Prospective Intention-Based Lifestyle Contracts: mHealth Technology and Responsibility in Healthcare

Emily Feng-Gu,Hannah Maslen,Justin Oakley,Rebecca C H Brown,Julian Savulescu,Jim Everett

doi:10.1007/s10728-020-00424-8

Abstract

As the rising costs of lifestyle-related diseases place increasing strain on public healthcare systems, the individual’s role in disease may be proposed as a healthcare rationing criterion. Literature thus far has largely focused on retrospective responsibility in healthcare. The concept of prospective responsibility, in the form of a lifestyle contract, warrants further investigation. The responsibilisation in healthcare debate also needs to take into account innovative developments in mobile health technology, such as wearable biometric devices and mobile apps, which may change how we hold others accountable for their lifestyles. Little is known about public attitudes towards lifestyle contracts and the use of mobile health technology to hold people responsible in the context of healthcare. This paper has two components. Firstly, it details empirical findings from a survey of 81 members of the United Kingdom general public on public attitudes towards individual responsibility and rationing healthcare, prospective and retrospective responsibility, and the acceptability of lifestyle contracts in the context of mobile health technology. Secondly, we draw on the empirical findings and propose a model of prospective intention-based lifestyle contracts, which is both more aligned with public intuitions and less ethically objectionable than more traditional, retrospective models of responsibility in healthcare.

Highlights

Healthcare expenditure has grown substantially in recent years [55], in part due to the rise of so-called ‘lifestyle diseases’ which are closely tied to behaviours such as tobacco use, harmful alcohol use, physical inactivity, and poor diet.Individual responsibility for health has been proposed as a solution to unsustainable growth in public healthcare costs, with the language of individual responsibility becoming more prominent within health policies and guidelines across the developed world [16, 28, 43, 52]
This is a retrospective model of responsibility; the focus is on past behaviours and whether they causally contributed to a disease in a way that makes that individual morally responsible
Our research aims to achieve the following three goals: (1) to explore public attitudes towards different methods of incorporating responsibility into healthcare allocation; (2) to explore public willingness to use mobile health (mHealth) technology to help determine responsibility; and (3) to build on Feiring’s [20] lifestyle contract model and show that our empirically informed conceptual analysis supports a prospective framework of responsibility over a retrospective framework and that mHealth technology can serve as a useful adjunct in the prospective model

Summary

Introduction

Healthcare expenditure has grown substantially in recent years [55], in part due to the rise of so-called ‘lifestyle diseases’ which are closely tied to behaviours such as tobacco use, harmful alcohol use, physical inactivity, and poor diet.Individual responsibility for health has been proposed as a solution to unsustainable growth in public healthcare costs, with the language of individual responsibility becoming more prominent within health policies and guidelines across the developed world [16, 28, 43, 52]. The first examples of lifestyledependent healthcare access are beginning to appear [43], with access to treatments, including elective surgery or fertility treatment, being restricted based on patient factors such as body mass index (BMI) or smoking status [31, 50] In another example, the (since discontinued) 2006 West Virginian Medicaid Reform saw insurance coverage being held conditional upon on the fulfilment of patient responsibilities [9]. Much of the bioethical literature focuses on whether people should be given lower priority access to healthcare if they are responsible for their disease This is a retrospective model of responsibility; the focus is on past behaviours and whether they causally contributed to a disease in a way that makes that individual morally responsible. We propose a modified version of Feiring’s prospective lifestyle contract model which has both pragmatic and normative benefits over the retrospective model, in the context of the development of mobile health (mHealth) technology

Methods

Results

Discussion

Conclusion