Problems and Approaches

Some philosophers maintain that only individual persons of mature age can be held morally responsible, but others argue that collective responsibility is also a legitimate concept.

Those philosophers who wish to allow for collective responsibility usually distinguish between two different types of collective. Some collectives, they argue, have well-defined identities and decision-making procedures, such as large commercial businesses, or political entities such as the Cabinet in the United Kingdom’s government. They are often called “corporations” (French 1984). A second candidate to be called a collective is one in which the group members identify themselves as group members and share attitudes, values, and aims (Feinberg 1968; French 1984: 13—14). An army might be an example of a collective of this sort. I have no objection to calling both types of organization “collectives” and indeed there may be some legal convenience attached to doing so. Collectives of both types exert considerable influence on the behavior of the individuals who work within them; they could therefore be said to have some causal responsibility for the behavior of their members. But my position is that moral responsibility remains with individuals. Nevertheless, it is of interest to consider how the aims and values of these collectives influence the decisions of the doctors, patients, and bureaucrats who work in or receive health care.

These two types of collective are involved in different ways in the delivery of health care. The shared attitudes and values of the medical profession are of course central but health care is affected in crucial ways by the fact that a great deal of it takes place in hospitals, which are corporate bodies with the attitudes and values of commercial organizations. Even in the UK, where health care is publicly funded, hospitals are obliged to meet various targets, including financial ones. These are set by non-medical external bodies such as government departments.

Moreover, pharmaceutical companies, which are also corporate bodies, have a large impact on the delivery of health care. They too are under pressure to produce new drugs and to make profits for shareholders. Pressures from the aims and values of these different types of collective will affect the moral decisions and responsibilities of individual doctors working in health care. For example, there can be dilemmas for doctors caused by pressures from hospital management to meet targets, which may be at the expense of high quality care.

In addition to these complexities, it is important to note that the delivery of health care by doctors is currently, in the West at least, in a state of transition between different models of the doctor/patient relationship. Traditionally, the patient approached the doctor with a health problem, and the doctor made a diagnosis with a suggested treatment usually consented to by the patient. But at the moment, many patients approach the doctor with requests, or sometimes even demands, concerning the sort of treatment the doctor should provide. In other words, patients are becoming consumers of health care. And with this change, moral responsibility will become divided (Downie 2017). Doctors will remain morally responsible for supplying accurate information, but patients as consumers become morally responsible for making the choice of treatment.

In view of these several variations and complexities in the delivery of health care, it is unlikely that a clear picture of responsibility will emerge. But at least it can be shown where the problems of responsibility for the doctor and the patient/consumer arise. As a way into these problems, I shall begin by examining the morality of social roles and the type of responsibility involved, for doctors occupy social roles.

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Source: Bazargan-Forward Saba, Tollefsen Deborah (eds.). The Routledge Handbook of Collective Responsibility. Routledge,2020. — 538 p.. 2020

Problems and Approaches

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