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Responsibility and the limits of patient choice

机译：责任与患者选择的限制

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Patients are generally assumed to have the right to choices about treatment, including the right to refuse treatment, which is constrained by considerations of cost-effectiveness. Independently, many people support the idea that patients who are responsible for their ill health should incur penalties that non-responsible patients do not face. Surprisingly, these two areas have not received much joint attention. This paper considers whether restricting the scope of responsibility to pre-treatment decisions can be justified, or whether a demand to hold people responsible for 'usual suspect' choices such as smoking or failure to exercise commits us to also holding people responsible for their treatment choices. I argue that there is no good reason to support this restriction: those who advocate responsibility for (some) pre-treatment choices should also advocate responsibility for (some) treatment choices. However, I also note that, as with pre-treatment choices, patients may sometimes have reason to choose in ways that do not optimize their health. As such, I also consider a process, based on the idea of public reasons, for deciding which treatment choices patients cannot legitimately be held responsible for, along with a method for considering proposed changes to this category.
机译：通常假设患者有权有关治疗的选择，包括拒绝治疗的权利，这受到成本效益的考虑因素的限制。独立地，许多人支持对其健康状况不佳的患者的想法应该产生不良患者不面临的惩罚。令人惊讶的是，这两个领域没有得到很大的关注。本文考虑了限制预处理决策的责任范围，或者是否需要持有负责“通常嫌疑人”选择的人，例如吸烟或未能举行举行履行履行责任，也持有负责其治疗选择的人员。我认为没有充分的理由支持这种限制：倡导（一些）预处理选择的人也应该倡导（某些）治疗选择的责任。但是，我还注意到，与预处理选择一样，患者有时可能有理由选择不优化健康的方式。因此，我还考虑了一个过程，根据公共原因的想法，决定哪种治疗选择患者不能合法地持有负责，以及考虑该类别的提出变更的方法。

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