When things go wrong

In ‘Do No Harm – Do Patients Have Responsibilities Too?’, ¹ Margaret Brazier examined the relationship between morality and law in the context of patients’ responsibilities. She argued that patients have moral obligations, not wholly defined by legal parameters, which should be taken account of in the context of the patient–doctor relationship, as well in the healthcare system more generally. In this way, she sought to challenge widely accepted notions of patient autonomy and responsibility in the existing bioethics and healthcare law literature. Brazier noted that the patient’s position in healthcare, and the legal framework which governs it, have moved on from the ‘Dark Ages where the patient’s duty was to be patient’ and where ‘recipients of medical care were infantilised’. ² She identified distinct consequences of this shift in the context of a publicly funded healthcare system, such as the National Health Service (NHS) in the United Kingdom (UK), emphasising that patient responsibility exists in a communal context in which the actions of patients, healthcare providers, institutions and the community are intertwined. As she put it, it is in essence ‘a model of collaboration between doctors and patients, between the well and the sick, and between patients and patients’. ³ With this model, she suggests that ‘empowerment of patients… brings responsibilities’. ⁴