ABSTRACT
Chronic illness is becoming an increasingly large part of healthcare worldwide, partly driven by population ageing. This chapter sets out what is ethically distinctive about it, and why it cannot easily be accommodated in frameworks developed for other areas of healthcare. It argues that in treating patients with chronic illness healthcare professionals perform four distinct tasks: making decisions, providing treatment directly, providing treatment indirectly, and providing information. While the first two raise familiar ethical questions about choice, consent, and the need to respect autonomy, the chapter argues that existing answers are inadequate in this context. In contrast, the ethical questions raised when providing treatment indirectly (either by helping patients treat themselves, or assisting their families to help them) have received little attention. The chapter argues that this activity raises challenging questions about patient responsibility, confidentiality, privacy, and paternalism. Finally, the chapter argues that because chronic illness can last for years, more attention needs to be given to temporal dimensions of treatment. That affects what is required by the duty of beneficence and the duty to respect autonomy.
