Responsibility and Healthcare Project
Julian Savulescu’s Wellcome Trust Senior Investigator Award: Individual Responsibility and Healthcare.
Wellcome Trust 104848/Z/14/Z
Project dates: Jul 2015 - Jan 2022
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?
See below for a selection of project outputs, and Europe PMC for all open access papers linked to the grant.
Ethics, Conflict and Medical Treatment for Children: From Disagreement to Dissensus
Wilkinson, D. and Savulescu, J., (2018), 'Ethics, Conflict and Medical Treatment for Children: From disagreement to dissensus', (Elsevier)
FIRST PRIZE IN THE 2019 BMA BRITISH MEDICAL BOOK AWARDS, PRESIDENT'S AWARD CATEGORY
We are grateful to the Wellcome Trust and Elsevier for making Professors Savulescu and Wilkinson's 2018 book 'Ethics, Conflict and Medical Treatment for Children: From disagreement to dissensus' 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 download: https://www.ncbi.nlm.nih.gov/books/NBK537987/pdf/Bookshelf_NBK537987.pdf
Bad Beliefs: Why They Happen to Good People
Levy, N., (2021), 'Bad Beliefs: Why They Happen to Good People', (OUP) (Open Access, free to download)
With thanks to the Wellcome Trust and Oxford University Press for facilitating Open Access for this title.
Bad beliefs - beliefs that blatantly conflict with easily available evidence - are common. Large minorities of people hold that vaccines are dangerous or accept bizarre conspiracy theories, for instance. The prevalence of bad beliefs may be politically and socially important, for instance blocking effective action on climate change. Explaining why people accept bad beliefs and what can be done to make them more responsive to evidence is therefore an important project.
A common view is that bad beliefs are largely explained by widespread irrationality. This book argues that ordinary people are rational agents, and their beliefs are the result of their rational response to the evidence they're presented with. We thought they were responding badly to evidence, because we focused on the first-order evidence alone: the evidence that directly bears on the truth of claims. We neglected the higher-order evidence, in particular evidence about who can be trusted and what sources are reliable. Once we recognize how ubiquitous higher-order evidence is, we can see that belief formation is by and large rational.
The book argues that we should tackle bad belief by focusing as much on the higher-order evidence as the first-order evidence. The epistemic environment gives us higher-order evidence for beliefs, and we need to carefully manage that environment. The book argues that such management need not be paternalistic: once we recognize that managing the epistemic environment consists in management of evidence, we should recognize that such management is respectful of epistemic autonomy.
Free download: https://fdslive.oup.com/www.oup.com/academic/pdf/openaccess/9780192895325.pdf
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.
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.
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).
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.
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.
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.
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.
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.
Welcome to the Uehiro Centre’s Practical Ethics and Responsibility competition!
"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 think a lot about responsibility and how we can all do more to tackle some of the biggest ethical problems facing us today.
We're inviting people in school years 11, 12 and 13 in small teams (between three and five members) to send us a video 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. There’s a cash prize for the winning schools too!
The Oxford Uehiro Centre for Practical Ethics is grateful to Schools Outreach Co-ordinator Wedad Rattab, and to an advisory group of teachers for supporting this event.
See competition webpage for further details.
