Chronic illness and the moral obligations of healthcare professionals

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Most contemporary work in medical ethics focuses on things that doctors or other healthcare professionals do to their patients - for example, performing surgery on them or taking blood samples from them. As a result work on medical ethics has generally characterized the healthcare professional as active (the individual who acts) and the patient as passive (the individual who is acted on). However, this way of characterizing the healthcare professional/ patient relationship is inappropriate when we turn our attention to other areas of healthcare, such as treatment for patients with chronic or long-term conditions. A patient with Type 1 Diabetes may well take her own blood samples, test those samples, decide on the amount of insulin that should be provided, and inject herself with that insulin. In cases like this the patient is carrying out activities that in the medical ethics literature are standardly taken to be performed by healthcare professionals, while the healthcare professional's role shifts to one of enabling and supporting the patient to help herself. Similarly, for many healthcare professionals helping patients to protect their future health is a key part of their role. Here again it is not unusual for it to be the case that the patient is the one who needs to take the relevant steps, while the healthcare professional provides guidance and support.There has to date been no sustained and systematic work done on the implications of this supportive and enabling role for healthcare professionals' moral obligations. This project aims to fill this gap. Doing so is important because when our focus shifts from the healthcare professional doing something to her patients, to the healthcare professional supporting her patients to look after themselves, new moral challenges come to the fore. One of these is that accounts of healthcare professionals' obligations to provide information to patients have focused on what information is needed for patients to give informed consent to treatment (or to participate in research). But where the patient treats herself informed consent is not needed in the same way, and as such these accounts have nothing to say about how much information healthcare professionals should provide in such cases. A second challenge is that patients do not always follow agreed treatments. Sometimes this is because they change their mind about whether it is appropriate for them, but on other occasions it is not (e.g. the patient forgets to take their medication). How to deal with this is a significant problem in medical practice - raising questions about how interventionist healthcare professionals should be, and about the limits of the healthcare professional's responsibility. These questions are normative ones. They raise questions about how much healthcare professionals should respect their patients' autonomy, what this requires, and how to balance this value with other values (such as doing what is best for the patient). Despite this, and the considerable debate on autonomy and benefit in medical ethics, these questions have not yet been addressed by those working in medical ethics. It is a central aim of this project to tackle these, as yet unexplored, questions in a way that relates them to the challenges facing both healthcare professionals and patients.