BMJ 2013;347:f6837 doi: 10.1136/bmj.f6837 (Published 19 November 2013)

Page 1 of 1

Letters

LETTERS PAYMENT TO IMPROVE ADHERENCE

Ethical problems with paying patients to improve adherence to treatment George Szmukler professor of psychiatry and society Institute of Psychiatry, King’s College London, London SE5 8AF, UK

To offer patients financial incentives for taking antipsychotic drugs presents serious ethical problems,1 the most important of which can be termed “incommensurable values”2 or “commodification.”3

A stark example of commodification would be selling a baby. Such a transaction involves an exchange between “goods” lying in different spheres of valuation, one high and one low. Aligning their evaluation along a single metric—one characterising the lower value (money)—degrades or corrupts the character of the goods lying in the higher domain (a baby). Such an exchange fosters an inferior conception of personhood.

Priebe and colleagues offered money to induce reluctant patients to change their mind about taking drugs.1 So where is the harm? After weighing up the benefits and drawbacks of the drug, patients had made a decision in the light of what they thought is their best interests. The harm lies in the devaluation or denigration of patients’ decisions about what they consider best. This represents a failure of “respect for the person,” for their agency or self government, fundamental values in our society. The treatment is also denigrated—it becomes a commodity rather than something that serves a higher value related to human flourishing.

Some may respond by noting that in our market dominated society we are constantly being influenced by financial incentives to act in certain ways. This may be so, but in the context of mental health services, special caution is necessary. Patients regularly experience various forms of social marginalisation. Psychiatric treatments should aim to empower patients and strengthen their sense of personhood and agency, not undermine them. Other ethical obstacles involving the potential for exploitation and unfairness have been discussed elsewhere.2 Competing interests: None declared. Full response at: www.bmj.com/content/347/bmj.f5847/rr/668875. 1 2 3

Priebe S, Yeeles K, Bremner S, Lauber C, Eldridge S, Ashby D, et al. Effectiveness of financial incentives to improve adherence to maintenance treatment with antipsychotics: cluster randomised controlled trial. BMJ 2013;347:f5847. (7 October.) Szmukler G. Financial incentives for patients in the treatment of psychosis. J Med Ethics 2009;35:224-8. Sandel MJ. What money can’t buy: the moral limits of markets. Penguin, 2012.

Cite this as: BMJ 2013;347:f6837 © BMJ Publishing Group Ltd 2013

[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions

Subscribe: http://www.bmj.com/subscribe

Ethical problems with paying patients to improve adherence to treatment.

Ethical problems with paying patients to improve adherence to treatment. - PDF Download Free
164KB Sizes 0 Downloads 0 Views