet and our future make you think, then this competition is for you!

At the Oxford Uehiro Centre for Practical Ethics we've been thinking about responsibility and how we can all do more to tackle some of the biggest ethical problems facing us today.

Send us a video to tell us about an ethical problem and how you think responsibility is involved. 

The best entries will be invited to the University of Oxford for our Ethics and Responsibility day, where you can take part in a debate, lots of opportunities to discuss ethics with our researchers, and a taste of University life. Oh and there’s a cash prize for the debate winners too!

Competition launch date: 26th September 2019
Closing date for video entries: 13th December 2019 
Video winners are announced: January 2020 
Ethics and Responsibility day: More information coming soon! 24th March 2020

For full details, including some free resources, terms and conditions etc, see competition page

Podcast Series

Disease caused by lifestyle is a pressing public health issue. Rising costs from health conditions that seem to be partly due to individual behaviour make issues of resource allocation a priority. Some people think that the right response is to direct resources to those who are not responsible for their disease, at the cost of those who are. Such proposals raise many issues. While resources are limited, the NHS is based on a principle of equal treatment for equal need. Is it right to disrupt this principle in the name of cost-saving? 

Philosophers, psychologists and neuroscientists have also raised questions about the idea of freedom that underpins claims of responsibility, and of our ability to tell when people are responsible for their health. When our choices are shaped by our genes, upbringing and the broader social environment, does it even make sense to hold people responsible for their health? Or will we simply end up focusing on already stigmatised groups who need our support rather than our condemnation? Some have suggested that an inability to take responsibility is itself a health issue. In the future, we might try to enhance patients’ ability to take responsibility, strengthening their capacity for sticking to commitments and exercising willpower. 

Issues of responsibility also apply beyond the question of resource rationing. Holding patients responsible might be seen as a natural partner to respecting patient autonomy. But some people think that there are limits to how far autonomy should be respected in a health care service. Patients sometimes want treatments that are harmful or unnecessary, or refuse treatments that generate considerable public good at little personal cost. Must society really respect such choices in all cases?

Medical professionals also have responsibilities and rights. How should doctors, nurses and other caregivers behave when they object to providing a treatment on moral grounds?How should society and the healthcare system treat them? 

These pressing issues, among others, are the subject of this series of podcasts. The series is part of a broader project, funded by the Wellcome Trust and led by Professor Julian Savulescu, on Responsibility and Health Care

Brown, Rebecca

Should obese people be held responsible for being overweight? (Released 10 June 2019)
Suppose an obese person requires a hospital procedure for a condition that is in part linked to their obesity.  Many people might believe that a patient must bear responsibility for being overweight. And, other things being equal, that's a reason to prioritize the needs of another patient first.  So is the concept of responsibility a useful one in determining how to distribute health resources.  Becky Brown is not convinced.

Becky Brown is a philosopher at Oxford's Uehiro Centre for Practical Ethics, University of Oxford. Becky's work focuses on the ethics of health promotion, particularly questions about responsibility for unhealthy behaviour. This research involves considering how philosophical theories can be informed by evidence from the social and medical sciences and vice versa. Ultimately, the aim of this work is to better understand what kinds of approaches to encouraging healthy behaviour are justified.
 

Alberto Giubilini

Should patient autonomy always be respected? (Released 24 June 2019)
A fundamental value of modern medicine is patient autonomy.  Doctors should not insist upon a medical procedure or impose a procedure on a patient. The patient's consent - or the consent of a parent or guardian - needs to be obtained.  But are there any exceptions to this basic principle. Alberto Giubilini argues that there are.... 

Alberto Giubilini is a Research Fellow at the University of Oxford, working on the Oxford Martin Programme on Collective Responsibility for Infectious Disease. He is based at the Uehiro Centre for Practical Ethics and at the Wellcome Centre for Ethics and Humanities. He has a PhD in Philosophy from the University of Milan, and prior to joining Oxford he worked in Australia at Monash University, University of Melbourne and Charles Sturt University. He has published on different topics in bioethics and philosophy, including a recent  on The Ethics of Vaccination (Palgrave MacMillan 2019).
 

Levy, Neil

Responsibility and Addiction (Released 8 July 2019)
Normally, when we say that somebody is addicted to a substance, like a drug, we believe it is because they have lost control - they don't have the ability to resist their desire for it - even if they at some level still believe it is harmful to them.  And to some extent, we are inclined to say, they are no longer responsible for surrendering to this desire.  But Neil Levy says science should force us to reconsider the link between control, responsibility and belief.

Neil Levy is Professor of Philosophy at Macquarie University, Sydney, Australia, and a Senior Research Fellow at Oxford's Uehiro Centre for Practical Ethics, University of Oxford.
 

Hannah Maslen

What is the link between responsibility and effort? (Released 22 July 2019)
Compare the athlete who finds training really tough but does it anyway, with the athlete who takes a substance that makes training easier.  We tend to think that people who strain hard to achieve their goals are more deserving of praise than those for whom it is effortless, or who take advantage of shortcuts.  Hannah Maslen believes this intuition is mistaken.

Hannah Maslen is the Deputy Director of the Oxford Uehiro Centre for Practical Ethics, University of Oxford. Hannah works on a wide range of topics in applied philosophy, from neuroethics, to moral emotions and criminal justice. Hannah is currently the Editor-in-Chief for the journal Neuroethics.
 

Dominic Wilkinson

Doctors and their conscience! (Release date 5 August 2019)
Should doctors be allowed to deny a medical procedure to patients on grounds of conscience?  Some doctors believe abortion to be wrong.  Should they be permitted to turn away a woman who wants a legal abortion? Dominic Wilkinson is both a philosopher and a physician. 

Dominic Wilkinson is Director of Medical Ethics and Professor of Medical Ethics at Oxford's Uehiro Centre for Practical Ethics, University of Oxford, UK. He is a consultant in newborn intensive care at the John Radcliffe Hospital, Oxford, holds a health practitioner research fellowship with the Wellcome Trust, and is a senior research fellow at Jesus College Oxford.
 

ben davies

Responsibility and Justice (Release date 19 August 2019)

If two people have a medical condition that requires treatment and John is responsible for having the condition, but Janet is not, then some people believe that Janet should take priority.  Janet should be treated first.  But benefiting Janet in this way only really makes sense if we are first clear what we mean by John being ‘responsible’ for his condition.  

Ben Davies is a postdoctoral research fellow on Professor Julian Savulescu's Wellcome Trust project on the relevance of personal responsibility to healthcare policy. His primary research focus is on issues in medical resource allocation. He completed his PhD at King's College London in 2015, working on ethical issues related to enhancements targeting human ageing. 

 

Edmonds, Dave

Interviews by David Edmonds (OUC Distinguished Research Fellow & Consultant Researcher).

The podcast series is a collaboration between Philosophy 24/7 and the Oxford Uehiro Centre for Practical Ethics.

Philosophy 24/7 brings you concise interviews with leading philosophers about pressing moral, political and social questions and is hosted by David Edmonds, a multi-awarding winning BBC journalist, and one half of the duo behind the Philosophy Bites podcast.

We are grateful to the Wellcome Trust for funding the project.

Major publication

book cover ethics conflict medical treatment children

FIRST PRIZE IN THE 2019 BMA BRITISH MEDICAL BOOK AWARDS, PRESIDENT'S AWARD CATEGORY

We are grateful to the Wellcome Trust and Elsevier for enabling Professors Savulescu and Wilkinson's 2018 book 'Ethics, Conflict and Medical Treatment for Children: From disagreement to dissensus' to be made freely available.

What should happen when doctors and parents disagree about what would be best for a child? When should courts become involved? Should life support be stopped against parents’ wishes?

The case of Charlie Gard, reached global attention in 2017. It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world.

In this open access book, medical ethicists Dominic Wilkinson and Julian Savulescu critically examine the ethical questions at the heart of disputes about medical treatment for children. They use the Gard case as a springboard to a wider discussion about the rights of parents, the harms of treatment, and the vital issue of limited resources. They discuss other prominent UK and international cases of disagreement and conflict.

From opposite sides of the debate Wilkinson and Savulescu provocatively outline the strongest arguments in favour of and against treatment. They analyse some of the distinctive and challenging features of treatment disputes in the 21st century and argue that disagreement about controversial ethical questions is both inevitable and desirable. They outline a series of lessons from the Gard case and propose a radical new ‘dissensus’ framework for future cases of disagreement.

Free resources

Expand All

Brown, R., Maslen, H. and Savulescu, J., (Forthcoming), 'Responsibility, Prudence and Health Promotion', Journal of Public Health 

Milnes, S., Corke, C., Orford, N. R., Bailey, M., Savulescu, J. and Wilkinson, D., (Forthcoming), 'Patient values informing medical treatment: a pilot community and advance care planning survey', BMJ Supportive & Palliative Care

Savulescu, J. and Persson, I., (Forthcoming), 'The duty to be morally enhanced', Topoi: An International Review of Philosophy

Savulescu, J. and Earp, B. D., (forthcoming), 'Addiction, identity, morality', AJOB Empirical Bioethics 

Brown, R., (2019), ''Irresponsibly' Infertile? Obesity, Efficiency, and Exclusion from Treatment', Health Care Analysis, Vol: 27(2): 61–76 [PMC6548064]

Dai, B., Faber, N., Giubilini, A., Douglas, T., Selgelid, M. and Savulescu, J., (2019), 'Impartiality and infectious disease: prioritising individuals versus the collective in antibiotic prescription', AJOB Empirical Bioethics, Vol: 10(1): 63-69 [PMC6446247

Levy, N., (2019), 'Due Deference to Denialism: Explaining Ordinary People's Rejection of Established Scientific Findings', Synthese, Vol: 196(1): 313–327 [PMC6338713]

Levy, N., (2019), 'Are free will believers nicer people? (Four studies suggest not)', Social Psychological and Personality Science, Vol: 10(5): 612–619 [PMC6542011]

Levy, N., (2019), 'Nudge, nudge, wink, wink: Nudging is giving reasons', Ergo, Vol: 6(10) [PMC6774767]

Levy, N., (2019), 'Taking responsibility for responsibility', Public Health Ethics, Vol: 12(2): 103–113 [PMC6655467]

Everett, J. A. C., Savulescu, J., Faber, N. and Crockett, M. J., (2018), 'The costs of being consequentialist: Social inference from instrumental harm and impartial beneficence', Journal of Experimental Social Psychology, Vol: 79 (November): 200-216 [PMC6185873]

Giubilini, A., Douglas, T. and Savulescu, J., (2018), 'The Moral Obligation to be Vaccinated: Utilitarianism, Contractualism, and Collective Easy Rescue', Medicine, Health Care and Philosophy, Vol: 21(4): 547-560 [PMC6267229]

Giubilini, A., Douglas, N., Maslen, H. and Savulescu, J., (2018), 'Quarantine, isolation and the duty of easy rescue in public health', Bioethics, Vol:18(2): 182-189 [PMC6001516]

Giubilini, A. and Levy, N., (2018), 'What in the world is collective responsibility?', Dialectica, Vol: 72(2): 191-217 [PMC6380084

Kappes, A., Faber, N. S., Kahane, G., Savulescu, J. and Crockett, M. J., (2018), 'Concern for Others Leads to Vicarious Optimism', Psychological Science, Vol: 29(3): 379-389  [PMC5858641]

Levy, N., (2018), 'Addiction: The Belief Oscillation Hypothesis'. in H. Pickard and S. Ahmed, (Eds.)  The Routledge Handbook of Philosophy and Science of Addiction, (Routledge) [NBK540394]

Levy, N., (2018), 'Socializing Responsibility'. in K. Hutchison, C. Mackenzie and M. Oshana, (Eds.), Social Dimensions of Moral Responsibility. (Oxford University Press) NBK513458

Levy, N., (2018), 'Taking responsibility for health in an epistemically polluted environment', Theoretical Medicine and Bioethics, Vol: 39(2): 123-141 PMC6105200

Levy, N., (2018), 'Responsibility as an Obstacle to Good Policy: The Case of Lifestyle Related Disease', Journal of Bioethical Inquiry, Vol: 15(3): 459-468 PMC620903

Maslen, H., Cheeran, B., Pugh, J., Pycroft, L., Boccard, S., Prangnell, S., Green, A. L., Fitzgerald, J., Savulescu, J. and Aziz, T., (2018), 'Unexpected Complications of Novel Deep Brain Stimulation Treatments: Ethical Issues and Clinical Recommendations', Neuromodulation, Vol: 21(2): 135-143 [PMC5811790]

Pillutla, V., Savulescu, J. and Maslen, H., (2018), 'Rationing Elective Surgery for Smokers and Obese Patients: Responsibility or Prognosis?', BMC Medical Ethics, Vol: 19(28)  [PMC5921973]

Pugh, J., Pycroft, L., Sandberg, A., Aziz, T. and Savulescu, J., (2018), 'Brainjacking in Deep Brain Stimulation, and Autonomy', Ethics and Information Technology, Vol: 20(3): 219-232 [PMC6290799]

Savulescu, J. and Persson, I., (2018), 'The Moral Importance of Reflective Empathy', Neuroethics, Vol: 11(2): 186-193 [PMC5978797]

Savulescu, J., Bambery, B., Douglas, T., Selgelid, M., Maslen, H., Giubilini, A. and Pollard, A., (2018), 'Influenza vaccination strategies should target children', Public Health Ethics, Vol: 11(12): 221-234 [PMC6093440]

Shepherd, J., (2018), 'Consciousness and Moral Status', (Routledge)  [NBK540410]

Wagner, K., Maslen, H., Oakley, J. and Savulescu, J., (2018), 'Would you be willing to zap your child's brain? Public perspectives on parental responsibilities and the ethics of enhancing children with transcranial direct current stimulation', AJOB Empirical Bioethics, Vol: 9(1): 29-38 [PMC6068541]

Wilkinson, D. and Savulescu, J., (2018), 'Ethics, Conflict and Medical Treatment for Children: From disagreement to dissensus' (Elsevier) [NBK537987]

Wilkinson, D. Petrou, S. and Savulescu, J., (2018), 'Expensive care? Resource-based thresholds for potentially inappropriate treatment in intensive care', Monash Bioethics Review, Vol: 35(1-4), pp 2-23 [PMC6096869]

Wilkinson, D. and Savulescu, J., (2018), 'Cost equivalence and pluralism in publicly funded health care systems', Health Care Analysis, Vol: 26(4): 287–309 [PMC6208988]
 
 

 

Douglas, T., Pugh, J., Singh, I., Savulescu, J. and Fazel, S., (2017), 'Risk Assessment Tools in Criminal Justice and Forensic Psychiatry: The Need for Better Data', European Psychiatry, Vol: 42(May): 134–137. 

Douglas, T., Earp, B. D. and Savulescu, J., (2017), 'Moral Neuroenhancement'. in K. Rommelfanger and L. Johnson, (Eds.)   Routledge Handbook of Neuroethics, (Routledge) [NBK493126]
 Giubilini, A., Savulescu, J., Douglas, T., Birkl, P. and Maslen, H., (2017), 'Taxing Meat: Taking Responsibility for One’s Contribution to Antibiotic Resistance'Journal of Agricultural and Environmental Ethics, Vol: 30(2): 179-198 [PMC5837014]

Gyngell, C., Savulescu, J. and Douglas, T., (2017), 'The ethics of germline gene editing', Journal of Applied Philosophy, Vol: 34(4): 498–513 [PMC5573992]

Levy, N., (2017), 'Nudges in a post-truth world', Journal of Medical Ethics, Vol: 43(8): 495-500. 

Lowe, G., J. Pugh, G. Kahane, L. Corben, S. Lewis, M. Delatycki and J. Savulescu, (2017). 'How should we deal with misattributed paternity? A survey of lay public attitudes', AJOB Empirical Bioethics Vol:8(4): 234-242 [PMC5849225]

Persson, I. and Savulescu, J., (2017), 'Moral Hard-Wiring and Moral Enhancement', Bioethics, Vol: 31(4): 286-295. 

Pugh, J., Maslen, H. and Savulescu, J., (2017), 'Deep Brain Stimulation, Authenticity and Value', Cambridge Quarterly of Healthcare Ethics, Vol: 26(4): 640-657. 

Savulescu, J. and Schaefer, G. O., (2017), 'Better Minds, Better Morals: A Procedural Guide to Better Judgment', Journal of Posthuman Studies, Vol: 1(1): 26-43. 

Savulescu, J. and Schuklenk, U., (2017), 'Doctors Have No Right to Refuse Medical Assistance in Dying, Abortion or Contraception', Bioethics, Vol: 31(3): 162–170

Wilkinson, D. and Nair, T., (2017), 'Settling for second best: when should doctors agree to parental demands for suboptimal medical treatment?', Journal of Medical Ethics, Vol: 43(12): 831-840 [PMC5827708]  
 

Arora, C., Savulescu, J., Maslen, H., Selgelid, M. and Wilkinson, D., (2016), 'The Intensive Care Lifeboat: a survey of lay attitudes to rationing dilemmas in neonatal intensive care', BMC Medical Ethics, Vol: 17(1): 69. 

Persson, I. and Savulescu, J., (2016), 'Moral Bioenhancement, Freedom and Reason', Neuroethics, Vol: 9(3): 263-268. 

Porsdam- Mann, S., J, S. B. and Savulescu, J., (2016), 'Facilitating the ethical use of health data for the benefit of society: Electronic health records, consent and the duty of easy rescue', Philosophical Transactions A, Vol: 374(2083)(2083). 

Pugh, J., Kahane, G. and Savulescu, J., (2016), 'Partiality for Humanity and Enhancement'. in S. Clarke, J. Savulescu, C. A. J. Coady, A. Giubilini and S. Sanyal, (Eds.)   The Ethics of Human Enhancement: Understanding the Debate. (Oxford: Oxford University Press) 

Roache, R. and Savulescu, J., (2016), 'Enhancing Conservatism'. in S. Clarke, J. Savulescu, C. A. J. Coady, A. Giubilini and S. Sanyal, (Eds.)   The Ethics of Human Enhancement: Understanding the Debate (Oxford: Oxford University Press)

Savulescu, J., (2016), 'Concise argument—wellbeing, collective responsibility and ethical capitalism', Journal of Medical Ethics, Vol: 42(6): 331-333. [freely available]

Snoek, A., Levy, N. and Kennett, J., (2016), 'Strong-willed but not successful: The importance of strategies in recovery from addiction', Addictive Behaviors Reports, Vol: 4: 102-107. 

Wilkinson, D., De Crespigny, L., Skene, L. and Savulescu, J., (2016), 'Protecting Future Children from In-Utero Harm', Bioethics, Vol: 30(6): 425-432. 

 

The Practical Ethics Video Series makes the most important and complex debates in practical ethics accessible to a wide audience through brief interviews with high profile philosophers in Oxford.  Video interviews on this and other topics can be found on our YouTube channel.

Featured interview with Dr Rebecca Brown

 

Media

Giubilini, A., (2019), 'The World Vaccination Report: The Evidence', BBC World Service (22 June).

Brown, R., (2019), 'Obese people unfairly denied IVF by cost-cutting NHS, says Oxford academic', The Independent (14 April 2019). [This article is based on Dr Brown's open access paper available on EuropePMC PMC6548064]

Giubilini, A., (2019), 'Italy's attitude towards vaccine is a 'cultural and social problem'', Sputnik Radio (13 March).

Giubilini, A., (2019), 'The Ethics of Vaccination', book launch, Oxford Martin School (5 March). Livestreamed and available to view on YouTube.

Brown, R., (2018), 'Subfertility deserves attention, but not because it is a disease', BioNews comment piece. Philosophers have debated how best to define health and disease for some time. The main two approaches focus on biological nature and social construction. The first identifies disease as biological deviations from the norm. The second argues that societies construct diseases by responding to certain conditions in particular ways, for instance by treating them with medicine. Neither of these definitions is universally accepted. Subfertility provides an example of why it can be so difficult to determine exactly what makes something a disease. (16 July).

www.neuroethics.ox.ac.uk//responsibility-and-healthcare
19/10/2019 09:57:23
List of site pages