This depends fully on the financial structure (design) of the health care system.

If you have really to pay for treatment and care out of your own pocket, you will be more responsible. In a very socialized health care system, the healthy pay factually for the ill, while certain professional groups profiteer-from-disease. We need health care systems, where the physician is paid for keeping the patient healthy and not medical assembly lines. Private-public-partnerships are required to achieve this, not socializing costs or profiteering-from-disease. Your query implies the highly ethical level of self-responsibility and the social issue of medical help.

This depends fully on the financial structure (design) of the health care system.

If you have really to pay for treatment and care out of your own pocket, you will be more responsible. In a very socialized health care system, the healthy pay factually for the ill, while certain professional groups profiteer-from-disease. We need health care systems, where the physician is paid for keeping the patient healthy and not medical assembly lines. Private-public-partnerships are required to achieve this, not socializing costs or profiteering-from-disease. Your query implies the highly ethical level of self-responsibility and the social issue of medical help.

An interesting question, Dr Yusrita Zolkefli

Before I retired, I was a nurse practitioner for people with bladder and bowel problems. A lot of my work meant me involving my clients in their care, in that if they did not carry out their part of the care plan, e.g. pelvic floor exercises, then there was little that I could do to reduce - in this example - their stress incontinence.

So I used to have to make it clear that there was only so much that I could do.

I used to have some really successful outcomes, but had to explain that it was very much up to them to have success in this type of joint nurse / client partnership.

Thank you Stephen I. Ternyik and Mary C R Wilson for insightful comments. I think to some degree, patients must bear responsibility (partial, if not full) and take ownership for their own health. As health professionals, as what Mary C R Wilson has reflected, we must be prepared to enable the patient to take on such responsibility right from the start.

Stephen I. Ternyik RE: "If you have really to pay for treatment and care out of your own pocket, you will be more responsible."

I doubt that this is the case. People who aren't sick but indulge in unhealthy practices typically don't believe that they themselves will be affected. Moreover, unhealthy habits typically begin when people are young, long before ill effects are likely to be manifested. Early education and positive reinforcement of healthy lifestyle practices is more likely to produce responsible behavior. And we also need responsible behavior on the part of corporations that with full knowledge put unhealthy products on store shelves, with labelling designed to mislead the consumer.

Karl Pfeifer I am in agreement with your educational extension of my argument.

My economic reference is mainly about the design of a health care system, i.e. the payment chain (input/output). Several serious works in economics have shown that private-public-partnerships are needed to reduce overall and overhead costs of systemic health care, i.e. the market alone is the wrong tool. Your mentioned class of young people is not an essential part of the payment chain (financial architecture) of the health care system. But: you are right in stating that unhealthy behaviors can be transmitted from adults to the younger generation and this learning process requires indeed our special attention. Congrats, for your important observation.

Unusually, I disagree with colleagues. Whilst there is some truth in their positions I fear the fundamentals that determine concordance with care relate to social determinants, education, deeply embedded attitudes and so on which require social change to achieve results. I am all in favour of patients taking responsibility and seek to do myself. However, most of the negative outcomes relate to disempowered or vulnerable people and I think attempts by Government to go down the personal responsibility road are often driven by resource and ideological issues rather than the evidence base. So personal responsibility yes, punishing those who need to be empowered - NO!

Andrew William McCulloch Very good points, especially the last one. It burns down to prudent implementation rules of a health care system. Your argument points to health care as social policy making.

I agree entirely with Andrew William McCulloch who identified critical issues in an ethical approach to health care. 'Social determinants, education and deeply embedded attitudes' have a profound effect on individuals, their decision making and their lifestyle. I suggest that blanket rules might be drawn upon lastly as a fall back position, if, for whatever reason, the patient is not receptive.

Yes, it will be, mainly about his disease, as on diet and other etiologic factors and the probable dangers.

It certainly cannot be said that society encourages to take care of one's health. Until disease sets in, the idea is that there are no limits to what one can do: there will always be a pill.

Could I give some very simple examples? Having a headache on the weekend, the person does not sit down thinking why, but take a pill: don't want to ruin it.

If the back freezes having an important meeting, don't put it off: take a pill and go.

This in case OTCs are available, but there will be no difference in case the person do not understand what is happening: going to the doctor he will look for the best, that is often give another pill (or treatment not tried yet, and will work great!).

Basically: the social message does not encourage to understand what's going on, that means taking responsibility for one's health (which is different from having a diagnostic test). The cure is always referred to someone, to something external.

Taking care of our health is on the contrary an internal attitude first, cultivated as children and continued as adults - as mentioned above - and according to me not different from the love of reading.

Where do you want to draw the line demarcating own responsibilities and as a consequence deciding to provide or refuse public funded health care to an individual? A moral slippery slope in my view?

There seems to be two issues in the above question, both relate to previous answers.

From my position however, we might assume a cyclic pattern of responsibility from patient to practitioner, and then all being well, back again.

In the first instance, it would be my responsibility to take care of my own wellbeing as far as I am capable, and then if necessary to seek help. However, as mentioned beforehand, my capabilities will be determined by many contributing factors.

Then if consulted the practitioner has a moral obligation to care for me as a patient by drawing upon his/her knowledge to both help and inform me, and thus supporting my progress.

At that point, the responsibility would revert back to me in following through with the professional advice given.