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Patients' Charter Raises Range of Ethical Questions

Rising health care costs means personal responsibility is an ongoing issue

FRIDAY, Dec. 7 (HealthDay News) -- A patients' charter, which spells out the responsibilities of health care service users, should be discarded in favor of the concept of health responsibilities instead, but even such a charter can raise ethical issues that are difficult to resolve, according to an analysis published in the Dec. 8 issue of BMJ.

Harald Schmidt, of the Nuffield Council on Bioethics in London, U.K., looked at initiatives in Scotland, Germany and in the United States, and tackled the codification of patients' responsibilities.

All three examples explicitly spelled out the patient's obligation to try to stay healthy and lead a health-conscious life. However, encouraging people to lead a healthy lifestyle can be perceived as unwelcome paternalism, and raises issues as to who should pay for treatment required as a result of lifestyle choices.

"Clarity about such decisions is especially important for documents that have a binding status. They raise questions about equity and create a risk of victim blaming," the authors write. A health responsibilities charter can also cover obligations to the health of others and toward the health care system, both of which quickly become complicated to implement even when the responsibilities are reasonable on paper, he adds.

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