Doctors as judges: the verdict on responsibility for health

Smokers, drinkers, animal fat eaters, the inactive and the obese, they are all blamed for their potential ill health by doctors, society and their families, in western societies victim blaming is a widespread phenomenon. Doctors are encouraged or even put under pressure to judge behaviour as a tool to allocate and ration medical procedures, by governments or insurance companies that want to keep the healthcare expenditure within strict limits. In recent years the knowledge obtained by risk factor epidemiology and related to personal behaviour and lifestyle, has become more and more widely used to hold people responsible for their own health. This is not only happening within the doctor-patient relationship,1 but also in everyday social and domestic life.2 Governments and international corporations are in contrast rarely seriously blamed for the consequences their policies have for the health of the population. Although public health theory accepts the existence of biological, behavioural and societal causes of both sick persons and sick populations,3 4 the application of the available knowledge is clearly biased towards the individual behaviour.

However, to establish a person's responsibility we need more than just some connection between a behaviour related risk factor and a disease, even if we are dealing with an undoubted causal relation. Responsibility is a far more complex judgement, which also entails judgements regarding freedom and autonomy. In this piece we aim to clarify the conditions under which we can truly speak of a personal responsibility for health, as well as point at the limits of such a responsibility.