Non-Attendance for Health Care: When Rational Beliefs Collide

Abstract

Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests ‘positive choices’ for such non-attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's ‘cognitivist theory of action’ is used to conceptualise non-attendance as both a rational and irrational choice, from different perspectives. Because the perspective of non-attendees has been marginalised, the paper also suggests a typology of instrumental and non-instrumental ‘strong reasons’ for rational non-attendance. This may help groups such as professionals to understand and accept that non-attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non-attendees is needed to show respect for non-attendees’ moral agency and to begin to repair relationships with these individuals, who may seek help from health professionals in the future.